Talipes Information And Parental Support Group

INFORMATION FOR PARENTS ABOUT TALIPES (CLUB FOOT)

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TALIPES EQUINOVARUS

last updated 26 October 2006

Congential talipes equinovarus (or club foot) is a birth deformity of the foot, sometimes resulting from crowding in the uterus. In a clubfoot the bones in the front part of the foot are misaligned. There are several variations of the deformity, but in 95 percent of cases the front half of the foot turns in and down (equinovarus).

Talipes equinovarus occurs in about 1:1,000 live births.

• It is twice as common in boys as girls.
• Talipes may affect one or both feet.
• There is commonly a family incidence of talipes but the likelihood of further children in the family being affected remains small - approximately 3:100.

The important thing for parents to keep in mind is that children with club feet do exceptionally well with treatment and lead a normal life which includes, of course, sport and other physical activities.  

    TREATMENT OPTIONS

• Initially your baby can be referred to the orthopaedic outpatients at a public hospital specialising in children, where he/she will see a specialist doctor whose expertise includes talipes, or
• Your child can be referred to a private specialist doctor, and you will visit at his/her rooms.

SPECIAL PLASTER CASTING

• The most common initial treatment can start from day one onwards.
• The plaster is changed weekly initially, and then 2-weekly, gently moving the foot into the correct position.

SPLINTS

• Can be used at various times of your child's treatment, and are often used as a follow-up after serial plasters, or after plasters applied at surgery.
• Splints are either the denis browne type where the feet and lower leg are splinted, and then attached to a bar which can be adjusted gently daily, until eventually the feet are in the correct position, or
• Ankle-foot orthoses (AFO's), which are a light-weight, plastic splint held on by velcro.  These can be worn 24 hours a day, or at night only. They can be removed easily for bathing. (see photo).

SURGERY

Many children require surgery if it becomes apparent that the foot or feet are not responding to serial plasters or splinting. Surgery is usually performed when the child is about 6 months old, but different children and different doctors mean there is a range in the age of the child undergoing surgery.

Surgery means a day or two in hospital, followed by plaster casting. You will be able to stay with your baby and feed and care for him/her with the staff's guidance. If you are breastfeeding, you will be given support by the nursing staff so that you maintain your supply and be comfortable for the time that your child is fasting.

CARE OF CHILD WITH SERIAL PLASTERS

• The doctor will apply the plaster from above the knees to the base of the toes.
• You may be given a "plaster instruction" sheet which will alert you to any abnormalities. Do not hesitate to contact the doctor or hospital if you are at all concerned with the plaster.
• Your doctor or nurse will explain how to remove the plaster in the bath on the morning of your next appointment. Tip: Half a cup of vinegar in the bath water will help dissolve the plaster more quickly.
• You may wish to bring your baby's child health record to the hospital and weigh him/her on the scales provided before the plaster is reapplied.
• Although the plastering procedure will not cause your baby any pain, he/she may become upset. It appears to help if baby is fed shortly before the plaster is applied, and lots of cuddling afterwards seems to comfort.
• There are feeding and changing areas in all hospitals caring for children. Please ask staff for directions to these areas.
• It is important not to let the plaster get wet while keeping baby clean. Many parents have found advice in the Nursing Mothers Association Booklet "Plastered Kids" invaluable. While sponging carefully appears to be the safest way, there are some other suggestions, for example, a condom over a small plaster allows your baby to enjoy a normal bath.
• It is important to dry carefully around the top of the plaster, as otherwise 'plaster sores' can develop which can be troublesome.
• Some parents find cotton wool or skin cream around the skin at the top of the plaster prevents sores from developing.
• Conventional cloth nappies can be inadequate on a very small baby in protecting the plaster from soiling. There is a variety of ‘fitted’ cloth nappies with elastic legs on the market, or you may like to use disposable nappies while your child is in plaster.

Remember, if you have any questions or concerns during your child's treatment, please ask your child's doctor, who will be happy to provide answers.

Following treatment, children with talipes will go on to lead normal active lives.

• They will need to have regular assessment of their feet during childhood and adolescence until they reach maturity, as occasionally there can be a relapse of the condition.
• Although their feet will be perfectly functional, some children with one foot affected may require 2 different shoe sizes.
• Occasionally the calf muscle will be slightly smaller on the affected side.

  References

Dandy, David 1993, Essential Orthopaedics and Trauma, 2nd ed., Churchill Livingstone, U.K.

MacMahon, R.A. (ed.) 1984, An Aid to Paediatric Surgery, Churchill Livingstone, Edinborough

Nursing Mothers’ Association of Australia, Plastered Kids, NMAA, Melbourne

Williams, P.F. & Cole, W.G. (eds.) 1991, Orthopaedic Management in Childhood, 2nd ed., Chapman & Hall, London

 

About TIPS

T.I.P.S. is a support group based in Melbourne, Victoria, Australia. TIPS is run by parents whose children have, or had, Talipes. There is a bi-monthly newsletter which gives information for parents and a monthly play group meeting for parents and children on an informal basis.

TIPS members support each other through the difficult times such as initial diagnosis and surgery.

They can provide new parents with -

• Possibly a hospital visit
• Guest speakers
• Children's acitivities
• Opportunities to meet and talk with other parents of talipes children
• Reference library
• Information such as where to purchase split shoe sizes, and non slip hard wearing socks for infants and children moving around with plasters
• A bi-monthly newsletter which features a ‘story’ about one child in particular, from the parents’ point of view, describing treatments and other experiences. The newsletter also provides details of functions organised by TIPS, keeps you informed of TIPS behind-the-scenes activities, and conveys any other current information relevant to talipes.
• Advice about removing plasters
• Emotional support
• A Website with talipes information and stories from parents. It also includes Email correspondence.
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 * Please Note:  At this stage TIPS has no plans and no funds to distribute our newsletters outside Australia. The content of the  newsletters is primarily targetted at parents who do not have access to the Internet and most of the information in these newsletters appears on this website.

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