William was born in 2009 with bilaterial Congenital Talipes Equinovarus (CTEV), commonly referred to as Talipes or clubfoot. Although sounding complicated, when broken up, it becomes easier to understand.
Congenital - Present at birth
Talipes - the foot and ankle
Equino - foot pointing down
Varus - heel turning inwards
The term CTEV is rarely used, it is usually diagnosed as ‘talipes’ but is also commonly referred to as Clubfoot.
It may affect one foot (unilateral) or both feet (bilateral). Often the calf muscle is less developed on the affected side.
Clubfoot can occur when the muscles on the outer side of the leg are weaker than those on the inside of the leg. The tendons on the inside of the leg also become shorter than normal. Tendons are the tough cords that connect muscles to bones. In clubfoot, the bones of the foot are abnormally shaped and the Achilles tendon (the large tendon at the back of the heel) is tight.
In most cases the cause of club foot is unknown, but it occasionally runs in the family. If you have had a child with club foot, you are 20 times more likely to have another child with the condition. Clubfoot affects one baby in every 1000 born in the UK and is twice as common in boys than girls. In around 50% of the cases both feet are affected.
How is Talipes / Clubfoot Detected?
Clubfoot can be detected during routine pregnancy scans, although it is not possible to determine the severity of the condition at this stage. If not picked up prenatally, clubfoot will be detected at birth as the feet are visibly turned inwards. Treatment is the same regardless of when the condition is detected.
Clubfoot can be classified into 4 categories:
Congenital clubfoot is by far the most common, and most affected children have no other conditions. It is sometimes referred to as isolated clubfoot or idiopathic (meaning cause unknown) clubfoot. Idiopathic clubfoot occurs in about 1 to 2 per 1000 live births.
Positional clubfoot occurs when an otherwise normal foot is held in an incorrect position in the womb. The foot is flexible rather than rigid and can be manipulated into a neutral position easily by hand. Physiotherapy usually corrects this type of clubfoot.
Complex or Atypical clubfoot refers to feet which are more resistant to routine treatment but are still correctable, using a slightly different casting technique. Atypical feet are short and chubby with a deep crease across the sole. The big toe may also stick up at an odd angle to the other toes.
Syndromic clubfoot, which occurs in only a small minority of cases, is associated with additional chromosomal/ genetic abnormalities or syndromes. Further tests may be offered to you by your consultant.
Treatment of Talipes / Clubfoot
The treatment for clubfoot is minimally invasive and is known as the Ponseti method. Steps have produced a booklet about talipes and its treatment.
Treatment involves weekly sessions in which a specialist moves the foot with their hands, gradually correcting the position. A plaster cast is then applied from toes to groin to hold the foot in its new position.
Casts are changed weekly, with further correction of the foot position at each appointment. A minor operation, usually performed under local anaesthetic, known as a tenotomy is also usually required to release the Achilles tendon that passes down the back of the foot to the heel.
When the foot corrected, the child wears special boots attached to a bar (brace) to hold the feet in position. The boots are worn for 23 hours a day for the first 3 months and then just at night and nap times for up to the age of 4/5years. Regular footwear may then be worn at all other times.
What is the long-term outcome?
Following treatment, the specialist will probably monitor your child until their feet have stopped growing.
Most children do very well with treatment and there will be no problems going to school and taking part in a full range of sporting activities. There has only been one long term - 30 years plus - study following children through to adulthood and this was specifically to look at the results of the Ponseti method. This study showed that the use of this method resulted in no greater severity of foot pain in adulthood to those experienced by people not affected by club foot.
Relapse
Talipes is never ‘cured’, rather the position and function of the feet are maximised by the treatment. Sometimes, clubfoot can reoccur. This is known as a relapse and it is estimated to occur in 1 or 2 out of every 10 cases. Relapses are more likely if the Ponseti method is not followed exactly.
When there has been a relapse, it may be necessary for some of the treatment stages to be repeated - for example, your child may need to have their foot manipulated again and put in a cast. However, in other cases where there has been a relapse, surgery may be required.