You are here

Club Foot

clubfoot picture 

clubfoot picture

clubfoot xray picture

clubfoot xray picture

synonyms: congenital talipes equinovarus, clubfoot

Clubfoot ICD-9

Clubfoot Etiology / Epidemiology / Natural History

  • Foot deformity with the hindfoot equinus, midfoot varus, and forefoot adductus or talipes equinovarus.
  • Etiology unknown
  • 1/1000 live births, M/F=3/1, 40% bilateral, highest incidence in polynesians
  • Genetic predisposition: incidence is 10x higher in families with an affected individual.
  • May be congenital or acquired secondary to cerebral palsy, myelomeningocele, polio, amniotic band syndrome.
  • Natural History: generally function well as children, but as body weight increases, lateral forefoot wear becomes painful and shoe wear difficult.

Clubfoot Anatomy

  • The talar neck is deviated in a medial and plantar direction; calcaneous is rotated medially, Navicular is displaced medially; cuboid displaced medially.
  • CAVE: cavus, adductus, varus and equinus.

Clubfoot Clinical Evaluation

  • Forefoot adductus and suppination; hindfoot equinos and varus.
  • Medial crease
  • Lateral head of talus
  • Empty heal
  • Posterior crease
  • RE
  • CLB

Clubfoot Xray / Diagnositc Tests

  • A/P view
    -Talocalcaneal (Kite's) angle: 20-40° is normal; <20° = clubfoot. Lines drawn throught the long axis of the talus and os calcis.
    -Talus-1st metatarsal angle (0-20° = normal, <0° = clubfoot. Lines drawn through the long axis of the talus and the 1st metatarsal.
  • Lateral view
    -Talocalcaneal angle: typically <25°. Lines drawn through the long axis of the talus and inferior margin of the calcaneous.
  • Dorsiflexion lateral (Turco's) view; measure the talocalcaneal angle (>35° is normal: <35° with flat talar head = clubfoot).

Clubfoot Classification / Treatment

  • Position vs idiopathic vs tertologic
  • Ponsetti Method (manipulation and serial casting) 
    -Treatment should be started within the first month of life. Success rate without surgery is less if started later, but warrants consideration withn first @8 months.
    -First cavus is corrected by supination of forefoot and 1st ray dorsiflexion, then abduct forefoot with talar head as fulcrum.  Once foot is abducted under the talus to 69° outward rotation and dorsiflexion is attempted.  Ponsetti methods corrects the components of the clubfoot in the order of cavus, forefoot adductus, hindfoot varus, and equinus. 
    -Usually 6-8wks of weekly long-leg groin-to-toe casts.
    -Generally requires percutaneous Achilles lengthening or posterior capsular release if equines is rigid.
  • Surgery done at 6-12months if deformity fails to correct with serial casting.
  • Delayed presentation: 3-10yrs old, generally require: medial opening or lateral column shortening osteotomy or cuboidal decancelliation indicated.
  • Delayed presentation / refractory clubfoot: >10yrs old, generaly treated with triple arthrodesis. Consider talectomy for pts with insensate feet.

Clubfoot Surgical Technique

  • Cincinnati incision
  • Carefully protect posterior tibial artery.
  • Achilles, posterior tibialis, FHL lengthening
  • Talotibial, calcaneotibial, talonavicular, subtalar  +/-calcaneocuboid capsular release.
  • Equinus deformity: Achilles Z-lengthengin, posterior tibiotalar and talocalcaneal capsulotomy.
  • Hindfoot varus: posteromedial talocalcaneal capsulotomy +/- complete subtalar release.
  • Midfoot adduction: abductor hallucis and talonavicular joint release +/- calcaneal cuboid joint release or decancellation of the cuboid.
  • Cavus: plantar fascia release.
  • Recurrent deformition after surgical release=15-50%

Clubfoot Associated Anomalies / Differential Diagnosis

Clubfoot Complications

  • Cast sore
  • Wound breakdown

Clubfoot Follow-up Care

  • Weekly cast change for 6-8 wks
  • Denis-Browne bar worn at night for up to 3 yrs
  • May require anterior tibialis transfer for residual supination.
  • Ir recurrence occurs repeat casting / abduction orthosis is often successful. Surgical release should include only the affected extrinsic areas: generally posterior subtalar, ankle and talonavicular joints. Medial subtalar joint and interosseous ligament generally do not require release.

Clubfoot Review References



The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer