TALIPES EQUINOVARUS

 Talipes comes from a Latin word means talus and equino indicate alleviate heel like horse while the word varus indicates inward.the general and common name for talipes equinovarus is club foot. Most people use this common term in general practice for the convenience of patients and easy terminology.
Club foot disease can effect both foot too and it will be called as bilateral while more chances are of unilateral disease. Sometimes parents who are already having clubfoot  have seen to have a greater risk of clubfoot disease among their children.
One can easily judge a person of having talipes equinovarus by seeing the deformities and the clinical appear.
New born children go through rehabilitation process or proper treatment either conservative or non conservative management depend upon the condition. Treatment process starts from the first week after birth. Physiotherapy plays a main role in treatment of children with club foot or talipes equinovarus.
DEFORMITIES:
Deformities include increased medial arch “cavus” (mid foot).
Adduction of forefoot
Varus in the hind foot
Equinous of the ankle joint
CLINICAL APPEARANCE:
equinous at ankle joint  
Forefoot adducted and inverted
Concave medial border
Deep crease on midfoot
Convex lateral border
Apparent shortening of hallux (big toe)
Prominent body of talus
Tight tendinoachillus
DIAGNOSIS:
Diagnosis can be made by clinical appearance and the presence of upper mentioned factors in patient.
TREATMENT:
There are various treatment options . the decision of choosing treatment option should be taken by the healthcare provider that shows the best benefit for patient according to condition and level.
Treatment option majorly includes
Proper positioning
Stretching
Casting
Mobilization  
Taping the foot to maintain or improve ROM.
In severe cases surgery is considered . to ease and relax the foot then tendon is lengthened. Lengthening of achilis tendon relax the foot and reduces the spasticity thus ultimately ROM is enhanced.
In case of surgery the next option considered is :
Casting
Bracing
Almost 2 months require for bracing and casting.
Now we are about to discuss the details of all these treatment protocols one by one but one thing to keep remember is that the number of management protocols are there associated with clubfoot disease and to discuss all is not possible so the major and most important treatments are discussed below one by one.
PROPER POSITIONING
Proper positioning is the key element of every treatment that include physiotherapy or any other way of management because positioning effect the weight bearing , the pattern that is already developed in patient and the correct sequence or pattern that we want in our patient. Proper balance on foot or its appearance and positioning is highly linked with the pattern in which limb or foot is placed .   
And the most important patients ease and comfort first with the proper positioning specially among the patient who have reduced mobility and cant propel themselves properly.
For the purpose of patients comfort health care provider can use foam roller, pillows , supportive devices and blankets. Safety is also associated with correct placement or proper positioning.
Next important treatment protocol is physiotherapy management that includes
STRETCHING:
If one can give some pleasing alternate name to stretching ,it must be relaxing technique.
Not specifically for clubfoot but for each condition that is making you tired or causing you pain in legs or ankle , the main and most relaxing method to get relief is obviously stretching.
Stretching helps in getting comfort and to get rid of pain. Now if we talk about clubfoot then ankle stretching is very important.
Ankle stretch and release in clubfoot patient is passively done by the therapist in children . achilis tendon stretching and calf stretching plays a main role in increasing
ROM and relaxation of tendon. It helps in reduction of spasticity and tightness in tendon or ankle joint.
Calf stretches can also help in getting relief from pain and enhancement of range of movement.
Our next treatment protocol is:
MOBILIZATION:
Mobilization is considered one of the best treatment in the field of physiotherapy.
Basically you need to understand what mobilization actually is. Mobilization in easy words is a technique in which force is applied at the articulation of bones that ultimately makes joint. Mobilization is given to joints so there can be made enhancement in range of movement and the ability of movement is increased upto a greater level.
The sequence and correct pattern can be achieved as well with mobilization.
Some people also believe in taping of the foot to achieve their goals in clubfoot patient.
In above mentioned paragraphs we discussed the conservative treatments protocols and management .now we are going to discuss non conservative management that includes surgery.  
Surgery is considered last option when no other protocol is considered worth applying.
SURGERY:
Tendon transfer surgery:
Tendon lengthen surgery:
TENDON LENGTHENING SURGERY:
The tendon involves in this is achillis tendon. Achillis tendon surgery is performed in children to relax the foot. Basically tendon lengthening is performed. This procedure of achillis tendon lengthening helps in ease of the foot , to lower the spasticity at ankle joint and the foot can be stretched and able to move in a right direction or correct patter. The child is able to get passive movement by health care provider or therapist in a good correct pattern or position after undergone through a orthopedic surgery of tendon lengthening. After surgery if the child is feeling discomfort or going through pain then some pain killers can be administered by orthopedic surgeon to help in getting relief.
Child after surgery is gone through casting for proper healing.
CASTING:
After achillis tendon surgery a child is immediately given casting to heal properly. Almost 4 weeks casting is considered good for proper healing after surgery.
BRACING:
After casting for proper time the next step is that child have to wear brace for several weeks.
After all these steps of surgery some recovery exercises is performed by the therapist to have proper pattern of ankle joint and foot ,stretching and mobilization is also performed.
In short proper treatment protocols and healthcare can save a child from clubfoot. Parents attention in the start can save their child from an abnormal pattern of walk. Awareness regarding physiotherapy and rehabilitation should be spread.
This was a brief overview and basic knowledge about clubfoot or talipes equinovarus disease and its management.