👣 Section 715.3 · Talipes Equinovarus (Clubfoot)

Nelson Textbook of Pediatrics 22nd Edition | Congenital clubfoot: CAVE deformity (Cavus, Adductus, Varus, Equinus). Ponseti method is gold standard: serial manipulation/casting → percutaneous Achilles tenotomy (90%) → abduction bracing until age 3-5 years. Associated with DDH, arthrogryposis, myelodysplasia, chromosomal syndromes.

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📋 30 Clinical Scenarios — Clubfoot (Talipes Equinovarus)

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🩺 Clinical Recognition: Clubfoot

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📋 Ponseti Method: Stepwise Management of Clubfoot

🔑 Key Principles — Nelson Section 715.3 (Ponseti Method)
• CAVE mnemonic: Correction order: Cavus → Adductus → Varus → Equinus.
• Serial casting: Weekly cast changes, 5-10 casts typically required. Long-leg casts with knee flexed 90°.
• Percutaneous tenotomy: Required in ~90% of patients for equinus correction. Performed under local anesthesia as outpatient.
• Final cast: Long-leg cast with foot in maximal abduction (up to 70°) and 0-10° dorsiflexion for 3-4 weeks.
• Abduction bracing: Shoes on bar. Wear 22 hours/day for 3 months, then nighttime until age 3-5 years. Compliance is essential.
• Recurrence: Tibialis anterior tendon transfer to lateral cuneiform for dynamic supination deformity (up to 20%).
• Surgery: Reserved for nonoperative failures, neuromuscular, or syndromic clubfeet.

    ⚡ Reflex Prompts — Clinical Decisions in Clubfoot

    📖 Summary: Talipes Equinovarus (Clubfoot) — Nelson 715.3