Condition in which a newborn's foot or feet appear to be rotated internally at the ankle

Aetiology

• In utero abnormal alignment of the joints between the talus, calcaneus and navicular (7th week of embryo development)
• Around 50% of cases are bilateral
• More severe club feet associated with syndromes

Risk factors

• More common in males
• Family history
• Breech presentation
• Oligohydramnios

Pathophysiology

• The abnormal alignment of the joints between the talus, calcaneus and navicular results in contractures of the soft tissues (ligaments, capsule and tendons) resulting in a deformity consisting of ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot

Clinical features

• Postural talipes - feet turned in at birth but will stretch out with mild physiotherapy
• Club foot - structural malformation of the bones and muscles of the foot involving resulting in ankle equinus (plantarflexion), supination of the forefoot and varus alignment of the forefoot

Management

• Diagnosis normally obvious, treatment commenced as soon as possible after birth
• Ponsetti technique - splinting and casting
  • Deformities are corrected progressively in stages and held in plaster casts with 5 or 6 weekly cast changes
• 80% of children require a tenotomy of the Achilles tendon to maintain full correction