Clubfoot (Talipes)

  1. General information
    1. Abnormal rotation of foot at ankle
      1. Varus (inward rotation): would walk on ankles, bottoms of feet face each other
      2. Valgus (outward rotation): would walk on inner ankles
      3. Calcaneous (upward rotation): would walk on heels
      4. Equinas (downward rotation): would walk on toes
    2. Most common deformity (95%) is talipes equinovarus.
    3. Deformity almost always congenital; usually unilateral
    4. Occurs more frequently in boys than in girls; may be associated with other congenital disorders but cause unknown
    5. General incidence: 1 in 700-1000
  2. Medical management
    1. Exercises
    2. Casting (cast is changed periodically to change angle of foot)
    3. Denis Browne splint (bar shoe): metal bar with shoes attached to the bar at specific angle
    4. Surgery and casting for several months
  3. Assessment findings: foot cannot be manipulated by passive exercises into correct position (differentiate from normal clubbing of newborn's feet)
  4. Nursing interventions
    1. Perform exercises as ordered.
    2. Provide cast care or care for child in a brace.
    3. Child who is learning to walk must be prevented from trying to stand; apply restraints if necessary.
    4. Provide diversional activities.
    5. Adapt care routines as needed for cast or brace.
    6. Assess toes to be sure cast it not too tight.
    7. Provide skin care.
    8. Provide client teaching and discharge planning concerning
      1. Application/care of immobilization device
      2. Preparation for surgery if indicated
      3. Need to monitor special shoes for continued fit throughout treatment.