Definition
A congenital foot deformity in which the foot is turned inward and downward. It is present at birth and is one of the most common pediatric orthopedic conditions.
Components of Deformity (CAVE)
Remember CAVE:
C – Cavus (high medial arch)
A – Adduction (forefoot turned inward)
V – Varus (heel turned inward)
E – Equinus (ankle plantarflexed)
Causes
Idiopathic (most common)
Associated with:
Spina Bifida
Cerebral Palsy
Syndromic conditions
Intrauterine positioning (less common cause)
Clinical Features
Small, inward-turned foot
Tight Achilles tendon
Deep medial crease
Calf muscle wasting (on affected side)
Usually painless in infants
Diagnosis
Clinical examination at birth
Severity grading: Pirani Score
Management
Gold Standard Treatment
Ponseti Method
Steps:
Weekly gentle manipulation
Serial casting (5–8 casts usually)
Percutaneous Achilles tenotomy (if needed)
Foot abduction brace (Denis Browne splint)
Brace protocol:
23 hours/day for 3 months
Night-time wear until 4–5 years of age
Physiotherapy Role
Educate parents on brace compliance
Monitor skin condition
Stretching (if mild/flexible)
Strengthening when child starts walking
Gait training
If Untreated
Abnormal gait
Painful callosities
Functional disability
