Also known colloquially as club-foot, this is a deformity apparent at birth, affecting the ankle and foot: the foot is twisted at the ankle-joint so that the sole does not rest on the ground when standing. The heel may be pulled up so that the individual walks on the toes (talipes equinus); the toes may be bent up and the heel used for walking (talipes calcaneus); the sole may be twisted inwards (varus) or outwards (valgus); or the individual may have a combination of deformities (equinovarus). The condition is probably the result of genetic predisposition with an environmental trigger. In the UK the incidence is one in 1,000 live births and talipes is more common in boys than in girls, with 10 per cent of sufferers having a first-degree relative with the same condition. Clinically, there are two types of congenital talipes equinovarus (CTEV): a milder form – resolving CTEV – in which full correction to the normal position is relatively easily achieved; and a more severe type – resistant CTEV – which is harder to correct; and the infant has reduced calf-muscle bulk and abnormally shaped bones.
may be required from birth with the foot corrected to an improved position and then maintained in plaster of Paris or strapping – a procedure performed weekly or more often. If the deformity is not corrected by around six weeks of age, a decision has to be made about whether to carry out surgical correction. If a deformity persists to maturity, a triple arthrodesis – fusion of three affected joints – may be required.