Talipes

What Should I Know?

Introduction

Talipes, or congenital talipes equinovarus (CTEV), is a deformity of the ankle and foot that is present at birth. The affected ankle is twisted with the foot pointing downwards and inwards. In 50% of cases both the feet are affected (bilateral). Talipes is sometimes called 'club foot'.

This condition affects 1 in every 1000 babies, and occurs more often in boys than girls. If you have had a child with CTEV, there is approximately a 1 in 30 chance that your second child will also be affected.

Corrective treatment is usually required, ideally within the first few weeks of the baby's life, but older babies have been treated successfully. Some mild cases of the condition may not require any treatment at all.

Causes

In most cases, the cause of talipes is unknown. There may be a genetic or hereditary element to the condition, so it may run in the family. If one has CTEV, there is a 3-4% chance that their child will have the same condition . If both parents are affected, there is a 15% chance that their child will be affected by CTEV too.

Another possible cause is the positioning of the foot when it is in the womb. The baby's foot may be in an abnormal position and therefore the way it develops can be abnormal as well. For example, if there is too little amniotic fluid surrounding the baby in the womb (a condition called oligohydramnios), there is a higher rate of talipes, possibly due to increased pressure on the foot.

Treatment

Treatment is often started in the weeks following birth, and aims to allow the child to have flexible, pain-free and functional feet. Treatment will depend on both your doctor and the severity of your child's condition. It can include physiotherapy, gentle manipulation, use of plaster casts, splints and special boots, and surgery.

A growing number of orthopaedic specialists are now using a style of treatment called the Ponseti method. This treatment originated in the USA, and is gradually being used more in the UK, although it is not yet available nationwide. The Ponseti method includes weekly manipulation sessions and the application of plaster casts for a period of up to two months, followed by the child wearing boots with a splint (bar) to hold the feet in the most effective position.

To prevent relapses, the boots are worn constantly for two or three months, and at night for up to four years. Many children will require a small operation to lengthen the Achilles tendon as part of this process. This is usually performed under a local anaesthetic, and often means that more extensive surgery is not required. Your GP will be able to discuss all of the available treatment options with you.

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