INTRODUCTION
Talipes ("talus" = anklebone) describes
a positional abnormality of the foot, commonly called "club
foot". In the majority of cases the foot is
normally formed, with an abnormal relationship between
the position of foot and the lower limb. Fifty percent
of talipes cases are bilateral (affecting both feet).
Talipes is more frequent anomaly in males.
The most common defect (95% of cases) is for the
foot to be turned inwards with the soles of the feet
facing each other and is called equinovarus ("equinus" =
plantar flexed, "varus" = inversion of
the heel, hind-foot and forefoot). Shortened tendons
on the inside of the leg along with abnormally shaped
bones restricts movement outwards, causing the foot
to turn inwards. A tightened Achilles tendon causes
the foot to point downward. Calcaneovalgus ("calcanes" =
heel bone, "valgus" = pointing out) is
an anomaly where the foot is turned outwards, everted)
with the ankle angled in towards the other foot.
Talipes can occur as an isolated anomaly, as part
of a syndrome, as a result of intrauterine pressure
or position (e.g. oligohydramnios, intrauterine tumours),
or as a consequence of neurological damage (as a
result of muscle imbalance in spinal neural tube
defects or cerebral palsy).
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ANTENATAL
Talipes is identified in approximately 30% of cases
on routine ultrasound scanning. There is an association
between bilateral talipes and lethal chromosome anomalies,
such as trisomy 18, 15, and 13. The vast majority
of these cases will also have other structural anomalies,
early growth restriction, or advanced maternal age
as risk factors that will guide advice regarding
the necessity for invasive testing following diagnosis.
Talipes can be caused by absent fetal movements,
or a lack of liquor, and these elements should be
actively sought during ultrasound assessment. Early
amniocentesis (before 14 weeks gestation) has been
associated with talipes in 1 - 2% of cases. In cases
of isolated talipes with no other risk factors the
risk of this being the only feature of a syndromic
diagnosis is small, and probably does not justify
invasive testing.
The finding of isolated talipes does not alter
antenatal care significantly, and although some would
recommend counselling by paediatric specialists during
the pregnancy the degree of abnormality can be difficult
to predict, making discussion of possible treatments
vague and non-specific. The cases that are identified
prenatally are likely to be the more severe cases,
and the majority will ultimately require surgery.
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POSTNATAL
The priorities for the neonate are to establish
normal respiration, ensure normal swallowing and
feeding and to exclude features of syndromes that
might be linked with talipes. Once the baby is seen
to be thriving, there is no reason for protracted
hospital stay. The baby will need to be assessed
by an experienced physiotherapist, and a regime of
massage and strapping are usually used to produce
as much mobility as possible in the ankle joint.
Surgical correction of talipes is usually considered
between three and 9 months of age. Any surgical correction
should ideally be completed before 12 months of age
so that the infant can start to walk with the feet
in a position where the sole can be put flat to the
floor. Many cases will require long term follow-up
and further surgery may be required as the child
grows.
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WEST MIDLANDS
DATA
To be added
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