What Is Club Foot?
Congenital talipes equinovarus (CTEV) — commonly known as club foot — is a complex three-dimensional foot deformity present at birth, in which the foot is turned inward and downward. It affects approximately one to two infants per thousand births and is twice as common in boys as in girls. It may involve one foot (unilateral) or both (bilateral, in around half of cases).
The deformity comprises four components, remembered by the acronym CAVE:
- Cavus — high arch of the foot
- Adductus — forefoot turned inward (medially)
- Varus — heel turned inward
- Equinus — foot pointing downward (heel in raised position)
The cause is multifactorial, involving both genetic and environmental factors. The majority of cases are idiopathic (no underlying systemic or neurological condition). Club foot can also occur in association with neuromuscular conditions such as spina bifida or arthrogryposis, which may require modified treatment approaches.
The Ponseti Method
The Ponseti method is the internationally accepted gold standard for clubfoot treatment, replacing the extensive surgical releases that were previously standard care. It achieves excellent outcomes in over 95% of idiopathic cases when commenced early and the bracing phase is adhered to.
Serial Casting (Weeks 1–8)
Beginning in the first week of life, long-leg plaster casts are applied weekly, each cast gently correcting the deformity in a specific sequence. Four to eight casts are typically required.
Achilles Tenotomy
A minor procedure performed under local anaesthetic to release the tight Achilles tendon, correcting the equinus component. A final cast is worn for three weeks while the tendon heals.
Foot Abduction Brace (FAB)
A brace holding both feet in a corrected position is worn full-time (23 hours per day) for three months, then at night and during naps until age four to five years. Adherence to bracing is the most important factor in preventing relapse.
When Is Surgery Required?
Extensive surgical releases are rarely required for idiopathic clubfoot treated with the Ponseti method. Limited surgery may be necessary in specific circumstances.
- Relapse — recurrence of deformity, most often due to incomplete bracing compliance; may be managed with repeat casting or, in older children, a tibialis anterior tendon transfer
- Resistant or complex cases — children with a neurological or syndromic cause often require more extensive surgical correction
- Older children with established deformity — those presenting late or with residual deformity after treatment may require more formal surgical reconstruction
With appropriate early treatment, children treated for idiopathic clubfoot can expect normal or near-normal foot function, participate in all sporting and recreational activities, and wear standard footwear. Long-term orthopaedic follow-up through growth is recommended.
Discuss Club Foot Treatment
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600