Types of foot deformities
*CLUB FOOTTALIPES CALCANEOVALGUS
TALIPES CALCANEOVALGUS
*
Dr. Mahmoud [Link]
the foot postures are:
Talipes: any deformity when the foot is no
more in plantigrade position, its usually
congenital.
• Equinous foot: the foot is planter flexed
at the ankle.
• Calcaneus foot: the foot is dorsiflexed at
the ankle.
• Varus foot; is like an inverted foot with
the sole facing medially.
• Valgus foot; is like an everted foot with
the sole facing laterally.
• Pes cavus: it is the deformity where there is increased
medial arch of the foot and this is usually associated with
varus deformity and claw toes.
• Flat foot (pes planus): is the condition where there is
flattening of the medial longitudinal arch of the foot and
this is usually associated with valgus deformity.
Cogenital talipes eqinovarus:
• most common musculoskeletal birth
defect
• boys affected twice more often than
girls,
• It’s bilateral in one third of the cases.
• 80% of clubfoot is an isolated deformity
• may occur in cases of myelomeningocele and
in arthrogryposis.
Pathology:
muscle contractures contribute to the characteristic deformity
that includes (CAVE)
• Cavus of midfoot (tight intrinsics, FHL, FDL)
• Adductus of forefoot (tight tibialis posterior)
• Varus of hindfoot (tight tendoachilles, tibialis posterior, tibialis anterior)
• Equinus of hindfoot (tight tendoachilles)
bony deformity consists of medial spin of the midfoot and
forefoot relative to the hindfoot
• talar neck is medially and plantarly deviated
• calcaneus is in varus and rotated medially around talus
• navicular and cuboid are displaced medially
Clinical features:
• At birth the foot looks abnormally in
• midfoot in cavus
• forefoot in adduction
• hindfoot in varus and equinus
• Sometimes the deformity due to intrauterine malposition
and is flexible, (positional)
• in these cases we can do gentile manipulation of the foot with
dorsiflexion and eversion and the lateral aspect of the foot can
touch the front of the leg. While in rigid congenital eqinovarus the
deformity is fixed and cannot be corrected by manipulation.
• Always look for associated abnormalities as DDH,
arthrogryposis and spina bifida.
Club foot
Treatment:
• The aims of the treatment are:
• Correct the deformity early.
• To correct the deformity fully.
• To hold the foot in the corrected position until it stop
growing.
Correction can be achieved by one of the followings;
1- Stretching and splintage (Ponseti method )
Ponseti method is the gold standard in most of the world
• indications
• this is the standard of care for untreated clubfeet
• outcomes
• Ponseti method has a > 90% success rate in avoding comprehensive
surgical release
• children can be expected to walk, run and be fully active in the absence
of other comorbidities
• Technique
• goal is to rotate foot laterally around a fixed talus
• order of correction (CAVE)
• Cavus
• Adductus
• Varus
• Equinus
• Heel cord tenotomy needed in at least 80-90% of children in
most series
• Foot abduction orthosis (FAO)
• critical for long-term success
• FAO noncompliance is the biggest risk factor for deformity
recurrence
• FAO use is ~ full-time(23h) for 3 months and then at night (+/-
naps) for 2-4 years
2- Operative surgical correction:
• This is left for those who
• fail to respond to stretching and splintage and for cases that are
resistant from the start.
• It’s usually done after the age of three months or according to foot size
and body weight.
Here Achilles tendon is elongated,
all the shortened medial soft tissues are released
and the long plantiflexors are elongated
putting the foot in the normal position and this position held in POP
cast.
Here we start to correct equines then varus and lastly the
forefoot adduction.
The role here is to correct only and never overcorrect.
For children with failed correction and those who
present between 5-10 years the correction is
usually surgical and needs in addition to soft
tissue release bone reshaping and possible
tendon transfer.
For children above the age of 10 years wedge
tarsectomy or triple arthrodesis is indicated and
the prognosis is poor.
TALIPES CALCANEOVALGUS
• is a common deformity that presents in the
newborn as an acutely dorsiflexed foot.
• There is a deep crease (or several wrinkles) on
the front of the ankle, and the calcaneum juts out
posteriorly. Unlike congenital vertical talus the
anterior creases in congenital vertical talus are
located over the midfoot.
• usually bilateral.
• There is an association with hip dysplasia,
especially if it presents on one side .
• probably due to abnormal intrauterine positioning
• often corrects spontaneously in the neonatal
period. Severe deformities occasionally require
serial casts for correction.
