Talipes equinovarus

Apparent at birth. The child is born with clubfoot. Picked up on routine postnatal examination.

Metatarsus adductus

Common cause of intoeing in children. Only the forefoot is adducted and not the hindfoot.

Pes planus

All children are flatfooted and the arches are not fully developed until the age of ten. The parents may notice an abnormality of gait and perhaps rapid and uneven wear and tear of the shoes. Pain is rare.

Pes cavus

There is accentuation of the longitudinal arch of the foot. There may be pain and discomfort. Again, the condition may be noted by the child’s parent. There may be no specific cause. Alternatively, there may be a history of spina bifida, spina bifida occulta, poliomyelitis or rarely Friedreich’s ataxia, for which there will be a family history. Charcot–Marie–Tooth disease begins at puberty with foot drop and weakness in the legs.

Acquired talipes

There are a variety of causes of upper and lower motor neurone lesions giving rise to acquired talipes. Check for a history of spastic paresis, cerebrovascular accident, spina bifida, poliomyelitis. There may be a family history of Friedreich’s ataxia. The patient may be known to have muscular dystrophy. With Volkmann’s ischaemic contracture, there will be a history of ischaemia of the calf muscles, e.g. from supracondylar fracture of the femur with popliteal artery damage.

Trauma

There will usually be an obvious history of trauma or of burns causing contractures.

Talipes equinovarus

This will usually be apparent in the newborn. There is an equinus deformity, i.e. the hindfoot is drawn up with a tight Achilles tendon; varus deformity – the sole faces inwards; and adduction of the forefoot – the inner border of the forefoot is concave and points upwards.

Metatarsus adductus

The hindfoot is normal with a normal sized heel. The forefoot is adducted.

Pes planus

The longitudinal arch is flattened and the medial border of the foot rests on the ground.

Pes cavus

The high arch is clearly visible. The toes are clawed due to hyperextension of the MTP joints and flexion of the IP joints. The patient cannot straighten the toes. Callosities usually develop under the metatarsal heads. Check for spina bifida, spina bifida occulta (hairy patch over lumbar spine), poliomyelitis. With Charcot–Marie–Tooth disease, there will be foot drop and also atrophy of the peroneal muscles. With Friedreich’s ataxia, there will be other signs, e.g. ataxia, dysarthria and nystagmus.

Acquired talipes

Check for upper motor neurone and lower motor neurone lesions. Friedreich’s ataxia (see above). Volkmann’s ischaemic contracture will demonstrate firmness and wasting of the calf muscles together with clawing of the foot.

Trauma

The deformity will depend on the type and severity of the trauma. Scarring and contractures of burns will be obvious.

■ Foot X-rays
May help with assessment.