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CLUB FOOT (TALIPES EQUINOVARUS)

A club foot is a congenital foot deformity in which the heel is inverted (turns inward) and the ankle and heel are in the equinus position (heel doesn’t touch the ground). 

A club foot can be postural – secondary to positioning in the uterus or can be a “traditional club foot” where there are skin creases on the plantar (bottom) and medial (inside) of the midfoot, a small heel, calf atrophy and the navicular abutting the medial malleolus (inside ankle bone).  The affected foot is usually 1-3 sizes smaller. More males are born with this condition than females.

This is not always an isolated condition.  It is also found secondary to other congenital conditions and disabilities. 

Postural clubfoot responds well to non-surgical treatments such as stretching and casting as well as orthotics and shoes that keep the corrected foot in a good position.  Where surgical intervention is required, orthotics and shoes are also required to keep the foot from regressing.

Other names or similar foot conditions:

• Gastrocnemius equinus

Symptoms:

• Limp
• Lack of ankle flexibility on the club foot
• Calf atrophy
• Compensation symptoms on opposite foot and leg
• Leg length differences

Signs to look for:

• Heel turns inward and the ankle and heel are in the equinus position
• Small heel
• Calf atrophy 
• Navicular abutting the medial malleolus (inside ankle bone)
• The affected foot is usually 1-3 sizes smaller and there can be leg length differences

Possible Causes:

• Congenital
• Secondary to other medical conditions

Goals:

• Obtain a mobile, painless foot with normal weight-bearing capabilities and function
• Restore a normal relationship among the talus, calcaneous and navicular
• Correct foot as much as possible through physical therapy, Pedorthic care and/or surgery
• Maintain orthotics and shoe adjustments throughout lifetime

Solutions:

Arch Supports:

• Custom orthotic with metatarsal lift

• Arch supports for children as soon as they start walking

• Internal heel lift (if 3/8“or less) or external heel lift (over 3/8”)

• Extra depth shoes, to include high toe box and out flare

Other: 

• Medical assessment and care beginning at birth, such as serial casting and/or surgery

• Medical and Pedorthic monitoring through early adulthood

• Lateral heel and sole wedging as necessary

Activities:

Regular stretching program of gastrocnemius and soleus muscles, Achilles tendon and arch structures