Equinovarus foot deformity is one of the most common birth defects (1 in 1000 live births).
Can be identified on prenatal ultrasound (true-positive rate 83%).
Exam demonstrates a hindfoot in varus, a forefoot that is adducted, and an ankle in equinus.
Prognosis is good with a nonoperative 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
- neurologic 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 radiographs
- CT foot
- CT spine
- abdominal ultrasound
at initial diagnosis
- Metatarsus adductus
- Calcaneovalgus or talipes calcaneal valgus
- Diagnosis and treatment of idiopathic congenital clubfoot
- Management of clubfoot deformity in children up to walking age
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