Talipes is a congenital deformity that develops in the womb during the first trimester (between 8 to 12 weeks) and causes an abnormal twisting of the ankles, heels, toes and feet. Talipes is present in one of every 1,000 childbirths in the United States (US), and 95 percent of these incidences are known as congenital talipes equinovarus (CTEV) or clubfoot. This type causes the foot to be curled inwards with toes pointing downward.
Causes. Among the causes of talipes is the abnormal position of the feet and limited space in the womb during fetal development, which can result in malformed tendons, muscles and bones. Furthermore, the lack of amniotic fluid in the sac surrounding the fetus, or oligohydramnios, can increase pressure on the feet, leading to talipes as well.
While there is no conclusive proof that talipes is hereditary, statistics indicate that there is a three to four percent probability that a child will develop it if one parent has this deformity. This percentage increases to 15 percent if both parents are affected. For normal parents who have a child with this problem, there is a two to five percent chance that their next child will have talipes. Additionally, male babies are twice as likely to be afflicted with this condition than female babies.
Treatment. Treatment for talipes should commence immediately after birth. The goal is to restore the feet to their normal position to enable proper function as well as eliminate pain and deformity. The treatments available are:
1. Serial plaster casting and splinting
This weekly treatment for talipes consists of gentle manipulations to move the feet as much as possible towards the correct position and to hold this correction with a plaster cast. Splints are then used as a follow-up treatment. These are flexible, as they can be used at various times during the treatment and can be worn 24 hours a day or only at night. Shoes used with splints should be straight laced shoes with a straight medial border.
2. Non-surgical methods
There are two well-known non-surgical methods to treat talipes:
a) The Ponseti method
Developed by Dr. Ignacio Ponseti of Iowa, the Ponseti method begins with a series of gentle manipulations and toe-to-thigh cast placements for the first five to seven weeks. The heel-cord is cut to complete the correction of the foot before the last cast is applied. Then, the last cast is placed for three weeks, by which time the heel-cord has healed properly.
After this, a special splint called the Denis-Browne splint is put in place. This splint is made of two high-top, open-toed shoes connected by a bar, which is adjusted according to the correct position of the feet. The splint is worn full-time for two to three months and then only at night for the next two to four years.
b) The French method
This treatment requires daily one-hour therapy with a qualified physical therapist. It consists of gentle stretching of the feet, followed by taping to maintain their improved position. At night, the taped feet are connected with a machine that allows for a continuous passive motion to maximize stretching. For two hours every day, the tape is removed to air the skin. Physical therapy sessions continue daily for as long as three months, and taping is discontinued once the child begins walking.
- a) The Ponseti method
The posteromedial release surgery aims to loosen and lengthen tightened ligaments and tendons in the medial and posterior parts of the feet. To hold the corrected position after surgery, the feet are casted bi-weekly for six weeks and then splinted or braced for another six weeks. Surgeons usually wait until the child is one year old, but some begin operating when it is clear that non-surgical methods fail to correct talipes.
The risk of recurrence of talipes is up to 25 percent until the child reaches one year old. Even so, constant follow-up and careful observation are required throughout childhood and adolescence. Without any recurrence, children with talipes will continue to lead normal and active lives.