Congenital Talipes Equinovarus (Clubfoot)

July 22, 2025

Clubfoot is a structural deformity of the foot present at birth. It is characterized by four main components, remembered by the acronym CAVE

Cavus: High arch of the foot
Adduction: Forefoot turned inward
Varus: Heel turned inward
Equinus: Foot pointing downward (plantarflexed)

That type of positioning makes it impossible or challenging for the child to place the sole flat on the ground. In many instances, the reason for clubfoot remains unidentified. Some cases are associated with other disorders most commonly Spina Bifida, Cerebral Palsy and intrauterine positioning. Clubfoot is usually diagnosed at birth through clinical examination, and in many cases, it can be identified before birth through ultrasound as early as 20 weeks.

After birth examinations may include

Physical assessment of foot deformity
X-rays to check bone alignment
Physiotherapy plays a very important role in the management of clubfoot—before, during, and after corrective treatments such as the Ponseti method or surgery.

The Ponseti method consists of 2 equally important phases:

Casting phase
Maintenance phase
Casting Phase: Which consists of Manipulation, Casting and Tenotomy(Surgical procedure to release tendon)
Maintenance Phase: Which is the use of Foot Abduction Brace to prevent relapse.

The main physiotherapy goals are to improve foot alignment, strength, mobility, and prevent recurrence. In early interventions for mild cases some techniques are used such as Gentle passive stretching of tight structures (especially calf and medial foot), Mobilization, Taping and Parent education on positioning and handling.

Common physiotherapy tools

Common physiotherapy tools that are used include:

Passive ROM exercises (dorsiflexion, abduction, eversion)
Resistance bands for strengthening
Proprioceptive and balance boards
Kinesiology taping
Functional play-based therapy (e.g., kicking, climbing)

Essential Physiotherapy Considerations:

Start treatment as early as possible in 1st week after birth
Be consistent and follow up regularly
Educate and involve caregivers at every stage
Monitor for signs of recurrence well into early childhood.

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