What Is Club Foot?
A club foot can be postural, in which case it is secondary to intrauterine malposition and does not exhibit any of the changes typically seen in a true club foot. It can also be the traditional club foot(Fig. 7-3)with skin creases on the plantar and medial aspects of the midfoot. a small heel, calf atrophy, and the navicular abutting the medial malleolus.
In spite of the tremendous interest in club foot, little is known about its cause. Many different theories have been proposed including that the club foot is secondary to intrauterine mechanical factors, a stage of fetal growth arrest, a neuromuscular defect, or a germ plasm defect. None of these theories is universally accepted in the medical field.
In true talipes equinovarus, the foot and lower leg look like a club, The dorsum of the foot faces plantarward, and the heel is small and rolled under in a varus position. There are usually deep, tight creases along the posterior aspect of the ankle joint, just above the heel. The forefoot and midfoot are inverted and adducted. When combined with heel inversion, this condition places the head and neck of the talus on the dorsolateral aspect of the foot. In addition, the skin in the region is stretched and thinned. The lateral malleolus sits posterior to the medial malleolus and is more prominent because of the foot inversion.
A medial and plantar subluxation or dislocation of the talocalcaneonavicular complex underlies these soft-tissue changes. The basic defect responsible for this condition is the medial and plantar deviation of the anterior end of the talus. The navicular and calcaneus are displaced medially and plantarward around the talus, the cuboid is displaced medially on the calcaneus, and the ankle joint is in equinus.
Talipes equinovarus is not always an isolated entity. It may be associated with multiple congenital malformations, or it may be Part of a syndrome. It has been seen in arthrogryposis. diastrophic dwarfism, Streeter’s dysplasia, Freeman-Sheldon syndrome. Larson's syndrome, and myelodysplasia. It is also seen with hip dysplasia. Patients who present with a club foot should have their hips checked for dysplasia. The inheritance pattern for the club foot is polygenic with a threshold effect; that is, many factors are involved, and a club foot is produced or only when a certain threshold is crossed.
The treatment of talipes equinovarus is aimed at obtaining a mobile, painless foot with normal weight-bearing capabilities and function. This aim is accomplished by restoring and maintaining a normal relationship among the talus, calcaneus, and navicular. Although nonoperative therapy to achieve this goal in congenital talipes equinovarus is often unsuccessful, postural club foot responds well to nonoperative intervention. In postural club foot, treatment consists of stretching to correct forefoot adduction and inversion, heel inversion, and hindfoot equinus. After stretching, the corrected position must be maintained, usually by use of plaster of Paris casts. However, other modalities, including Robert Jones strapping and a Denis Browne bar and shoes, are sometimes used.
Treatment of postural or congenital talipes equinovarus must be started as soon as possible. During the first three weeks of life. the ligamentous tissues are still somewhat lax and may respond to repeated manipulations and casting, allowing successful nonoperative treatment to be accomplished.