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Congenital clubfoot (talipes equinovarus, CTEV)
Clubfoot is a fixed congenital foot deformity with four components (CAVE: cavus, adductus, varus, equinus), and first-line treatment is the Ponseti method: serial casts, an Achilles tenotomy in most cases and an abduction brace.
Why it matters in the exam
Questions ask you to name the components, to tell a fixed deformity from a positional one that corrects easily by hand, and to choose the right step of the Ponseti method. It occurs in about 1 in 1,000 births, more in boys, and roughly half of cases are bilateral. Look for associated conditions such as spina bifida, arthrogryposis and chromosomal syndromes, and examine the hips because of the link with dysplasia. Most failures come from poor brace use in the first years, not from the casts. Extensive surgical release is kept for resistant cases only. Diagnosis is often made already on the prenatal anatomy scan, and after birth it is clinical and needs no radiograph. On examination there is a small foot, a high heel that is hard to feel, a deep skin crease on the inner side of the foot and a relatively thin calf on the affected side, a finding that remains even after successful treatment and that parents should be told about in advance. In treatment questions, remember that casts are changed every week and that most children reach full correction after five to eight casts. Success is very high when parents keep to the brace, and the result is a flexible, functional foot that allows normal walking and sport. It is also important to distinguish milder deformities such as metatarsus adductus, in which the heel is normal and correction is much simpler.
Key points
- A fixed congenital deformity: cavus, adductus, varus and equinus.
- About 1 in 1,000 births, more in boys, roughly half bilateral.
- The Ponseti method: serial casts in a fixed order.
- Most children need an Achilles tenotomy to correct equinus.
- An abduction brace until age 4 prevents recurrence.
Summary table
| Component | Description | Order of correction (Ponseti) |
|---|---|---|
| Cavus | High arch, forefoot plantar-flexed | Corrected first by lifting the first metatarsal (supination) |
| Adductus | Forefoot points inward | Corrected in later casts by abduction around the head of the talus |
| Varus | Heel tilts inward | Corrected together with the adductus |
| Equinus | Heel raised and foot plantar-flexed | Corrected last, by Achilles tenotomy in most cases |
| Maintaining correction | Foot abduction brace | 23 hours a day for about 3 months, then at night until age 4 |
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Sources
- Lovell and Winter's Pediatric Orthopaedics, 8th ed. (2020) — The Foot
- Ponseti IV, Congenital Clubfoot: Fundamentals of Treatment, Oxford University Press (1996) — Treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.