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Paediatric Orthopaedics

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What is clubfoot?

Clubfoot or CTEV (Congenital Talipes Equinovarus) is a common condition, present from the early stages of pregnancy, that causes the lower leg, ankle and foot to be twisted inwards from the normal position.

There are several theories, but the exact reason why this occurs in unknown. Boys are more commonly affected by clubfoot than girls. One or both feet may be affected.

Clubfoot can sometimes be associated with hip or spine problems, so the baby's spine and hips will be checked by the doctor or physiotherapist.

How is it treated?

At the Nuffield Orthopaedic Centre we treat clubfeet using the Ponseti method, which is now the most accepted form of treatment worldwide.

This is a non-surgical method that involves gentle manipulation to the foot to correct each element of the deformity. Above-knee plaster casts are used with the knee flexed to maintain the corrected foot position. We aim to begin treatment within the first week to ten days from birth; usually, weekly plaster cast changes and manipulations to the baby's foot/feet are required, in order to gradually achieve a corrected foot posture.

Most babies usually require a small procedure to lengthen the normally tight achilles tendon at the back of the heel. This is normally required to gain full correction of the foot and is performed under a local anaesthetic as an outpatient; the baby will be allowed home after the procedure. A further three week period in above-knee casts will be required.

To prevent the foot deformity relapsing the baby will then be required to wear boots-on-bar. These are open-toed sandals attached to a bar, with boots set in an out-turned position. These need to be worn for three months full-time, and then at nights only until five years of age. This part of the treatment is essential for maintaining a well corrected clubfoot.


All babies who have a clubfoot are followed up regularly by the physiotherapy team and reviewed with the doctors every six months to yearly after treatment when the plaster casts have been completed.