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234: CLUBFOOT

Kay Tasso, PhD, PT, PCS

CONDITION/DISORDER SYNONYMS

  • Congenital talipes equinovarus (CTEV)

  • Congenital clubfoot

ICD-9-CM CODE

  • 754.51 Congenital talipes equinovarus

ICD-10-CM CODE

  • Q66.0 Congenital talipes equinovarus

PREFERRED PRACTICE PATTERN

  • 4B: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Impaired Posture1

PATIENT PRESENTATION

While hospitalized, a 3-day-old infant is referred to physical therapy with a diagnosis of myelomeningocele. The infant was diagnosed in utero and subsequently, delivered by caesarean section. Surgical reduction of the meningocele occurred within the first 24 hours. Post-op precautions include no positioning in supine. The infant is being monitored to determine if a ventroperitoneal shunt will be needed. Upon examination, the therapist notes bilateral talipes equinovarus with the feet postured in plantar flexion, inversion, and abduction. The physical therapist provides passive range of motion to the feet and ankles and instructs the parents on how to complete this activity as part of the home exercise program.

KEY FEATURES

Description

  • Three malformations of the foot/ankle complex seen at birth

    • Plantar flexion (ankle or hindfoot equinus)

    • Inversion (rearfoot varus)2

    • Adduction (forefoot varus or metatarsus adductus)2

Essentials of Diagnosis

  • Idiopathic, though can be hereditary

  • Neurogenic

  • Associated with syndromes such as arthrogryposis and Larsen syndrome3

  • Postural or positional; not a true club foot

General Considerations

  • Two categories: Flexible or rigid

  • Results from abnormally shaped tarsal bones that cause ligament and joint changes

  • Often associated with myelomeningocele4

  • May result from arthrogryposis

FIGURE 234-1

Deformities of the foot. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Demographics

  • Incidence 1 to 2 per 1000 infants

  • 2:1 male–female ratio

  • Hispanics at greater risk

  • Asians at least risk

  • 50% bilateral

  • Occurs most often in first-born infants

FIGURE 234-2

Clinical appearance of congenital right club foot. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Either flexible or rigid deformities of the foot including plantar flexion, adduction, and inversion

  • Contracted intrinsic muscles of the foot

  • Vertical talus

Functional Implication

  • Unable to stand with flat foot or bear weight on the involved side

Possible Contributing Causes

  • Genetic: Siblings 30 times more likely to also have club foot

  • Environmental: In ...

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