Hektoen International

A Journal of Medical Humanities

Two tales of talipes equinovarus

Christopher Walker
Bielsko-Biala, Poland

Drawings of a clubbed foot alone and held by surgeons at different angles
Operations for club-foot. Wellcome Collection.

Congenital talipes equinovarus, better known as clubfoot, is a poorly understood but surprisingly common medical condition. According to Ansar et al, it affects about one in one thousand newborns, though this figure varies by country.1 There is a roughly fifty-fifty split between those born with bilateral clubfoot and those with only one foot affected, most often the right.

Miedzybrodzka discusses the likely origins of the condition—but is unable to draw a firm conclusion.2 “Neurological, muscular, bony, connective tissue and vascular mechanisms have been proposed, but the only firm evidence is that the mildest cases appear to be associated with intra-uterine posture.” Treatment is available but not always successful. Untreated, clubfoot can cause a painful disability that is difficult to manage.

Two memorable characters affected by clubfoot appear in early twentieth century literature: Rickie Elliot in E.M. Forster’s The Longest Journey published in 1907, and Philip Carey in Of Human Bondage by W. Somerset Maugham, published eight years later. Both characters are affected in one foot only; their disability is a driver of character change and plot development in both stories, but the condition may have represented different things in the writings of Forster and Maugham.

The Longest Journey, like Of Human Bondage, is a bildungsroman. We join Rickie Elliot at Cambridge University, where he is engaged in discovering his soul. The friends he has made there will accompany him for the rest of his life—the characters we are introduced to in the first pages will remain present until the end, and one assumes that this was how Forster intended his story to play out. The title is taken from Percy Bysshe Shelley’s poem “Epipsychidion” and is a reference to the life journey from youth to spiritual maturity. Elliot is faced with many spiritual challenges during the course of the novel, though he dies a brave death at the end and is rewarded, so to speak, with his great ambition of becoming a writer of some renown realized posthumously. Though the ending is tragic, the reader nonetheless feels some sense of celebration in the final chapter: the religious attendee of Forster’s work, for whom the existence of heaven would be taken for granted, might imagine Elliot looking down on the world with some pleasure.

Elliot’s clubfoot is a curse to him throughout the novel. He thinks of himself as a frail, delicate person. He cannot ride a horse like other gentlemen in his circle and cannot even walk fast enough to always keep up with his interlocutor. His condition is inherited, having also affected his father. Miedzybrodzka found that “a family history is present in 24-50% of cases.”2 In the story, Elliot, now married, discovers to his horror that his wife is pregnant. He is certain that his progeny will suffer the same fate, if not worse, and this indeed comes to pass. His daughter is completely lame, on receipt of which news he faints. In a book remarkable for its high death count, it comes as little surprise that the child dies within a few short paragraphs of her unfortunate birth. After this tragic event, Elliot renews a vow made earlier in the story never again to bring life into the world—he cannot bear the thought that he would thus be cursing another soul to the same torment he has suffered for so long. However, this promise leads to his estrangement from his wife, towards whom he has always seemed drawn platonically rather than sexually.

We can read Elliot’s case of talipes equinovarus as a cipher for something else the writer wanted to say but felt he could not. This would not have been unusual in Forster’s time. Although there are other instances of clubfoot in literature – one of the minor characters suffers the condition in Flaubert’s Madame Bovary—one suspects that in The Longest Journey the protagonist’s condition is metaphorical. Forster, himself a homosexual, wrote only one novel of an openly gay nature, Maurice, which he refused to have published until after his own death (thus completing, in a sense, the pattern established in The Longest Journey). Elliot considers himself unsuited for marriage, horrified at the thought of having to raise a child and looking at his male companions from Cambridge as his true friends. At the insistence of his wife he pushes his male friends out of his life, and only reconciles with them—in particular his great friend, Stewart Ansell—after leaving his wife. In Maurice the story of Elliot and Ansell here left untold is taken up by Maurice and Clive Durham, likewise at university.

W. Somerset Maugham too was homosexual—he declared himself a bisexual, though his romantic history suggests he was far less interested in women than in men. In his highly autobiographical Of Human Bondage therefore we might be tempted to see in Philip Carey’s clubfoot as another cipher for the same confused or buried sexuality as Forster experienced and wrote into Rickie Elliot.

Such an assumption, however, might here prove mistaken. Maugham was born not with a clubfoot but with a stutter. Given the written style of an earlier Maugham novel, Liza of Lambeth, which was rendered mostly in dialect, we may be relieved that Maugham effected the substitution—had Philip Carey been allowed his stutter, the resulting seven-hundred pages would have made for heavy reading.

In The Longest Journey Rickie Elliot’s affliction relates directly to the plot and provides the justification for much that occurs in the protagonist’s life. The same cannot rightly be said for Philip Carey in Of Human Bondage. During his time in Paris training as an artist, little mention is made of the clubfoot, and Carey seems to find reasons other than medical not to pursue his romantic inclinations. The trend continues when Carey returns to England to train as a doctor (Maugham studied medicine, and his experiences were usefully employed in Liza of Lambeth); eventually Carey is approached by a colleague in a London hospital and told that an operation has been pioneered that could cure his difficulty. Thus is the problem handily dealt with, leaving Carey free to fall in love without the impediment of a physical disability. By the end of the novel, Carey has become engaged to a girl he thought he had made pregnant (this proves to be a false alarm) and takes up a position in a rural surgery, eschewing earlier ambitions to leave for Spain to travel and discover himself. It is here that we might turn to the title of the book for elucidation—like The Longest Journey the name of the story is the key. Of Human Bondage comes from Spinoza, where the philosopher links the inability of people to control their emotions (such as falling in love with the wrong person) to the idea of emotional slavery and ultimate bondage.

It is interesting that Forster and Maugham shared so much in common—their sexual orientation, their predilection for the bildungsroman and the autobiographical, and their aptness of choice of quotations from elsewhere in literature—and that within so short a space of time they should happen to introduce a protagonist suffering from the same affliction. Only in The Longest Journey do we see talipes equinovarus as a plot device, and only in that same book is the condition a direct metaphor.

Clubfoot—and other disabilities of a similar bent—have become less fashionable as ciphers used by writers in their autobiographical novels. Yet we find clubfoot no less common than it has ever been and treatments still provide no guarantee of full recovery. Thus a character exhibiting clubfoot would seem just as likely in the twenty-first century as in the twentieth. But the need for such metaphorical ailments has diminished greatly since Forster’s and Maugham’s time, and it would be strange indeed for Western writers to have to hide their orientation until safely on the other side of the grave. For this we ought to be thankful that societal mores have developed more rapidly than medical science.


  1.  Ansar A, Rahman AE, Romero L, et al. “Systematic review and meta-analysis of global birth prevalence of clubfoot: a study protocol.” BMJ Open 2018;8:e019246. doi: 10.1136/bmjopen-2017-019246.
  2. Miedzybrodzka Z. “Congenital talipes equinovarus (clubfoot): a disorder of the foot but not the hand.” J Anat 2003;202(1):37–42. doi:10.1046/j.1469-7580.2003.00147.x.

CHRISTOPHER WALKER is a writer and English teacher based in the south of Poland. His works have appeared in numerous journals and anthologies, and he has self-published some longer literature on Amazon.

Highlighted in Frontispiece Volume 12, Issue 1 – Winter 2020

Spring 2019




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