Talipes refers to an abnormal ankle and foot position that is present at birth. It may be idiopathic in an otherwise healthy baby, or be associated with other conditions, such as spina bifida.
Talipes can be either:
- Structural (underlying changes to the soft tissues and joints result in a fixed abnormal position)
- Positional (the foot can be passively moved into a normal position)
Congenital talipes equinovarus is typically structural and is commonly known as clubfoot. It describes an abnormal position with:
- Ankle plantarflexion (foot pointing down)
- Hindfoot varus (inversion of the ankle with the calcaneus tilting inwards)
- Forefoot adduction (the forefoot turns inwards towards the midline)
- Cavus (high foot arch)
Congenital talipes calcaneovalgus tends to be positional (rather than structural), and involves:
- Ankle dorsiflexion (foot pointing up)
- Hindfoot valgus (eversion of the ankle with the calcaneus tilting outwards)
Ponseti Method
The Ponseti method is a way of treating congenital talipes equinovarus. It is usually very successful. Treatment is started almost immediately after birth.
The foot is manipulated into a position that is closer to normal, and a cast is applied to hold it there. This is repeated until the foot remains in the correct position. An Achilles tenotomy is often performed near the end of casting to release tension in the Achilles tendon.
After casting is complete, a foot abduction brace is used to maintain the correct foot and ankle position and prevent relapse. This is used for a set number of hours each day, according to the local protocol, until the child is around 5 years old. This brace is sometimes referred to as “boots and bars”, and looks a bit like a snowboard.
Surgery may be required if the Ponseti method fails or cannot be used.
Positional Talipes
Positional talipes is a common condition in which the ankle is in an abnormal resting position, either equinovarus or calcaneovalgus. However, the ankle is not fixed in this position, and there are no fixed structural abnormalities of the bones or joints. The foot can still be passively moved into the normal position.
The mild tightness of the soft tissues and muscles around the ankle may result from positioning in the uterus during pregnancy. After birth, the soft tissues and muscles can stretch and move, and the condition resolves with time.
Positional talipes may benefit from referral to a physiotherapist for simple exercises to help the foot return to a normal position. Positional talipes will resolve in most cases within 6-8 weeks.
Last updated July 2026
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