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Definition
Talipes deformity is a disorder of ankle and foot. It comes from the Latin wordstalus meaning ankle
and pes meaning foot.
Incidence
Commonly called clubfoot, it is a congenital anomaly occurring at approximately 1 to 2 in every 1000 live
births.
Male-female incidence ratio is 2:1.
Bilateral deformity involvement accounts 30%-50% of cases.
True Talipes Disorder
Talipes deformity could either be unilateral (affecting a single foot only) or bilateral (both feet are affected).
Regardless of which extremity is affected, some newborns have developed a twisted foot appearance due
to intrauterine position. However, with manipulation the foot can be brought into a straight position. This
temporary abnormality is called a pseudo-talipes disorder. A true clubfoot cannot be aligned properly
without further intervention.
Skeletal Anatomy of the Foot
Two essential functions of the foot:
1. Reinforces body weight
2. Allows the body to move forward when running or walking
Facts about the foot bone:
1. The weight of the body is carried by the largest tarsal bones, calcaneus (heelbone) and talus (ankle
bone).
2. To create a strong arch of the foot it is arranged longitudinally (medial and lateral) and transverse.
Parts of the Foot Bone:
Tarsus – the posterior half of the foot composed of seven tarsal bones:
1. Medial cuneiform
2. Intermediate cuneiform
3. Lateral cuneiform
4. Cuboid
5. Navicular
6. Talus
7. Calcaneus
Metatarsals – form the sole and are composed of 5 bones.
Phalanges – form the toes and are composed of 14 bones. Each toe has 3 phalanges with the exception of
the great toe having only 2.
Ligaments – connects bones.
Tendons – attaches bone to a muscle allowing movements or a specific amount of elasticity.
Pathophysiology
Etiology
The exact cause of this deformity is unknown. But suggestions or hypotheses of its disease process are
the following:
Genetic factor
Abnormal tendon insertion
Anomalous tendons may affect the alignment of the foot.
Retracting fibrosis (myofibrosis)
Collagen found in all ligaments and tendons are coiled and could be stretched with the exception of Achilles
tendon (made up of tightly coiled collagen and cannot be stretched).
Thickening and scarring of fibrous tissue could cause the twisted foot appearance.
Neurogenic factors
Innervation changes during the prenatal period could be due to the presence of neurologic events or
disorder such as, spina bifida. Studies show that 35% of children with clubfoot have neurologic impairment.
Oligohydramnios
Fluid leak during the prenatal period could cause restriction of fetal movements thereby, predisposing to a
deformed foot.
Developmental arrest of fetal development
Disruption of the medial rotation of the fetal foot could result to a clubfoot condition.
Diminished Vascular Circulation
Disruption of the branches of the vascular supply of the lower extremity could contribute to misalignment of
the foot.
Types of True Talipes Deformity
1. Equinus (plantarflexion)
2. Calcaneus (Dorsiflexion)
3. Varus (foot turns inward)
4. Valgus (foot turns outward)
Some children with this deformity have a combination of the types listed. For example, a child who walks on
the heel with the foot turning outwards hascalcaneovalgus disorder while the child who tiptoes with the
foot inverted has equinovarus deformity.
Diagnostic Evaluation:
Physical Examination
Twisted foot appearance should be assessed and gently manipulated. If the straightened foot does
not move to a normal position, true clubfoot is present.
Radiography
Use of x-rays is definitive diagnosis for clubfoot as it determines abnormal bone anatomy and
assesses the treatment efficiency.
Management
Categories of treatment:
1. For mild cases: manipulation, cast and splint application (nonsurgical management)
2. For severe cases: surgery
Nonsurgical management
Source: http://nursingcrib.com/case-study/talipes-deformity-case-study-clubfoot/