Case Study: Congenital Talipes Equino Varus (clubfoot)

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Management of Clubfoot-Clinical Setting (2010-2012)

Subjective:

A 1.5-year-old male presented with a diagnosis of congenital talipes equinovarus (clubfoot), referred for physiotherapy. The child was initially uncooperative during treatment, displaying anxiety and fear in the clinical setting. His mother reported difficulty in calming him during sessions but remained actively involved and motivated throughout the process.

Objective:

• Observation: Right-sided fixed deformity with forefoot adduction, hindfoot varus, and equinus.

• Gait: Delayed gross motor milestones; the child was not independently ambulatory at the time of initial assessment.

• ROM: Limited passive and active dorsiflexion of the ankle.

• Muscle tone: Mild tightness in the triceps surae.

• Behavioral response: Crying, withdrawal from contact, refusal to engage in tasks in early sessions.

Outcome Measures:

  • Gross Motor Function Measure-88 (GMFM-88): Administered periodically to track functional mobility and gait development.
  • Foot Posture Index (FPI-6): Used to assess improvement in foot alignment.
  • Parent satisfaction survey and sessional behavior logs tracked patient cooperation and engagement over time.

Assessment:

• Congenital clubfoot with associated soft tissue contractures and delayed weight-bearing milestones.

• Behavioral challenges due to age-related separation anxiety and clinical unfamiliarity.

• Positive response to play-integrated, parent-assisted therapy.

• Gradual improvements in ankle mobility, weight-bearing tolerance, and functional activities.

Plan:

Treatment Techniques Employed:

1. Passive stretching and soft tissue mobilization targeting the Achilles tendon and tibialis posterior.

2. Weight-bearing activities such as supported standing with balance toys and stepping games.

3. Play-based functional tasks incorporating reaching, climbing, and crawling to stimulate motor planning and balance.

4. Taping and ankle-foot orthosis (AFO) used as needed to support alignment during gait training.

5. Parental involvement in home exercise routines with guided demonstrations and take-home protocols.

6. Gait training with manual facilitation, progressing to independent walking.

Frequency: 2–3 sessions per week over a 5-month period, adjusted based on progress and family availability.

Outcome:

At discharge, the child demonstrated:

• Independent walking and running without assistive devices.

• Improved ankle dorsiflexion and neutral foot alignment on standing.

• GMFM-88 score improved by >30% from baseline.

• FPI-6 indicated normalized foot posture.

• Significant increase in cooperation and engagement with therapy tasks, as reported by both therapist and parent.

The case was considered a successful conservative management of clubfoot through a combination of evidence-based physical interventions and child-centered strategies.

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