Equinovarus foot deformity

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 12 Apr 2025

Last updated: 31 Aug 2023

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.

Definition

Equinovarus foot deformity, better known as clubfoot, is a relatively common birth defect. It can occur on average in 1 in 1000 live births.[1][2][3][4] The foot has a classic appearance of maximum equinus, as well as varus, adduction, and cavus deformities.

History and exam

Key diagnostic factors

positive family history
equinus deformity
hind foot in varus and adducted
forefoot adducted

Full details

Other diagnostic factors

male sex
hip dysplasia
neurologic or chromosomal abnormalities
smaller lower extremity
dimpling, hairy patch along spine line

Full details

Risk factors

family history of equinovarus foot deformity
male sex
associated congenital abnormalities
parental smoking

Full details

Diagnostic tests

Tests to consider

anteroposterior and lateral radiographs of foot
dynamic hip ultrasound
pelvic radiographs
CT foot
CT spine
abdominal ultrasound

Full details

Treatment algorithm

ACUTE

at initial diagnosis

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Contributors

Authors

Scott E. Van Valin, MD

Associate Professor

Pediatric Orthopaedic Surgery

Medical College of Wisconsin

Milwaukee

Disclosures

SEVV declares that he has no competing interests.

Peer reviewers

Shyam Kishan, MD

Assistant Professor of Orthopaedics

Department of Orthopaedic Surgery

Loma Linda University

Loma Linda

Disclosures

SK declares that he has no competing interests.

Mark J. Adamczyk, MD

Pediatric Orthopedic Surgeon

Akron Children's Hospital

Akron

Disclosures

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

Oswestry

Shropshire

Disclosures

NK declares that he has no competing interests.

Donald Campbell, MD

Consultant

Paediatric Orthopaedic Surgery

Ninewells Hospital and Medical School

Dundee

Scotland

Disclosures

Not disclosed.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Cady R, Hennessey TA, Schwend RM. Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics. 2022 Feb;149(2):e2021055555.Full text Abstract

British Society for Children’s Orthopaedic Surgery (BSCOS). Management of clubfoot deformity in children up to walking age. Jul 2021 [internet publication].Full text

Besselaar AT, Sakkers RJB, Schuppers HA, et al. Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta Orthop. 2017 Mar 7;88(3):305-9.Full text Abstract

Staheli L, ed. Clubfoot: Ponseti management, 3rd ed. Seattle, WA: Global HELP; 2009.Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Metatarsus adductus
- Skewfoot
- Calcaneovalgus or talipes calcaneal valgus
More Differentials
Guidelines
- Diagnosis and treatment of idiopathic congenital clubfoot
- Management of clubfoot deformity in children up to walking age
More Guidelines
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Equinovarus foot deformity

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

Tests to consider

Treatment algorithm

at initial diagnosis

relapse

Contributors

Authors

Scott E. Van Valin, MD

Disclosures

Peer reviewers

Shyam Kishan, MD

Disclosures

Mark J. Adamczyk, MD

Disclosures

Nigel Kiely, FRCS

Disclosures

Donald Campbell, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice