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    Skeletal     dysplasia
    Polydactyly and     syndactyly


Introduction Antenatal Postnatal West Midlands Data



Talipes ("talus" = anklebone) describes a positional abnormality of the foot, commonly called "club foot". In the majority of cases the foot is normally formed, with an abnormal relationship between the position of foot and the lower limb. Fifty percent of talipes cases are bilateral (affecting both feet). Talipes is more frequent anomaly in males.

The most common defect (95% of cases) is for the foot to be turned inwards with the soles of the feet facing each other and is called equinovarus ("equinus" = plantar flexed, "varus" = inversion of the heel, hind-foot and forefoot). Shortened tendons on the inside of the leg along with abnormally shaped bones restricts movement outwards, causing the foot to turn inwards. A tightened Achilles tendon causes the foot to point downward. Calcaneovalgus ("calcanes" = heel bone, "valgus" = pointing out) is an anomaly where the foot is turned outwards, everted) with the ankle angled in towards the other foot.

Talipes can occur as an isolated anomaly, as part of a syndrome, as a result of intrauterine pressure or position (e.g. oligohydramnios, intrauterine tumours), or as a consequence of neurological damage (as a result of muscle imbalance in spinal neural tube defects or cerebral palsy).

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Talipes is identified in approximately 30% of cases on routine ultrasound scanning. There is an association between bilateral talipes and lethal chromosome anomalies, such as trisomy 18, 15, and 13. The vast majority of these cases will also have other structural anomalies, early growth restriction, or advanced maternal age as risk factors that will guide advice regarding the necessity for invasive testing following diagnosis. Talipes can be caused by absent fetal movements, or a lack of liquor, and these elements should be actively sought during ultrasound assessment. Early amniocentesis (before 14 weeks gestation) has been associated with talipes in 1 - 2% of cases. In cases of isolated talipes with no other risk factors the risk of this being the only feature of a syndromic diagnosis is small, and probably does not justify invasive testing.

The finding of isolated talipes does not alter antenatal care significantly, and although some would recommend counselling by paediatric specialists during the pregnancy the degree of abnormality can be difficult to predict, making discussion of possible treatments vague and non-specific. The cases that are identified prenatally are likely to be the more severe cases, and the majority will ultimately require surgery.

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The priorities for the neonate are to establish normal respiration, ensure normal swallowing and feeding and to exclude features of syndromes that might be linked with talipes. Once the baby is seen to be thriving, there is no reason for protracted hospital stay. The baby will need to be assessed by an experienced physiotherapist, and a regime of massage and strapping are usually used to produce as much mobility as possible in the ankle joint. Surgical correction of talipes is usually considered between three and 9 months of age. Any surgical correction should ideally be completed before 12 months of age so that the infant can start to walk with the feet in a position where the sole can be put flat to the floor. Many cases will require long term follow-up and further surgery may be required as the child grows.

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To be added

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© Perinatal Institute 2011