Abstract

Congenital talipes equinovarus (CTEV) is one of the most common developmental abnormalities affecting the lower limb. It may be associated with a variety of disorders and can be diagnosed antenatally using high-resolution ultrasound. Depending on severity, treatment usually involves passive manipulation of the affected joint or surgery. We investigated the medium-term childhood outcome of children diagnosed antenatally with isolated CTEV. Over a seven-year period, 174 cases of talipes were identified with 83 being isolated, which were subdivided into mild, moderate and severe classifications. 44 cases were unilateral and 39 were bilateral. The Ponseti technique, which involves serial casts often followed by tenotomy, was used in 85% of mild and moderate cases. Additional surgery was required in 69.3% of bilateral cases and in 60.4% in unilateral cases. In both cohorts surgical soft tissue release was required for in 85% of the unilateral severe and 95% in the bilateral severe groups respectively. In the unilateral group gait abnormalities were present in 22.2% of cases compared with 32.1% of bilateral cases. More severe CTEV resulted in the increased likelihood of gait and functional associations. Five percent of cases with bilateral talipes compared with none in the unilateral group had additional problems (learning and attention issues) at school, which was separate from the orthopaedic abnormality. Overall 92.3% of parents were satisfied with the outcome of postnatal treatment, however counselling regarding management, medium and long-term sequelae of CTEV are of paramount importance.