One of the most common birth defects (1 in 1000 live births).
Can be identified on antenatal ultrasound (true-positive rate 83%).
Examination demonstrates a hindfoot in varus, a forefoot that is adducted, and an ankle in equinus.
Prognosis is good with a non-operative approach using the Ponseti method of treatment (bracing and serial casting).
Achilles tenotomy is used in >90% of cases to improve dorsiflexion.
Tibialis anterior tendon transfer and posteromedial release and tendon lengthening are further surgical treatment options.
History and exam
Key diagnostic factors
- positive family history
- equinus deformity
- hind foot in varus and adducted
- forefoot adducted
Other diagnostic factors
- male sex
- hip dysplasia
- neurological or chromosomal abnormalities
- smaller lower extremity
- dimpling, hairy patch along spine line
- family history of equinovarus foot deformity
- male sex
- associated congenital abnormalities
- parental smoking
Investigations to consider
- anteroposterior and lateral radiographs of foot
- dynamic hip ultrasound
- pelvic x-rays
- CT foot
- CT spine
- abdominal ultrasound
at initial diagnosis
Scott E. Van Valin, MD
Pediatric Orthopaedic Surgery
Medical College of Wisconsin
SEVV declares that he has no competing interests.
Shyam Kishan, MD
Assistant Professor of Orthopaedics
Department of Orthopaedic Surgery
Loma Linda University
SK declares that he has no competing interests.
Mark J. Adamczyk, MD
Pediatric Orthopedic Surgeon
Akron Children's Hospital
MJA declares that he has no competing interests.
Nigel Kiely, FRCS
Consultant Orthopaedic Surgeon
Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust
NK declares that he has no competing interests.
Donald Campbell, MD
Paediatric Orthopaedic Surgery
Ninewells Hospital and Medical School
- Metatarsus adductus
- Calcaneovalgus or talipes calcaneal valgus
- Guideline on the diagnosis and treatment of primary idiopathic clubfoot
- Clubfoot: Ponseti management, 3rd ed
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