Club Foot / CTEV

Clubfoot (also known as Congenital Talipes Equino Varus) is the most common congenital foot deformities in which foot is turned inwards and downwards. It can be present in one foot or both feet (in 50% cases) and is more common in males. It can be present as an isolated deformity (Idiopathic clubfoot) or in association with other abnormalities of musculoskeletal system, eg. Arthogryposis multiplex congenita (AMC), Developmental dysplasia of hip (DDH), Metatarsus adductus, Congenital muscular torticollis(CMT), etc. Syndromic clubfeets are more stiffer and complex to correct in comparison to Idiopathic clubfeet.

Treatment:The goal of treatment is to give a well corrected, supple and plantigrade foot to the child. It is mainly divided into casting and bracing phase.

Casting Phase:The good news is that if treatment is started early (preferably within the first week of life), this deformity can be fully corrected with Ponseti casting treatment within a span of few weeks without any major surgical intervention. At the final cast, a percutaneous Tendoachilles tenotomy is done to correct the equinus. This can be done under local anaesthesia. Ponseti casting treatment (devised by Ignacio Ponseti) is one of the most successful and popular treatment with published long term results and is considered the gold standard of clubfoot treatment. It is possible to treat clubfoot in older children, however if not treated early, it can lead to a more rigid deformity which will need soft tissue and bony surgery for correction.

Bracing Phase:After correcting the deformity, child has to wear foot abduction braces upto 4 years (as per the protocol) to prevent recurrences which are as high as 50% without braces.

Outcomes: With treatment most clubfeet are correctible and have good function however their foot size and leg girth remains smaller than the normal limb.

Tips for compliance of brace wear:

• Always follow the protocol for brace wear as suggested.
• Check for proper fitting of the brace (heel should be properly seated).
• Keep the bar padded
• Encourage your child to play and kick in the brace.
• Check the skin atleast 3-4times in a day for redness and other signs of pressure sore.
• Don’t use any oil or lotion under the shoes.