Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Congenital talipes equinovarus (CTEV) — clubfoot — is one of the most common congenital musculoskeletal deformities, affecting approximately 1 in 1,000 live births. The Ponseti method of serial casting has transformed pediatric clubfoot management, achieving correction in over 95% of idiopathic cases with minimal surgery when initiated in the newborn period. However, a significant number of adults present for podiatric evaluation with residual or relapsed clubfoot deformity — either because of inadequate initial treatment, non-compliance with maintenance bracing, teratologic clubfoot (associated with neuromuscular conditions requiring different treatment algorithms), or relapse during adolescence.

Residual and Relapsed Clubfoot Deformity in Adults

The adult with treated but relapsed clubfoot typically presents with a rigid equinovarus deformity, with the hindfoot in varus, the forefoot in adduction and supination, and the ankle in equinus. The deformity is accompanied by muscle imbalance — the anterior and posterior tibial muscles are typically overactive relative to the peroneals — and often by significant calf muscle atrophy and reduced leg length on the affected side from the childhood deformity. Bony changes that develop over years of abnormal loading include talar flattening, calcaneal deformity, and midfoot arthrosis.

Functional Consequences

Adults with significant residual clubfoot deformity walk with a characteristic high-steppage gait, weight-bearing on the lateral and dorsal foot rather than the plantar surface. This produces severe callus formation over the lateral border and dorsolateral midfoot, pressure ulceration in neuropathic patients, and progressive osteoarthritis of the subtalar, midtarsal, and ankle joints. Pain from midfoot and hindfoot arthritis, recurring lateral border ulceration, and difficulty with footwear fitting are the most common complaints driving adult presentation.

Management Options

Mild residual deformity may be accommodated with custom-molded shoes, depth shoes with custom orthotics, and ankle-foot orthosis (AFO) bracing. Moderate deformity may benefit from soft tissue procedures — percutaneous Achilles tendon lengthening, posterior capsule release, and peroneal muscle strengthening. Severe rigid deformity in a functional patient who has failed conservative care requires bony reconstruction — typically a combination of calcaneal osteotomy, plantar fascia release, and sometimes triple arthrodesis (calcaneo-cuboid and talonavicular fusion). Dr. Biernacki at Balance Foot & Ankle provides comprehensive adult foot deformity evaluation and surgical correction when indicated. Call (810) 206-1402 for evaluation at our Bloomfield Hills or Howell office.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

Related Conditions & Resources

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• Plantar Fasciitis
• Neuropathy Treatment
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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Adult Clubfoot Treatment in Michigan

Untreated or relapsed clubfoot in adults presents unique challenges. Our surgeons offer comprehensive evaluation and reconstruction to improve function and reduce pain.

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Clinical References

1. Ippolito E, De Luca S, Farsetti P, et al. Long-term comparative results of untreated and surgically treated clubfeet. J Pediatr Orthop. 2003;23(2):246-253.
2. Ponseti IV, Zhivkov M, Davis N, et al. Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res. 2006;451:171-176.
3. Penny JN. The neglected clubfoot. Tech Orthop. 2005;20(2):153-166.