My Synopsis of "The Newborn Foot"

The Newborn Foot
ALVIN I. GORE, M.D., D.P.M., San Diego, California JEANNE P. SPENCER, M.D., conemaugh Memorial Medical Center, Johnstown, Pennsylvania
Am Fam Physician. 2004 Feb 15;69(4):865-872.

     The foot can be separated into 3 anatomic regions. The hindfoot is the heel part of the foot and includes the talus and calcaneus. The forefoot is the front "fingers" part of the foot and consists of the metatarsals and phalanges. The midfoot is the.... middle part of the foot and contains everything else (navicular, cuboid, and cuneiforms). 
     Metatarsus adductus is the deformity where the metatarsals pitch in medially. The lateral aspect of the feet have a convexed appearance. The first and second digits have a splayed appearance and the medial midfoot develops a deep cleft in the skin. This article discusses performing the "V" test by placing the infant's foot between the clinician's index and middle finger to better observe any deformity. Treatment is conservative. Patients can perform stretching exercises, which consists of stabilizing the hindfoot while distally distracting the forefoot and correcting the position. In severe refractory cases, serial casting and bracing may be needed, but it is rare. 
     Clubfoot has four components to the deformity;
1. Inversion and adduction of the forefoot
2. Inversion of the heel and hindfoot (the heels may actually face each other)
3. Tight achilles causing flexed ankle "equinus" (foot stuck in plantarflexion)
4. Internal rotation if the leg
On x ray, the talus and calcaneus will appear "stacked". Basically the foot is flexed "down and in". There are two types of clubfoot. It can be extrinsic (supple) or intrinsic (rigid). Extrinsic is a severe position or soft tissue deformity and is treated with serial casting. Intrinsic deformity will need a surgical correction. 
     Calcaneovalgus is a deformity of the tibiotalar joint where the foot is in extreme dorsiflexion. The dorsum of the foot may be in contact with the anterior part of the distal leg. It may be associated with an overstretched achilles tendon, tight anterior leg muscles, or an externally rotated calcaneus. The deformity has an "up and out" appearance. It will oftentimes resolve on it's own. Stretching exercises can aid in resolution. It is performed by gently putting the foot in plantar flexion and inversion. Splinting or casting may be needed in severe cases.
     Congenital vertical valgus is a deformity also known as "rocker bottom foot". The hindfoot is pointed down, in an "equinus" position, and the forefoot is dorsiflexed. This causes the midtarsal bones to become dislocated. Patients with this deformity may have other congential deformities as well, so a thorough exam should be performed.  Stretching can be done, but surgery is usually needed. 
     Polydactyly is the "sixth" toe or "sixth" finger. They are primarily genetic. Treatment is usually surgery (or ligation banding if it is purely soft tissue). Syndactyly are webbed toes/ fingers. It is a genetic deformity. Treatment is not necessary and is only done for cosmetic purposes. Overlapping toes are often familial and bilateral. It is corrected with gently stretching and paper tape splinting. Surgery may be needed if treatment is delayed.