Talipes Equinus Varus/ Club Foot

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. As I have an interest in all things physiotherapy related and am a parent myself I thought that it might be helpful to examine some of the conditions that affect children. The first condition that we will have a look at is a relatively common condition affecting the feet of young children: Talipes Equinus Varus otherwise known as Club Foot.

What is Talipes Equinus Varus or Club Foot?

Talipes Equinus Varus or Club Foot is a condition of the feet in very young children and involves the feet of a baby being born pointing inwards. It is usually identified after birth and affects a relatively large number of children in the UK (approximately 16/1000 births). There are two types of Talipes Equinus Varus: positional talipes which usually resolves well with stretching and time and congenital talipes which does not and requires intervention. It is not possible initially to determine which type a baby has, this is determined by time and response to treatment.

What Causes Talipes Equinus Varus?

The exact reasons and causes are hard to define and are still an area of substantial debate and research. Genetics and the baby’s environment such as position in the womb and pressure on the baby’s feet are thought to play a major role. If a baby has Talipes Equinus Varus (club foot) then their feet will be pointing inwards towards each other (the position they were in, in the womb). Some children will have only one foot affected and others will have both of their feet affected. There is some evidence that suggests that it runs in families and if both parents have had the condition then there is approximately a 1 in 3 chance of the child having Talipes Equinus Varus (club foot).

How is Talipes Equinus Varus Diagnosed?

Usually the condition is identified very soon after birth either by health visitors, a mid-wife or potentially the parents themselves at which point a doctor will make a referral to a paediatric physiotherapist for a formal diagnosis. Occasionally it can be picked up by ultrasound scan during one of the routine scans in pregnancy.

Although an extremely worrying and distressing condition for parents of a baby with Talipes Equinus Varus (club foot), usually it resolves naturally over time and in the vast majority of cases will not affect their walking or development. As described earlier it is usually identified after birth and your doctor will make a referral to a paediatric physiotherapist for further assessment and advice on how to help your baby improve their foot position. Your paediatric physiotherapist will be able to recommend and demonstrate stretches and exercises that should help improve your baby's foot position, they will also be able to provide general advice on how to assist your baby to improve their foot position.

Sometimes despite stretching and physiotherapy things do not resolve and in this case the condition is identified as Congenital Talipes Equinus Varus. For Congenital Talipes Equinus Varus babies will usually require more intervention than just simple stretching and will often need to have their foot cast into position using The Ponsetti Method.

 

Treatment for Talipes Equinus Varus

Below I have detailed a usual process of initial assessment and then treatment for Talipes Equinus Varus (club foot). Obviously, each case is individual and it will depend upon how your child responds to treatment as to which option is chosen.

1. Assessment and Diagnosis: this is a vital part of treatment for Talipes Equinus Varus and usually happens immediately or at least very early after birth. It is important that this diagnosis and assessment is made early because at this stage the bones of the foot are still very malleable and will better respond to treatment.
2. Paediatric Physiotherapy: after a diagnosis is made it is important that you are able to gain access to a paediatric physiotherapist who will decide upon the best stretches and general course of treatment.
3. Stretches: Initially stretches of the baby’s foot and gentle massage will be advised by the paediatric physiotherapist as with most children this is all that is required and usually this helps achieve a better foot position and things resolve over time. In general these stretches are very gentle and just involve encouraging yoru child’s feet to move through positions.
4. The Ponsetti Method: if after a period of time the foot position does not improve sufficiently then a referral will be made to a specialist to use the Ponsetti Method. This involves casting the baby’s foot into a better position and then repeating this process until eventually the child has achieved a good foot position. Once out of the cast, an operation is often required to lengthen the Achilles Tendon and allow the foot to move into a better position. At this point they will usually need to wear some form of boots or braces to maintain this foot position. The boots are usually worn for at least 3 months and then children are slowly weaned off them. Physiotherapy plays a key role in assisting the strengthening of foot muscles and improving balance and co-ordination and once the child is no longer in a cast must be done regularly to maximise recovery.

Sometimes, after one of the treatment options described above children will relapse and redevelop Talipes Equinus Varus (club foot) and they will need to have further treatment.

In general the prognosis and outlook is good for children with Talipes Equinus Varus (club foot) and they will usually walk at the normal age and have few ill effects. Occasionally they may have a slightly shorter leg and this may slow them down whilst running.

I hope that you have found the article above about Talipes Equinus Varus (Club foot) helpful as for many parents and children it can be a worrying condition but is also one that if treated early enough responds well to intervention. If you want any further information about Talipes Equinus Varus (club foot) this link will take you to the NHS information page: https://www.nhs.uk/conditions/club-foot/

Over the next few blogs we shall be carrying on looking at paediatric conditions. For anyone reading this physiotherapy blog for the first time we are a home visit physiotherapy service based in Lichfield and serving areas such as Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall. For more information regarding this service please contact us on 0788 428 1623 or via  enquiries@threespiresphysiotherapy.co.uk