Positional clubfoot

Positional Talipes

• in this condition the foot is held in an abnormal position
  • this is the position the feet would have been in whilst in the in utero
  • due to limited space within the utero the fetus has not been able to stretch his/her feet as they grew
• there are two types of positional talipes:
  • Positional Talipes Equinovarus (PTEV) in which the foot is held pointing inwards towards the other foot
  • Positional Talipes Calcaneovalgus (PTCV) in which the foot is held turned outwards and upwards
  • Positional Talipes is a fairly common problem, affecting 16 per 1000 live births in the UK (Hart 2006) (1)

Outcome:

• positional Talipes will usually correct fully and not affect walking (2)

Treatment

• paediatric physiotherapist review
  • parent (s) will be shown how to carry out some gentle stretches on your neonate's foot
  • physiotherapist will monitor feet until the Positional Talipes has corrected.
  • positional foot deformities are fully correctable with gentle positioning and do not require any other interventional treatment (3)

Advice for parents:

• Allow your baby lots of time to freely kick. In the bath or at changing time when the nappy is not restricting them can be useful
• Avoid tight baby gro's or leggings so that there is plenty of room for your baby to stretch their legs and feet
• Avoid wearing baby shoes and tight socks

Stretches

• To be performed at every nappy change/ feed
• Do not stretch if your baby is agitated or upset. Your baby should be relaxed during the stretches.

Stretching the inside of the foot

• Hold the baby's calf in one hand, keeping the knee bent (do not hold the heel)
• Take hold of both sides of the foot with the other hand using thumb and finger
• Firmly but gently stretch the foot outwards towards the point where the knee and foot are in line
• Hold for 15 seconds and release. Increase up to 1 minute if your baby remains relaxed
• Repeat 5 times.

Stretch of Achilles Tendon

• Hold the baby's calf in one hand and the foot with the other
• Bring the whole foot up towards the shin in order to stretch the back of the heel
• Hold for 15 seconds and release. Increase up to 1 minute if your baby remains relaxed
• Repeat 5 times

Reference:

• Hart D: Variability in the Physiotherapy Treatment of Talipes Equinovarus, APCP Journal, June 2006
• Mid Cheshire Hospitals NHS Foundation Trust. Physiotherapy advice for Positional Talipes (Accessed 11/2/2014).
• Grant AD, Atar D. Highlights of talipes equinovarus deformity. Am J Orthop 1995; 24: 393-399.