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Clubfoot and Other Foot Defects

By Simeon A. Boyadjiev Boyd, MD, Professor of Pediatrics and Genetics, Section of Genetics, Department of Genetics, University of California, Davis

Clubfoot (talipes equinovarus) is a defect in which the foot and ankle are twisted out of shape or position.

The usual clubfoot is a down and inward turning of the hind foot and ankle, with twisting inward of the forefoot. Sometimes the foot only appears abnormal because it was held in an unusual position in the uterus (positional clubfoot). In contrast, true clubfoot is a structurally abnormal foot, which is a true malformation. With true clubfoot, the bones of the leg or foot or the muscles of the calf are often underdeveloped.

Larsen syndrome is a disorder in which children are born with clubfeet and dislocations of the hips, knees, and elbows.

Common Types of Clubfoot

Positional clubfoot can be corrected by immobilizing the joints in a cast and by using physical therapy to stretch the foot and ankle. Early treatment with immobilization is beneficial for true clubfoot, but surgery, often complex, is also generally needed.

Other foot defects include metatarsus adductus, metatarsus varus, talipes calcaneovalgus, and pes planus.

Metatarsus adductus

In metatarsus adductus, the foot turns inward. Mobility of the joints of the foot and ankle may be limited. Treatment of metatarsus adductus depends on the severity of the deformity and immobility of the foot. Most mild cases resolve spontaneously. Corrective shoes or splints may be needed in more severe cases. Surgery is required only in exceptional instances.

Metatarsus varus

In metatarsus varus, the bottom surface of the foot is turned inward, so that the arch is raised. This defect usually results from positioning in the womb, does not usually resolve after birth, and may require a corrective cast.

Talipes calcaneovalgus

In talipes calcaneovalgus, the foot is flat or rounded and bent backward with the heel turned outward. Early treatment with a cast or with corrective braces is usually successful.

Pes planus

In pes planus (flat feet), the normal arch in the middle of the feet appears flattened. Until about 3 years of age, all children have flat feet and then the arch begins to develop. There are two main reasons for flat feet.

Flexible flat feet

In flexible flat feet, the feet remain flat because the arch of the foot is unusually flexible. Flexible flat feet usually do not require treatment. However, if an older child has pain or cramps in the feet, corrective shoes may be needed.

Tarsal coalition

In tarsal coalition, the feet are fixed in a flattened position. Tarsal coalition may be a birth defect or result from conditions such as injuries or prolonged swelling. Treatment for tarsal coalition often includes a cast. Sometimes surgically separating the stiffened foot joint restores mobility to the foot.

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