Talipes (Club Foot)
This a condition where one or both of the baby’s feet and ankles bend inwards or sometimes upwards. Generally, the cause of this condition is unknown, but it is thought that it may be due to the positioning of the baby while they are inside the uterus (womb) and have been curled up snugly. The condition can present in both mild and severe forms.
In mild cases – called ‘positional’ talipes (Talipes Metatarsus), the soft tissues (ie ligaments, tendons, skin and muscle) of the foot and ankle are affected. One or both feet and ankles may curl inwards or sometimes upwards; they can however, be moved easily into a normal position. No treatment is required and the feet and ankles will straighten within a few days as the baby stretches and moves normally. This form of talipes is not uncommon and is seen equally in both boys and girls.
In more severe cases of talipes – called ‘fixed’ talipes (Talipes Equinovarus), the foot will not return to a normal position when moved. This form of talipes is due to the bony structures of the foot and ankle also being affected. Fixed talipes occurs in 1:1000 births, and, unlike positional talipes, male infants are twice as likely to be affected compared to female. This form of talipes is also more common amongst babies who have brothers or sisters who were also born with similar problems.
Some babies will need to be treated with a series of exercises from a physiotherapist and parents are also taught how to manipulate their baby’s feet. However, other babies will require more intensive treatment involving gentle manipulation to stretch the ligaments and tendons of the foot, so that the foot gradually turns towards its correct position. A plaster cast is then placed around the foot to prevent it from moving; this allows the displaced bones to gradually move into their correct positions. This approach is known as the Ponseti treatment. The treatment is repeated every one to two weeks, where the plaster cast is removed, the foot manipulated and the cast replaced. After three months of treatment, if the baby’s foot/feet have maintained a correct position then the plaster cast(s) are used for a further three to six months to ensure that the bones, ligaments and tendons continue to grow in alignment. Research studies have concluded that this is a very effective non-surgical method of treatment.
If conservative treatment proves to be ineffective, an operation may be required to surgically release the soft tissues responsible; this allows the foot to straighten. Surgery is effective in 80-90 per cent of infants and is found to be most effective when performed during the first six to 12 months’ of age. Further corrective surgery may be required later in childhood.