equinovarus

Equinovarus, commonly referred to in the context of clubfoot, is a complex foot deformity in which the hindfoot is in varus and equinus, and the forefoot is adducted and often cavus. In this pattern the foot points downward and turns inward, with a rigid alignment that can affect function and appearance.

Etiology and classification vary. Equinovarus can be idiopathic and present congenitally, or it may occur secondary to neuromuscular conditions such as cerebral palsy or spinal abnormalities, or as part of a broader syndrome. Contributing factors may be genetic and multifactorial. The deformity is typically present at birth or develops in early infancy, and relapse can occur after treatment.

Clinical features are usually evident on examination and radiographs. The foot shows plantarflexion of the ankle (equinus), inward turning of the heel (varus), inward deviation of the forefoot, and often a cavus contour of the midfoot. The deformity is frequently rigid and may limit ankle dorsiflexion. Imaging with X-rays can reveal hindfoot varus and altered talocalcaneal relationships, aiding assessment and planning.

Diagnosis relies on clinical assessment, with imaging used to document alignment and to guide treatment, particularly in older children or complex cases. Management aims to achieve a functional, plantigrade foot and to minimize relapse.

Treatment is most effective when started early. The Ponseti method—serial manipulations and casting, often followed by a percutaneous Achilles tenotomy to correct equinus—is the standard nonoperative approach for many idiopathic cases. Long-term bracing is typically required to prevent relapse. Surgical options, such as soft-tissue releases or osteotomies, are reserved for resistant or neuromuscular cases and may be needed to improve function or alignment. Prognosis improves with early, consistent treatment and adherence to bracing, though neuromuscular etiologies may have a more guarded outcome.