Current management of clubfoot (congenital talipes equinovarus)

doi:10.1136/bmj.c355

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Joshua Bridgens, post-CCT fellow in paediatric orthopaedic surgery1,
Nigel Kiely, consultant paediatric orthopaedic surgeon1

¹Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG

Correspondence to: J Bridgens jpbridgens{at}doctors.org.uk

Accepted 13 January 2010

Summary points

Clubfoot is a common congenital deformity that affects one in 1000 live births in the United Kingdom
Most cases are idiopathic and not associated with other conditions
Babies should be referred early for treatment
Current best treatment is by casting and bracing according to the Ponseti method
Results are better with manipulative methods than with surgical release
Recurrences can occur and are normally caused by non-compliance with bracing

The standard treatment of clubfoot has changed greatly in the past 10 years. Previously, extensive surgery was common in children born with this condition. The publication of long term evidence of good outcomes with more minimally invasive methods, such as the Ponseti technique, has led surgeons worldwide to change their approach. Ponseti treatment consists of sequential plasters and prolonged bracing, with minor surgical procedures.

This clinical review describes clubfoot and its current management. It is particularly aimed at general readers who are non-specialists but may be involved in the care of patients with this condition. The evidence underpinning this review is largely observational. Although the Ponseti method was first described over 30 years ago, it is only since the publication of long term outcomes of case series that it has been widely adopted.

Sources and selection criteria

No Cochrane reviews or other systematic reviews are available on the treatment of clubfoot. We searched PubMed for English language peer reviewed articles on clubfoot using search terms that included “clubfoot”, “Ponseti”, “surgical release clubfoot”, and “external fixator clubfoot”. We also used standard texts on the management of clubfoot.

What is clubfoot and who gets it?

Clubfoot, also known as congenital talipes equinovarus, is a developmental deformity of the foot. It is one of the most common birth deformities with an incidence of 1.2 per 1000 live births each year in the white population.1 Clubfoot is twice as common in boys and is bilateral in …