الفهرس 
ANATOMY 0 F TI-lE FOOTOnly 14 pages are availabe for public view
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Abstract
Congenital talipes equmovarus JS the commonest congenital abnormality of the foot. In our series,
it is 2.2 as common in boys as in girls and bilateral in 38.9% of cases.
Although, the very mild corrected so called postural clubfoot is still considered to be related to
the position of the foot in utero, the true etiology of the severe clubfoot is still unknown.
Hence the use of term idiopathic .
The basic anatomic derangement m clubfoot is a congenital subluxation of the talocalcaneonavicular
joint in which the navicular and the calcaneus are displaced medially in relation to the talus.
History is a light guide to predict is it idiopathic clubfoot or . associated with
other anomalies. Careful general examination of the infant and local examination of the
deformity are essential to diagnose a case of idiopathic clubfoot.
The clinical picture of talipes equinovarus is characteristic. The affected foot and leg have a
club like appearance. The deformity has four components, equinus, varus, adduction and may be
cavus. Idiopathic clubfoot should be differentiated from postural clubfoot.
Some authors advocate x-ray for assessment of the clubfoot while
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many paid less attention to the value of x-ray in assessing the clubfoot.
Radiologic e: 2mination is important to exclude other associated
anomalies during assessment of a case of idiopathic clubfoot. X-ray helps in assessment of the
deformity but has no role in drawing the plane of treatment. All feet corrected clinically are
corrected when assessed radiologically, and all feet uncorrected clinically also are not
satisfactory when assessed radiologically.
In talipes equmovarus a universally accept d method of classification of the severity of the
deformity (to help to detect the proper treatment or to prognosticate the outcome ) is lacking and
no standardized method of evaluating the results of the treatment has been developed yet.
Conservative treatment must be started as soon as possible immediately after birth. Early gentle
stretching manipulation, then adhesive strapping and then manipulation and serial application
of casts is the optimum sequence of a successful conservative treatment program.
The optimum age for surgical intervention is the age of six month, even in cases which are known
to be uncorrectable conservatively at an earlier age.
Posterior release is recommended to fully correct the residual equinus deformity while lengthening
of tendo Achilles was found intraoperatively not sufficient alone to fully correct the equinus
deformity.
Complete subtalar release of Carroll is recommmended to fully reduce the talocalcaneonavicular
joints. This technique for complete subtalar release provides good exposure with less wound
complications
For easy proper and
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compreh( nsive
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assessment of results of
treatment of an idiopathic clubfoot, the foot is considered ·having satisfactory results if it has
normal shape (no residual deformity and plantigrade) and normal function (no pain with activity
and no tenderness) and also be radiologically is normal. Absence of any of the previous crieteria
is denoting that the results are not satisfactory and the foot is not fully corrected .