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Figure 5.49. Bilateral clubfoot (talipes equinovarus). Talipes equinovarus causes the foot to be sharply plantar flexed and inverted so that the sole is toward the median plane. Note the "tip toe" position with the soles of the feet nearly facing each other. The calcaneus is in varus position and some degree of metatarsus adductus is almost always present. The skin and subcutaneous tissue over the lateral part of the joint may be thin and dorsi-flexion is minimal or absent.

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Figure 5.50. Bilateral clubfoot. The occurrence of club feet has been considered to be the result of a congenital malformation or a postural deformity. If the legs and feet are subjected to mechanical stress during the last weeks in utero, especially if the fetus is in the breech position, a clubfoot may develop. If the constraint has been relatively mild or brief, the deformity is usually flexible in that the foot can be manipulated into normal position. A fixed deformity implies either severe, prolonged immobilization with contractures of the ligaments and capsules of the joints or an intrinsic skeletal anomaly. This type is resistant to conservative treatment, and casting or surgery is the treatment of choice.

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