Clubfoot (CTEV)

Congenital talipes equinovarus (CTEV), commonly known as clubfoot, is a foot deformity present at birth in which the foot is turned inward and downward. It occurs in approximately 1-2 per 1,000 live births and can affect one or both feet. The management of CTEV depends critically on whether it is structural or postural - and this distinction determines the role of physiotherapy in your child’s care.

Structural vs postural CTEV: why the distinction matters

Structural (true) CTEV involves rigid deformity of the bones, joints, and soft tissues of the foot and cannot be passively corrected to a neutral position. It is managed primarily with the Ponseti method - a serial casting technique performed by an orthopaedic surgeon or specialist, beginning in the first weeks of life. Physiotherapy is an adjunct to the Ponseti pathway, not a replacement for it.

Postural CTEV is a flexible deformity in which the foot can be passively corrected to a normal position. It is caused by intrauterine positioning and is not a true structural problem. Postural CTEV responds directly and quickly to physiotherapy exercises and parent-guided home exercise, without requiring casting.

If your baby has been diagnosed with CTEV, the treating team will have assessed which type it is. If you are unsure, our physiotherapist will clarify this at assessment and refer to orthopaedics if a structural deformity requires the Ponseti pathway first.

What role does physiotherapy play in structural CTEV?

For structural CTEV managed with the Ponseti method, physiotherapy typically becomes relevant at several stages:

• During the bracing phase: after casting is complete, children wear a foot abduction brace (FAB), also known as boots and bar. Physiotherapy supports compliance, skin monitoring, and parent education on brace management
• Post-casting maintenance: exercise programmes to maintain the correction achieved through casting
• Gross motor development: some children with CTEV have associated delays in standing and walking, particularly if treatment began late or if the foot required surgical intervention. Physiotherapy supports developmental progression
• After tenotomy or surgical correction: post-operative physiotherapy supports recovery of range of motion, strength, and normal gait

What does a session at Goji involve?

Our physiotherapist will begin with a thorough history: the diagnosis, what treatment your child has had to date, their current developmental stage, and what concerns you as a parent. The physical assessment includes:

• Foot assessment: passive range of motion in all directions, rigidity vs flexibility, any residual deformity
• Gait and weight-bearing (in ambulant children): how the foot functions during walking, noting any compensatory patterns
• Developmental screen: gross motor milestone attainment relevant to your child’s age

Treatment for postural CTEV is primarily parent-led: our physiotherapist will teach you the stretching technique in detail and provide a home programme, with regular review sessions to monitor progress. For children in the Ponseti pathway or post-surgical, the programme is coordinated with the orthopaedic team’s plan.

What if my child is already walking but the foot still turns in?

Intoeing (where one or both feet point inward during walking) in toddlers is very common and frequently resolves spontaneously without treatment, particularly when caused by rotation of the thigh bone or leg bone rather than foot deformity. CTEV-related intoeing in an ambulant child warrants assessment to distinguish residual deformity from normal developmental variation. Our physiotherapist will advise on whether ongoing physiotherapy, orthopaedic review, or watchful waiting is appropriate.

Frequently asked questions

My baby was diagnosed with CTEV at birth. When should we start physio?

As soon as your orthopaedic or paediatric team has made the structural vs postural distinction. For postural CTEV, physiotherapy can begin in the first few weeks of life. For structural CTEV being managed with Ponseti casting, your orthopaedic team leads initially; contact Goji to discuss timing for physiotherapy support within that pathway.

How many sessions will my baby need?

For postural CTEV, most babies respond significantly within 3-5 sessions, provided the home programme is followed consistently. Structural CTEV within the Ponseti pathway is longer-term; the bracing phase alone can last 2-4 years, and physiotherapy involvement is periodic rather than intensive throughout that period.

Can CTEV be treated without surgery?

The Ponseti method achieves correction without surgery in the majority of structural CTEV cases (approximately 90% in optimal conditions). The Achilles tendon may require a minor percutaneous tenotomy (a small procedure, usually under local anaesthesia in infants). Major open surgery is reserved for cases that do not respond to casting, relapse significantly, or are not identified early.

My child had Ponseti casting and is now in a brace. Why are they still having difficulty walking?

Brace wear - particularly the foot abduction orthosis - may affect how children learn to stand and walk. Some developmental delay in walking milestones is common during the bracing phase. Physiotherapy can support motor development, encourage appropriate movement patterns, and advise on what activities are safe and beneficial during brace wear.

Is the outcome different for one foot vs two feet?

Bilateral CTEV (both feet affected) is common and does not necessarily mean a worse outcome. The Ponseti method is equally applicable. The practical challenge is brace compliance and the impact on mobility during the bracing phase, which physiotherapy support can help to navigate.

My child is 4 years old and was never treated for their clubfoot. What can be done?

Late-presenting or untreated CTEV in older children requires orthopaedic assessment first, as surgical correction may be indicated. Physiotherapy plays a post-operative role in this case. Please contact your paediatrician or GP for a referral to a paediatric orthopaedic surgeon; Goji can then support the rehabilitation component.