paediatric
Congenital Talipes Equinovarus (Clubfoot)
advanced
6 min
28 marks
6 questions
Clinical Scenario
A newborn male is referred from the postnatal ward with bilateral foot deformities noted at birth. There is no family history of clubfoot. The pregnancy was uncomplicated with normal antenatal scans. On examination, both feet demonstrate the classic clubfoot deformity with forefoot adduction, midfoot cavus, hindfoot varus, and ankle equinus. The deformities are rigid with deep medial and posterior skin creases. The calves appear thin.
Clinical photograph of a newborn with bilateral idiopathic clubfoot. The deformity shows the four components: Cavus (high arch), Adductus (forefoot pointing medially), Varus (heel turned inward), and Equinus (foot pointing downward). The feet appear rigid with deep posterior and medial creases. The calf muscles appear underdeveloped. Pirani score would be calculated for severity assessment.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the clinical features and classification of clubfoot.
Question 2 (5 marks)
Explain the Ponseti method in detail including the sequence of correction.
Question 3 (6 marks)
What is the role of percutaneous Achilles tenotomy?
Question 4 (5 marks)
How do you manage recurrence and what is tibialis anterior transfer?
Question 5 (4 marks)
What are the causes of treatment failure and resistant clubfoot?
Question 6 (4 marks)
What are the surgical options for resistant or neglected clubfoot?
Exam Day Cheat Sheet
Must Mention
- •CAVE: Cavus, Adductus, Varus, Equinus
- •Ponseti sequence: Cavus → Adductus/Varus → Equinus (CAVE)
- •Counter-pressure on lateral talar head
- •Tenotomy for residual equinus (80-90%)
- •Brace: 23hr/day × 3mo, nights to age 4-5
- •TATT for dynamic supination (>2.5yr)
Common Pitfalls
- •Pronate forefoot (rocker-bottom)
- •Force equinus first (rocker-bottom)
- •Pressure on calcaneus
- •Poor brace compliance
- •Wrong Ponseti sequence
- •Late presentation