Talipes calcaneovalgus is a foot deformity encountered fairly frequently in neonates. Its incidence is around 4 cases per 10,000 newborns [1], but less severe cases may occur as frequently as in 5% of newborns [2]. Girls are affected more frequently than boys, and the condition can appear in one leg or both [3]. Predisposing factors are being a first-born, and breach delivery [1]. Together with irregularities in the digits, vertical talus, clubfoot, and metatarsus adductus, it represents the most prevalent foot problem apparent in the examination of the newborn.

The nomenclature of the foot deformities is somewhat ambiguous. The term clubfoot is used by some as the equivalent of talipes equinovarus (the sensu stricto clubfoot, a condition with plantar flexion and other characteristics). Others describe ”clubfoot” as a group of irregularities that include talipes calcaneovalgus (with dorsal flexion) and metatarsus adductus (with forefoot involvement only), in addition to talipes equinovarus. Congenital talipes calcaneovalgus is categorized as a positional talipes because the deformity is determined by the position of the foot pressed against the wall of the uterus.

Talipes calcaneovalgus is characterized by dorsal flexion of the foot, sometimes to an extreme degree, such that the toes touch the anterior tibia. The foot cannot be plantar-flexed beyond 90 degrees, and often is flexed to less than 90 degrees. In addition, the calcaneus is rotated externally, the feet are everted, the Achilles tendon is stretched, and the muscles of the leg are taut [4]. The ‘up and out’ appearance of talipes calcaneovalgus is the opposite of the ‘down and in’ presentation of talipes equinovarus – i.e. clubfoot in the narrow sense. Hence the name “reverse clubfoot” occasionally emerges for talipes calcaneovalgus [5]. Talipes calcaneovalgus must be differentiated from congenital vertical talus [6].

• Collapse

  As a form of flatfoot, it has the distinct characteristic of the condition: a partial or total collapse of the foot arch. [kimfoottwo.junglecoders.com]

  […] since, with the common ("classic") type of clubfoot (talipes equinovarus), the foot is turned in sharply and the person seems to be walking on their ankle.As a form of flatfoot, it has the distinct characteristic of the condition: a partial or total collapse [frenilal.ru]

• Strabismus

  Strabismus, nystagmus, and optic atrophy are common. Neuropsychiatric disturbances including impulsivity, poor attention span, hyperactivity, and emotional lability are also common. [ncbi.nlm.nih.gov]

• Visual Impairment

  Disease progression is rapid, resulting in severe spasticity, progressive cognitive decline, and visual impairment. Many affected children do not survive beyond their first decade. Atypical NAD shows more phenotypic variability than INAD. [ncbi.nlm.nih.gov]

• Foot Deformity

  Talipes calcaneovalgus is a foot deformity that is relatively commonly observed in newborns. It is characterized by dorsiflexion and a valgus position of the foot. [symptoma.com]

  […] a positional or structural foot deformity depending on severity and/or causality. [amp.pharm.mssm.edu]

  Yes 1 Exempt from POA reporting No The ICD code Q66 is used to code Foot deformity A foot deformity is a disorder of the foot that can be congenital or acquired. [icd.codes]

  3 Treatment of foot deformities? Need foot specialist: In general, treatment is either via splinting/ bracing, or surgical correction & repair. [healthtap.com]

• Coxa Vara

  vara Q65.89 Other specified congenital deformities of hip Q65.9 Congenital deformity of hip, unspecified Q66 Congenital deformities of feet Q66.0 Congenital talipes equinovarus Q66.1 Congenital talipes calcaneovarus Q66.2 Congenital metatarsus (primus [icd10data.com]

• Brachydactyly

  MedGen UID: 354669 • Concept ID: C1862139 • Congenital Abnormality A type of brachydactyly characterized by brachymesophalangy affecting mainly the 2nd and 5th digits. [ncbi.nlm.nih.gov]

• Agitation

  […] can be useful Avoid tight baby gro's or leggings so that there is plenty of room for your baby to stretch their legs and feet Avoid wearing baby shoes and tight socks Stretches To be performed at every nappy change/ feed Do not stretch if your baby is agitated [gpnotebook.co.uk]

• Tremor

  The most common features of parkinsonism in these individuals are bradykinesia, resting tremor, rigidity, and postural instability. [ncbi.nlm.nih.gov]

• Nystagmus

  Strabismus, nystagmus, and optic atrophy are common. Neuropsychiatric disturbances including impulsivity, poor attention span, hyperactivity, and emotional lability are also common. [ncbi.nlm.nih.gov]

• Resting Tremor

  The most common features of parkinsonism in these individuals are bradykinesia, resting tremor, rigidity, and postural instability. [ncbi.nlm.nih.gov]

Foot deformities are discovered in the newborn by careful examination of both feet. Even the skin can reveal unusual tightness in cases of abnormality, but an important part of the examination is testing for the movements of the joints. In talipes calcaneovalgus, the plantarflexion is markedly limited; however, the dorsiflexion can, to some extent, be rectified by gently stretching the foot. In contrast, congenital vertical talus, which can be misdiagnosed for talipes calcaneovalgus, and which is characterized by a rigid bone dislocation, is not correctable.

Radiographs are used to verify the diagnosis and for differentiating talipes calcaneovalgus from congenital vertical talus. On lateral radiographs, the first metatarsal aligns with the talus bone in case of a talipes calcaneovalgus foot, whereas the axis of the talus is plantar to that of the first metatarsal in the congenital vertical talus condition.

1. Nunes D, Dutra MG. Epidemiological study of congenital talipes calcaneovalgus. Braz J Med Biol Res. 1986;19(1):59-62.
2. Gore AI, Spencer JP. The Newborn Foot. Am Fam Physician. 2004;15;69(4):865-887.
3. Connors JF, Wernick E, Lowy LJ, Falcone J, Volpe RG. Guidelines for evaluation and management of five common podopediatric conditions. J Am Podiatr Med Assoc. 1998;88:206–222.
4. Trott AW. Children's foot problems. Orthop Clin North Am. 1982;13:641–654.
5. Edwards ER, Menelaus MB. Reverse club foot. Rigid and recalcitrant talipes calcaneovalgus. J Bone Joint Surg Br. 1987;69(2):330-334.
6. Harris EJ, Vanore JV, Thomas JL, et al. Clinical Practice Guideline Pediatric Flatfoot Panel. Diagnosis and Treatment of Pediatric Flatfoot. The Journal of foot and ankle surgery. 2004;43(6):341-370.