Human skeleton anatomy: Congenital Talipes Equinovarus Clubfoot

Sunday, March 15, 2015

The term talipes is derived from of the Latin words for ankle(talus) & foot (pes).

The term refers to the gait of severely affected
patients, who walked on their ankles.

Clubfoot is a severe fixed deformity of the foot characterized by fixed ankle plantar flexion (equinus), inversion of the subtalar (talocalcaneal) joint (varus), and medial subluxation of the talonavicular and calcaneocuboid joints (adductus)

Etiopathogenesis

Idiopathic majority , some secondary to muscle pathology
All the tissues of the foot i.e. bone, joint,ligaments and muscles have developmental abnormality
Bone: smaller in size, neck of talus is angulated so that head of talus is directed downwards and medially. Calcaneum is small and concave medially
Joints: equinus deformity occurs primarily at ankle joint. Inversion deformity occur in subtalar joint. Adduction occurs in midtarsal joints
Muscles and tendons: muscles of calf are underdeveloped.
Capsule and ligament: all the ligamentous structure on the postero-medial side of the foot shortened
Skin shows adaptive change
Callosities and bursae over bony prominences on the lateral side

Congenital Talipes Equinovarus

Bilateral in 60%.
General examination to rule out other deformities
Normally, the foot of newborn can be dorsiflexed until the dorsum touches the anterior aspect of shin of tibia
Components of the deformity:
Equinus.
Varus.
Adduction.

X-ray

AP view and a lateral view in a position of maximum dorsiflexion.
Kite angle is the angle subtended by the long axes of the calcaneus and the talus on the AP view.
This angle is normally between 20 and 40 degrees.
In the clubfoot, this angle is less than 20 degrees with relative parallel alignment of the talus and calcaneus.
The relationship of the talus and calcaneus should also be assessed on the lateral view. Again, in the clubfoot, this shows relative parallel alignment compared with the normal foot

Treatment

Nonoperative :

Best results are achieved with early manipulation.
(as early as first week of life) and serial casting (changed every 2 week). Adduction deformity is corrected first followed by inversion and then equinus deformity. If this sequence is not followed rocker bottom foot may result

Wearing Of Dennis-Browne(DB) splints for maintenance.

Good results may be achieved if previous technique is applied.

Operative Technique :

In less than 3 years only soft tissue release may be sufficient while older children require bony operations.
Indicated for manipulation failure cases, recurrence and neglected cases
Posteromedial soft tissue release (PMSTR)
Tendon transfer
Dwyer’s osteotomy- open wedge osteotomy of calcaneus
Dilwyn-Evan’s procedure : PMSTR with calcaneo-cuboid fusion
Wedge tarsectomy
Triple arthrodesis

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