What is talipes?

Talipes is a general term used to describe an unusual position of the foot or ankle. It does not necessarily mean that a baby has a structural problem with their feet.

There are several different types of talipes, but one of the most important distinctions in newborn babies is between positional talipes and structural talipes, or congenital clubfoot.

The good news is that these can usually be distinguished by looking at how the foot moves and how easily it can be brought towards a more neutral position.

Positional talipes

Positional talipes occurs when a baby's foot has been held in an unusual position during pregnancy.

The foot itself is structurally normal, but it may look turned inwards or downwards after birth.

The important feature is that it is flexible.

When gently moved, the foot can usually be brought towards a normal position. As the baby grows and has more opportunity to move and kick, the position commonly improves naturally.

Some babies may benefit from simple stretches or movement exercises, usually demonstrated by a healthcare professional for parents to continue at home.

What might positional talipes look like?

You may notice that your baby's:

• foot turns inwards
• toes point slightly towards the other foot
• foot appears turned downwards
• feet look different from one another
• foot position changes when your baby kicks or moves

A particularly reassuring feature is that the foot is easy to move and can be gently brought towards a more neutral position.

What is clubfoot?

Clubfoot, also called congenital talipes equinovarus (CTEV), is different from positional talipes.

In clubfoot, the foot has a structural difference and is typically more rigid. It may point downwards and inwards and can be difficult to move into a normal position.

The foot may also have a more pronounced arch, the heel may turn inwards, and the calf on the affected side can be smaller.

Clubfoot can affect one or both feet and may sometimes be identified during the pregnancy ultrasound scan. It can also be recognised after birth.

Importantly, clubfoot is treatable, and early specialist treatment generally produces very good functional outcomes.

How can you tell the difference?

The flexibility of the foot is one of the most useful things healthcare professionals consider.

Positional talipes vs structural clubfoot

Positional talipes is usually a flexible condition, meaning that the baby’s foot can generally be gently moved towards a more neutral position. The foot itself is structurally normal and, in many cases, the position improves naturally as the baby grows and moves. Some babies may simply need monitoring and gentle exercises. Structural clubfoot, on the other hand, is typically stiffer and more restricted, and the foot can be difficult to move manually towards neutral. This is associated with structural differences in the foot and usually requires assessment and specialist treatment.

There can sometimes be uncertainty, particularly when a baby is very young. If there is any doubt about whether a foot is positional or structural, further assessment is appropriate.

Who diagnoses talipes?

A baby's foot position may first be noticed by a parent, midwife, health visitor, GP, paediatrician or another healthcare professional.

If there is concern that a baby may have structural clubfoot, they will usually be referred for assessment by a specialist paediatric orthopaedic service or an appropriate paediatric physiotherapy/orthopaedic team.

The assessment will look at the feet themselves as well as the wider lower limbs. The healthcare professional may examine the baby's legs, hips and other areas to make sure there are no associated concerns.

What happens if my baby has clubfoot?

If a baby is diagnosed with structural clubfoot, treatment is usually started within the first few weeks of life.

The most commonly used treatment is the Ponseti method. This involves a series of gentle manipulations and plaster casts, with the position of the foot gradually corrected over several weeks.

Most babies also require a small procedure called an Achilles tendon tenotomy to complete the correction. Once the foot has been corrected, the baby wears special boots attached to a bar to help maintain the position and reduce the risk of the foot returning to its original position.

This treatment is carried out by a specialist team, which may include paediatric orthopaedic surgeons, specialist paediatric physiotherapists and trained Ponseti practitioners.

What can parents do at home?

If your baby has been assessed as having positional talipes, you may be given some simple exercises or stretches to do at home.

In general, giving babies plenty of opportunities to move their legs and feet freely is helpful. During awake and supervised tummy time and floor play, babies naturally kick, stretch and move their feet in different directions.

If exercises have been recommended for your baby, your healthcare professional should show you how to perform them gently.

You should never force a baby's foot into a position or attempt to correct a stiff or resistant foot yourself.

Can an osteopath help with talipes?

This is an important question, particularly because parents may be looking for help when they notice that their baby's foot is turned in.

As paediatric osteopaths, we can assess the baby's overall musculoskeletal movement rather than looking at the foot in isolation.

During an assessment, we may look at:

• the position and movement of the feet and ankles
• how easily the foot moves towards a neutral position
• the knees and hips
• the movement of both sides of the body
• the baby's spontaneous kicking and leg movements
• areas of muscular or soft-tissue restriction
• overall symmetry and movement.

For a flexible positional foot posture, gentle osteopathic treatment may be appropriate where there are associated areas of restriction. Treatment is focused on supporting comfortable movement rather than forcibly correcting the foot.

We can also help parents understand what they are seeing and, where appropriate, demonstrate simple movement or stretching techniques.

However, osteopathy should not replace specialist treatment for structural clubfoot.

If a baby's foot is stiff, fixed, significantly asymmetrical or does not appear to be improving, referral for specialist assessment is important.

When should I ask for further assessment?

Speak to your GP, health visitor, paediatric physiotherapist or another appropriate healthcare professional if:

• your baby's foot feels stiff or difficult to move
• you cannot gently bring the foot towards a more neutral position
• one foot looks significantly different from the other
• the foot remains noticeably turned inwards or downwards
• you are not seeing any improvement over time
• you have been told your baby has talipes but are unsure what type it is
• you are simply worried about your baby's foot position.

You do not need to wait until your baby is walking before asking for advice. If there is concern about a structural foot deformity, early assessment is important.

The reassuring part

Seeing your newborn baby's foot turned inwards can understandably be worrying, particularly when you first hear the word "talipes".

But not every turned-in foot is clubfoot.

Positional talipes is common, usually flexible and often improves naturally as your baby grows and moves. Structural clubfoot is different, but it is a well-recognised and treatable condition, and specialist treatment is highly effective for most babies.

The most important thing is to understand whether the foot is flexible or fixed and to make sure that babies who need specialist treatment are referred appropriately.

How we can help at Osteopathy West London

At Osteopathy West London, our paediatric osteopathic assessments look at your baby as a whole, including their feet, ankles, legs, hips and general movement.

If your baby's foot appears to be in an unusual position, we can assess its movement and flexibility, explain what we are seeing and advise you on whether monitoring, gentle exercises or further assessment would be appropriate.

Where we identify a foot position that may require specialist assessment, we will recommend referral to the appropriate healthcare professional.

If you are concerned about your baby's foot position, you don't have to work out what it is yourself. An assessment can help you understand what you are seeing and what, if anything, needs to happen next.