Synopsis
Distinguish rigid congenital talipes equinovarus from positional foot posture and deliver the Ponseti correction and prolonged bracing sequence that prevents avoidable relapse.
- True clubfoot combines cavus, forefoot adduction, hindfoot varus and ankle equinus and is rigid compared with positional talipes.
- First-line assessment is clinical at birth, including foot flexibility, perfusion, movement, hips, spine and features of arthrogryposis or neurological disease.
- First-line treatment is the Ponseti method begun early: gentle weekly manipulation followed by toe-to-groin casts in a precise correction sequence.
Key red flags
A stiff small foot with deep medial or posterior creases and fixed cavus, adduction, hindfoot varus and equinus is true clubfoot rather than packaging.
Investigation priorities
Confirm CAVE deformity, flexibility and idiopathic versus syndromic features and establish a severity baseline.
Management branches
A newborn foot has fixed cavus, adduction, varus and equinus.
- Examine flexibility, skin, perfusion, movement, hips, spine and other contractures and document a severity score.
- Differentiate positional talipes and vertical talus and refer true clubfoot directly to a trained Ponseti service.
Key medicines
Local anaesthetic for Achilles tenotomyUse the specialist infant protocol with weight-appropriate local anaesthetic concentration and maximum dose, documenting total milligrams and adding oral or general anaesthesia only according to age and service practice.
Paracetamol after casting or tenotomyPrescribe the current BNFC age- and weight-based dose with exact milligrams, formulation volume, interval and maximum for the infant.