Congenital talipes equinovarus

Dr Praveen Jha and Dr Yuranga Weerakkody et al.

Congenital talipes equinovarus (CTEV) or club foot (CF) is a common skeletal anomaly
affecting the foot. It is the commonest anomaly affecting the feet diagnosed on antenatal
ultrasound 4.

Epidemiology
It carries an estimated incidence of 0.5-5% of live births 4. Some reports suggest a male
predilection with a male to female ratio of 2:1. The condition is bilateral in more than half of
cases.

Pathology
The deformity involves both ankle and subtalar joints. The malalignment is fixed by joint,
ligamentous and tendinous contractures.
There may be a familial predilection in approximately 15% of cases 9. If detected antenatally, a
careful search for other associated anomalies are recommended.

Associations
There can be an immense number (estimated at 200) 8 of associations which include:

chromosomal anomalies
o

18q deletion syndrome

trisomy 18

Wolf-Hirschhorn syndrome

other syndromic conditions

o

Freeman Sheldon syndrome

Meckel Gruber syndrome

Roberts syndrome

renal anomalies
o

prune belly syndrome

renal agenesis

connective tissue disorders

o

Marfan syndrome

Ehlers-Danlos syndrome
spinal anomalies

caudal regression syndrome

diastematomyelia

spina bifida

skeletal dysplasias
diastrophic dysplasia

Radiographic features
Assessment requires weightbearing DP and lateral radiographs. Where weightbearing is not
possible, it should be simulated.
Talipes equinovarus consists of four elements 7:

hindfoot equinus: lateral talocalcaneal angle less than 35o

hindfoot varus: talocalcaneal angle less than 20o

metatarsus adductus: adduction and varus deformity of the forefoot; talus to first
metatarsal angle greater than 15o
talonavicular subluxation: medial subluxation of the navicular on the talus

Treatment and prognosis

Many (at least 50%) require orthopaedic intervention 8.
Therapeutic options range from casting and manipulation, through to surgical release. The most
common surgical complication is over-correction resulting in a "rockerbottom" flat foot deformity.
Overall prognosis will often depend on other associated condition. Isolated condition may be
treated successfully 8.

References

1. Koulouris G, Morrison WB. Foot and ankle disorders: radiographic signs. Semin
Roentgenol. 2005;40 (4): 358-79. doi:10.1053/j.ro.2005.01.018 - Pubmed citation
2. Thapa MM, Pruthi S, Chew FS. Radiographic assessment of pediatric foot
alignment: review. AJR Am J Roentgenol. 2010;194 (6): S518.doi:10.2214/AJR.07.7143 - Pubmed citation
3. Wainwright AM, Auld T, Benson MK et-al. The classification of congenital talipes
equinovarus. J Bone Joint Surg Br. 2002;84 (7): 1020-4. doi:10.1302/0301620X.84B7.12909 - Pubmed citation
4. Bromley B, Benacerraf B. Abnormalities of the hands and feet in the fetus:
sonographic findings. AJR Am J Roentgenol. 1995;165 (5): 1239-43. AJR Am J Roentgenol
(abstract) - Pubmed citation
5. Allen SD, Harvey CJ, O'regan D. Interpretation of ankle and foot radiographs. Br J
Hosp Med (Lond). 2006;67 (1): M8-11. - Pubmed citation

6. Tillett RL, Fisk NM, Murphy K et-al. Clinical outcome of congenital talipes
equinovarus diagnosed antenatally by ultrasound. J Bone Joint Surg Br. 2000;82 (6): 87680. doi:10.1302/0301-620X.82B6.9777 - Pubmed citation
7. Greenspan A. Orthopedic imaging, a practical approach. Lippincott Williams &
Wilkins. (2004) ISBN:0781750067. Read it at Google Books - Find it at Amazon
8. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies.
Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon
9. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical
Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon