Congenital talipes equinovarus

Congenital talipes equinovarus (CTEV) is considered the most common anomaly affecting the feet diagnosed on antenatal ultrasound.

While some use CTEV and club foot (CF) synonymously, in certain publications term clubfoot is considered a more general descriptive term that describes three distinct abnormalities:

  • talipes equinovarus (adduction of the forefoot, inversion of the heel and plantar flexion of the forefoot and ankle)
  • talipes calcaneovalgus (dorsal flexion of the forefoot with the plantar surface facing laterally)
  • metatarsus varus (inversion and adduction of the forefoot alone)

It carries an estimated incidence of 0.5-5% of live births 4. Some reports suggest a male predilection with a male to female ratio of 2:1. The condition is bilateral in more than half of cases.

The deformity involves both ankle and subtalar joints. The malalignment is fixed by joint, ligamentous and tendinous contractures.

There may be a familial predilection in ~15% of cases 9. If detected antenatally, a careful search for other associated anomalies are recommended.

There is an immense number (estimated at 200) 8 of associations which include:

Assessment requires weightbearing DP and lateral radiographs. Where weightbearing is not possible, it should be simulated.

Talipes equinovarus consists of four elements 7:

Approximately 10-20% of individuals with prenatal diagnosed clubfoot may have a normal foot or positional foot deformity requiring minimal treatment. Conversely, 10-13% of prenatally diagnosed individuals with isolated clubfoot will have complex clubfoot postnatally, dependent on the presence of additional structural or neurodevelopmental abnormalities 13-15.

Sonographic features may vary dependent on severity. Both the tibia and fibula may be on the same image as the medially deviated foot and the foot may additionally appear plantar flexed.

Many (at least 50%) require orthopaedic intervention 8. The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. Therapeutic options range from casting and manipulation, through to surgical release. The most common surgical complication is overcorrection resulting in a "rockerbottom" flat foot deformity. Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully 8.

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Article information

rID: 10749
Section: Pathology
Synonyms or Alternate Spellings:
  • Clubfoot
  • Club foot
  • Talipes equinovarus
  • Club feet
  • Clubfeet

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Cases and figures

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    Talipes equinovar...
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    Club foot
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    Club foot
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    Case 4
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    Lateral talocalca...
    Case 5: with lateral talocalcaneal angle = 14 degree
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     Case 6: in fetus
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    Left foot
    Case 7
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    Case 8
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    Adduction of the ...
    Case 9: antenatal - 4d reconstruciton
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    Case 10
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    Case 11
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