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HealthInfo Waitaha Canterbury

Club foot

Waewae whakaroto

A photo of a baby's legs, showing that it has clubbed feet.Club foot, also called congenital talipes equinovarus or CTEV, is a fairly common condition that affects the lower leg. "Congenital" means present at birth, "talipes" means affecting the foot and ankle and "equinovarus" means pointing downwards and inwards.

Around one or two pēpi (babies) in every 1000 are born with club foot, and half of them have both feet affected. It's more common in boys than girls.

Nobody knows what causes club foot, but it could run in the family, or it may be because your baby's muscles did not form properly in the womb.

But club foot is treatable, and your tamaiti (child) will be able to live a normal, active life after they're treated.

Treating club foot

Your baby's club foot may be noticed before they're born during a pregnancy scan. Ideally, you'll have an appointment with the Orthopaedic Outpatient Department (OOPD) before your pēpi is born so you can get the information you need and prepare for the treatment.

Your pēpi should be seen at the OOPD by the time they're two weeks old.

Worldwide, club foot is treated using the Ponseti method. This method has three stages – casting, tenotomy and boots and bar.


Clubfoot casting treatment lasts for 4 to 6 weeks and gradually changes the angle of the foot, with five different castsThis is the first stage of treatment. Ideally it should start in the first two weeks after your pēpi is born.

Plaster of Paris is used to mould your baby's foot into position and hold it in place. Soft fibreglass then goes over the top of the plaster, extending over the knee and covering the thigh to keep the cast in position. The cast is changed every week for four to six weeks. Casting doesn't hurt your pēpi.

Removing the cast

When the cast is first taken off in hospital, the nurses will show you how to do the first part of the cast removal at home before your future appointments.


This is the second stage. Once your pēpi is out of their cast, they will probably need a small operation to release the tight, short tendon at the back of their heel (the Achilles tendon). This is called a tenotomy.

Your pēpi will have the tenotomy under a general anaesthetic (they will be asleep). It's a very short procedure. Their foot will be put in another cast, which will stay on for three weeks, while the tendon grows and heals.

Boots and bars

Boots joined by a rigid bar that hold your child's feet in the right positionThis is the final stage of treatment and is very important. Once your baby's foot is in the right position and their Achilles tendon has healed, they need to be in boots and bar to hold their feet in the right position. If they do not wear the boots and bar, their muscles and ligaments will probably tighten and pull their foot back into an abnormal position.

The boots and bar your pēpi wears are made just to fit them. A nurse in the Orthopaedics Outpatients Department will show you how to put them on.

Your pēpi will need to wear the boots and bar for 23 hours a day for the first three months. After this, the time is gradually reduced until your tamaiti child is wearing the brace at night and nap time, at least until they're 2 years old, and maybe for longer. This may seem like a very long time, but most pēpi and parents adapt quickly to the brace, and it becomes part of normal life. It can help to join an online parent support group (find them through the suggested websites at the bottom of the page).

Once your pēpi is in the boots and bar, you'll have fewer follow-up appointments. If you have any concerns about your baby's feet or how the boots and bar are fitting, contact the Orthopaedics Outpatients Department. Phone 027-201-3124 between 8 am and 5 pm. Phone 021-628-224 between 5 pm and 11 pm and on weekends and public holidays.

Tips for using the boots and bar

Long term and follow-up

Almost all tamariki (children) treated early for club foot lead normal, active lives. They will continue seeing an orthopaedic surgeon until they stop growing, to make sure their foot is staying in the right position.

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Written by HealthInfo clinical advisers. Last reviewed May 2022.


Page reference: 132158

Review key: HICLF-132158