Definition
Idiopathic clubfoot is a complex deformity consisting of cavus, adductus, varus and equinus.
Assessment
- Examine both feet and the child overall
- Determine whether idiopathic or syndromic / neuromuscular
- Use a severity score such as Pirani or Dimeglio
Ponseti principles
- Correct cavus first by supinating the forefoot
- Abduct the foot around the talus to correct adductus and varus
- Correct equinus last, usually by percutaneous Achilles tenotomy
- Maintain correction with a foot-abduction brace
Bracing
- Essential to prevent relapse
- Compliance is critical
Relapse
Common and usually due to poor brace compliance. Early relapse may respond to repeat casting and limited surgery.
Surgery
Extensive release is now much less common and reserved for resistant or syndromic feet.
Diagram
