JAAOS Article J Am Acad Orthop Surg, Vol 10, No 4, July/August 2002, 239-248. David P. Roye, Jr, MD and Benjamin D. Roye, MD, MPH requires AAOS membership or subscription or pay per view
The etiology of idiopathic congenital talipes equinovarus is unknown, and there is no consensus as to the best treatment. Increasingly, ultrasound is being used to diagnose the condition prenatally, but the diagnosis remains clinical postnatally. Radiographs can help confirm the diagnosis and ascertain the severity of the condition. There are many classification schemes, but none offers adequate prognostic value. The mainstay of treatment is manipulation and casting, usually followed by soft-tissue release. However, some patients have been successfully treated with intensive physiotherapy instead of surgery.

Offering a strong historical/podiatry perspective, current concepts and pearls from his own experience, this author provides a thorough review of treating this complex condition.

Surg J R Coll Surg Edinb Irel., 2 February 2004, 47-51
The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four-year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management

This lecture covers:
* Talipes deformities (clubfoot)
* Pes planus (flat feet)
* Congenital vertical talus
* Pes cavus
* Tarsal coalitions

Clinical Anatomy: - affected limb may be shortened, calf muscle is atrophic, and foot is short compared to opposite side; - medial rotation of tibia;
Account of the abnormalities of joint position plus ligament and muscle contractures.

The congenital abnormalities covered in this chapter are: metatarsus adductus, skew foot, congenital clubfoot, calcaneovalgus foot, vertical talus, and tarsal coalition. Author - R. Jay Cummings, M.D. Nemours Children's Clinic Jacksonville, FL 32207

Free download of of Dr. Ignacio Ponseti's book "Congenital Clubfoot: Fundamentals of Treatment" Registered users of this site can download/read the material in electronic format for free. Users can download the book on their computers, a flash drive, and other electronic devices. By becoming a registered user, you will have access to additional materials that will be made available to this community in the near future.

The Ponseti International Association for the Advancement of Clubfoot Treatment is named after Ignacio Ponseti, MD, professor emeritus of orthopaedics and rehabilitation in the UI Roy J. and Lucille A. Carver College of Medicine. The association's mission is to improve the treatment of children born with the crippling deformity through education, research and improved access to care.

Idiopathic clubfoot is the most common congenital deformity of the foot. Its characteristic presentation of equinus, varus, adductus, and cavus deformities makes it easily recognizable, even as shown on ultrasonograms. Because the deformity is so apparent at birth, it can be devastating for parents to see their newborn with a foot that is essentially turned upside down

Objectives
1. Define clubfoot
2. Describe the pathological anatomy of clubfoot
3. Describe imaging of the infant clubfoot
4. Describe treatment of the infant with clubfoot
5. Discuss prognosis of the infant with clubfoot
Discussion points
1. What is a "true" clubfoot? How is it different from a postural deformation? Do you think some reported series may have different criteria for inclusion of an infant clubfoot? How would that alter results?
2. Should early surgery be performed for the infant with clubfoot? If so, what? Why or why not?
3. How do ultrasonographic findings suggestive of clubfoot correlate with postnatal clubfoot?

Objectives
1. Describe the approach to treatment of the child with a clubfoot resistant to casting and/ or physiotherapy
2. Describe, in general terms, operative approaches to the resistant clubfoot
3. Discuss factors related to outcome of the surgically treated clubfoot

Use the following Search String in the PubMed search box or click on the OWL "Create Bibliography" button ponseti ("Clubfoot/classification"[MAJR] OR "Clubfoot/complications"[MAJR] OR "Clubfoot/congenital"[MAJR] OR "Clubfoot/epidemiology"[MAJR] OR "Clubfoot/radiography"[MAJR] OR "Clubfoot/surgery"[MAJR] OR "Clubfoot/therapy"[MAJR] OR "Clubfoot/ultrasonography"[MAJR]) URL http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=PureSearch&db=pubmed&details_term=ponseti%5BAll%20Fields%5D%20AND%20%28%22Clubfoot/classification%22%5BMAJR%5D%20OR%20%22Clubfoot/complications%22%5BMAJR%5D%20OR%20%22Clubfoot/congenital%22%5BMAJR%5D%20OR%20%22Clubfoot/epidemiology%22%5BMAJR%5D%20OR%20%22Clubfoot/radiography%22%5BMAJR%5D%20OR%20%22Clubfoot/surgery%22%5BMAJR%5D%20OR%20%22Clubfoot/therapy%22%5BMAJR%5D%20OR%20%22Clubfoot/ultrasonography%22%5BMAJR%5D%29

Discussion: - helps to determine preoperative pathology; - in infancy, ossification centers of the talus, calcaneus, and cuboid are present, whereas the navicular does not appear until 3-4 yr; - Method of Beatson and Pearson; JBJS 1966;

AAOS Podium Presentation 2006
The Disease-Specific Instrument for patients with clubfoot consists of ten items designed to measure outcomes of treatment for clubfoot in terms of overall satisfaction, appearance, pain, and physical limitations with two distinct subscales: satisfaction and function. Outcomes for patients treated with manipulation and casting +/- anterior tibial tendon transfer were compared with patients treated by posterior release or PMR.62 patients were identified and asked the DSI for clubfoot questions in phone interviews.

Medscape Report on presentation by Vincent S. Mosca, MD 2002
Conditions such as flatfoot and clubfoot were highlighted, showing new advances in research as well as surgical and nonsurgical management of each.