Equinovarus foot deformity - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Equinovarus foot deformity is one of the most common birth defects (1 in 1000 live births).
Can be identified on prenatal ultrasound (true-positive rate 83%).
Exam demonstrates a hindfoot in varus, a forefoot that is adducted, and an ankle in equinus.
Prognosis is good with a nonoperative approach using the Ponseti method of treatment (bracing and serial casting).
Achilles tenotomy is used in >90% of cases to improve dorsiflexion.

Bilateral clubfeet in a newborn

From the collection of Scott E. Van Valin

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Bilateral clubfeet in a newborn
Three-dimensional view of clubfoot deformity in an adolescent, showing the classic equinus, varus, and adduction deformities
Untreated clubfoot in an adolescent

Citations

Key Articles

Cady R, Hennessey TA, Schwend RM. Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics. 2022 Feb;149(2):e2021055555.[Abstract][Full Text]
British Society for Children's Orthopaedic Surgery (BSCOS). Management of clubfoot deformity in children up to walking age. Jul 2021 [internet publication].[Full Text]
Besselaar AT, Sakkers RJB, Schuppers HA, et al. Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta Orthop. 2017 Mar 7;88(3):305-9.[Abstract][Full Text]
Staheli L, ed. Clubfoot: Ponseti management, 3rd ed. Seattle, WA: Global HELP; 2009.[Full Text]

Other Online Resources

Global HELP: clubfoot: Ponseti management

Referenced Articles

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10. Barker SL, Macnicol MF. Seasonal distribution of idiopathic congenital talipes equinovarus in Scotland. J Pediatr Orthop B. 2002;11:129-133.[Abstract]
11. Carney BT, Coburn TR. Demographics of idiopathic clubfoot: is there a seasonal variation? J Pediatr Orthop. 2005;25:351-352.[Abstract]
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16. Herceg MB, Weiner DS, Agamanolis DP, et al. Histologic and histochemical analysis of muscle specimens in idiopathic talipes equinovarus. J Pediatr Orthop. 2006;26:91-93.[Abstract]
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21. Cady R, Hennessey TA, Schwend RM. Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics. 2022 Feb;149(2):e2021055555.[Abstract][Full Text]
22. British Society for Children's Orthopaedic Surgery (BSCOS). Management of clubfoot deformity in children up to walking age. Jul 2021 [internet publication].[Full Text]
23. Ibrahim T, Riaz M, Hegazy A. The prevalence of developmental dysplasia of the hip in idiopathic clubfoot: a systematic review and meta-analysis. Int Orthop. 2015 Jul;39(7):1371-8.[Abstract][Full Text]
24. Paton RW, Choudry QA, Jugdey R, et al. Is congenital talipes equinovarus a risk factor for pathological dysplasia of the hip? : a 21-year prospective, longitudinal observational study. Bone Joint J. 2014 Nov;96-B(11):1553-5.[Abstract][Full Text]
25. Pollet V, Percy V, Prior HJ. Relative Risk and Incidence for Developmental Dysplasia of the Hip. J Pediatr. 2017 Feb;181:202-207.[Abstract][Full Text]
26. Besselaar AT, Sakkers RJB, Schuppers HA, et al. Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta Orthop. 2017 Mar 7;88(3):305-9.[Abstract][Full Text]
27. Carney BT, Vanek EA. Incidence of hip dysplasia in idiopathic clubfoot. J Surg Orthop Adv. 2006;15:71-73.[Abstract]
28. Westberry DE, Davids JR, Pugh LI. Clubfoot and developmental dysplasia of the hip: value of screening hip radiographs in children with clubfoot. J Pediatr Orthop. 2003;23:503-507.[Abstract]
29. Ponseti IV. The Ponseti technique for correction of congenital clubfoot. J Bone Joint Surg Am. 2002;84-A:1889-1890.[Abstract]
30. Ponseti IV, Becker JR. Congenital metatarsus adductus: the results of treatment. J Bone Joint Surg Am. 1966;48-A:702-711.[Abstract]
31. Staheli L, ed. Clubfoot: Ponseti management, 3rd ed. Seattle, WA: Global HELP; 2009.[Full Text]
32. Noonan KJ, Richards BS. Nonsurgical management of idiopathic clubfoot. J Am Acad Orthop Surg. 2003;11:392-402.[Abstract]
33. Dobbs MB, Rudzki JR, Purcell DB, et al. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004;86-A:22-27.[Abstract]
34. Bina S, Pacey V, Barnes EH, et al. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev. 2020 May 15;5:CD008602.[Abstract][Full Text]
35. Janicki JA, Narayanan UG, Harvey BJ, et al. Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am. 2009;91-A:1101-1108.[Abstract]
36. Faulks S, Richards BS. Clubfoot treatment: Ponseti and French functional methods are equally effective. Clin Orthop Relat Res. 2009;467:1278-1282.[Abstract]
37. Richards BS, Faulks S, Rathjen KE, et al. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008;90-A:2313-2321.[Abstract]
38. Richards BS, Johnston CE, Wilson H. Nonoperative clubfoot treatment using the French physical therapy method. J Pediatr Orthop. 2005;25:98-102.[Abstract]
39. Pittner DE, Klingele KE, Beebe AC. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. J Pediatr Orthop. 2008;28:250-253.[Abstract]
40. Morcuende JA, Abbasi D, Dolan LA, et al. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005;25:623-626.[Abstract]
41. Scher DM, Feldman DS, van Bosse HJ, et al. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24:349-352.[Abstract]
42. Agius L, Wickham A, Walker C, et al. Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons. N Z Med J. 2018 May 18;131(1475):44-50.[Abstract]
43. Lebel E, Karasik M, Bernstein-Weyel M, et al. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. J Pediatr Orthop. 2012 Jun;32(4):412-5.[Abstract][Full Text]
44. Chen RC, Gordon JE, Luhmann SJ, et al. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop. 2007 Jul-Aug;27(5):522-8.[Abstract]
45. Alvarez CM, De Vera MA, Chhina H, et al. The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up. Pediatr Orthop. 2009;29:570-575.[Abstract]
46. Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. J Pediatr Orthop. 2009;29:564-569.[Abstract]
47. Alvarez CM, Wright JG, Chhina H, et al. Botulinum toxin type A versus placebo for idiopathic clubfoot: a two-center, double-blind, randomized controlled trial. J Bone Joint Surg Am. 2018 Sep 19;100(18):1589-96.[Abstract]
48. Chhina H, Howren A, Simmonds A, et al. Onabotulinumtoxin A injections: a safety review of children with clubfoot under 2 years of age at BC Children's Hospital. Eur J Paediatr Neurol. 2014 Mar;18(2):171-5.[Abstract][Full Text]
49. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62-A:23-31.[Abstract]
50. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot: a thirty-year follow-up note. J Bone Joint Surg Am. 1995;77-A:1477-89.[Abstract]
51. Dietz FR. Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. Instr Course Lect. 2006;55:625-629.[Abstract]
52. Dobbs MB, Gordon JE, Walton T, et al. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004;24:353-357.[Abstract]
53. Dobbs MB, Gordon JE, Schoenecker PL. Absent posterior tibial artery associated with idiopathic clubfoot: a report of two cases. J Bone Joint Surg Am. 2004;86-A:599-602.[Abstract]
54. Burghardt RD, Herzenberg JE, Ranade A. Pseudoaneurysm after Ponseti percutaneous Achilles tenotomy: a case report. J Pediatr Orthop. 2008;28:366-369.[Abstract]
55. Aydin BK, Sofu H. Predicting the need for surgical intervention in patients with idiopathic clubfoot. J Pediatr Orthop. 2015 Aug 11 [Epub ahead of print].[Abstract]
56. Goldstein RY, Seehausen DA, Chu A, et al. Predicting the need for surgical intervention in patients with idiopathic clubfoot. J Pediatr Orthop. 2015 Jun;35(4):395-402.[Abstract][Full Text]
57. Luckett MR, Hosseinzadeh P, Ashley PA, et al. Factors predictive of second recurrence in clubfeet treated by Ponseti casting. J Pediatr Orthop. 2015;35:303-306.[Abstract]