CTEV Casting and Surgical Correction
Treatment for clubfoot (CTEV) in children and adults.
Congenital Talipes Equinovarus (CTEV), commonly known as clubfoot, is a birth deformity in which one or both feet turn inward and downward. It is one of the more common congenital foot deformities, and when treatment begins early in infancy, most children go on to walk normally. Older children and adults with an untreated or relapsed clubfoot can also be treated, though the approach differs from infant care.
Types
Idiopathic Clubfoot
Clubfoot occurring on its own, without any other underlying condition - the most common form.
Syndromic Clubfoot
Clubfoot occurring alongside another underlying neuromuscular or genetic condition, often more rigid and harder to correct.
Positional Clubfoot
A foot that appears clubfooted at birth due to its position in the womb, but is flexible and typically corrects without extensive treatment.
Relapsed Clubfoot
A clubfoot that was previously treated but has partially returned, often needing repeat treatment.
Neglected Clubfoot
Clubfoot in an older child or adult that was never treated in infancy, usually more rigid and requiring more involved correction.
Common Causes
The exact cause of idiopathic clubfoot is not fully understood, though it is believed to involve a combination of genetic and environmental factors during pregnancy.
- Genetic factors - clubfoot runs in some families, and having an affected parent or sibling increases the likelihood.
- Intrauterine positioning - in some cases, the baby's position in the womb contributes to a positional variant.
- Associated syndromes - some cases of clubfoot occur alongside broader genetic or neuromuscular conditions.
- Unknown causes - in the majority of idiopathic cases, no single specific cause is identified.
- Delayed or absent treatment - in neglected clubfoot, the deformity persists and often worsens simply because it was never corrected.
Signs and Symptoms
- The foot turned inward and downward, visible at birth
- The affected foot and calf appearing smaller than the unaffected side
- Reduced flexibility when trying to move the foot into a normal position
- An abnormal walking pattern in an older child with untreated or relapsed clubfoot
- Calluses or skin changes on the outer part of the foot from abnormal weight-bearing in neglected cases
Diagnosis
Clubfoot is usually diagnosed by physical examination at birth, sometimes even detected on prenatal ultrasound. X-rays may be used in older children or adults to assess the bone alignment in more detail, particularly when planning surgical correction for a neglected or relapsed case.
Treatment Approach
The Ponseti method - gentle, weekly manipulation of the foot followed by casting - is the standard first-line treatment for infants, usually starting within the first few weeks of life. Most infants also need a minor procedure (Achilles tenotomy) partway through treatment, followed by a bracing period to prevent relapse. Older children and adults with neglected or relapsed clubfoot often need surgical correction, since the tissues are more rigid and less responsive to casting alone. Dr. K. G. Gopalakrishna assesses the child's age and the foot's rigidity before recommending the right approach.
Please note: This page is for general information only and does not replace a proper medical evaluation. Every case is different, and the underlying cause of your symptoms may not match what is described here. Please do not use this page to self-diagnose - consult Dr. K. G. Gopalakrishna or another qualified orthopaedic specialist for an accurate diagnosis specific to you.
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Last reviewed: August 2026