Congenital Tallipes Equino Varus (CTEV)

PAEDIATRIC ORTHOPAEDICS

Outline• Congenital Talipes Equino Varus

• DDH

• Perthes

• SCURFY

• Limb Length Discrepancy

• Angular Deformity

CTEV

AMALINA MOHD DAUD0917298

IIUM

Outline• What is CTEV?• Epidemiology• Causes• Anatomy and pathoanatomy• Clinical features• X-rays• Treatment

What is CTEV??

• Idiopathic clubfoot

• Causing CAVE - midfoot Cavus/ increase in height -forefoot Adductus -hindfoot Varus -hindfoot Equinus/ plantarflex

Hind foot equinus

Heel in varus

Midfoot cavus

Epidemiology

• Relatively common- 1 to 2 per thousand births• Boys affected twice• Bilateral in 1/3 of cases

Causes-unknown

• germ defect• arrested development

• neuromuscular disorder in neurological disorders and neural tube defect

• postural deformity

Common Types

1. Congenital - uncommon bony problems present upon childbirth not related to any neuromuscular factor or symptoms.

2. Teratologic -a/w neurological conditions (eg: spina bifida)

3. Positional - in contorted position in utero

4 Syndromic -a/w standard hereditary issue, which includes arthrogryposis.

Anatomy• Hindfoot -calcaneum, talar

• Midfoot -cuboid, navicular, cuneiform

• Forefoot - metatarsals, phalanges

Pathological Anatomy

Neck of Tallus-pointing downward and deviates medially

Body of Tallus- Rotated outward

Posterior part of calcaneum-held close to fibula by CF ligt-tilted into equinus and varus-rotated medially beneath ankle

Navicular and forefoot-shifted medially-rotated into supination(composite varus deformity)

Pathological Anatomy

• Skin and soft tissue of calf and medial side of foot are short and underdeveloped

• If not corrected early, secondary growth changes occur in the bones-PERMANENT

Clinical Features

• Heel is small and high• Deep creases appear posteriorly and medially• Abnormal thin calf

• Varying degree of resistance / fixed deformity when try to dorsiflex and evert the foot

Normal baby foot

• Associated disorders - congenital hip dislocation - spina bifida -arthrogryposis : absent of creases

• Look if other joints are affected

How to differentiate true and postural clubfoot?

• True clubfoot – fixed deformity• Postural talipes – easily correctable by gentle

passive movement

IMAGINGX-ray to assess progress of treatment

Anterioposterior view

Kite’s angle (talocalcaneal angle): normal 20-40 degree clubfoot angle almost parallel

30 degree plantarflex

Lateral Film (Turco view)

Normal angle : 40 degreeIf less 20 degree: rocker bottom deformity - calcaneum seem to be dorsiflexed but it had broken at midtarsal level

Foot dorsiflex

TREATMENT

Aim

To produce and maintain a plantigrade, supple foot that will function well

Non Operative Operative

• Serial Manipulative and Casting (Ponsetti’s method)

• -Posteromedial tissue release and tendon lengthening

• -medial opening or lateral column-shortening osteotomy, or cuboidal decancellation

• -triple arthrodesis

• -tallectomy

Serial Manipulative and Casting (Ponsetti’s method)

• Goal-rotate leg laterally around the fixed tallus• Order of correction (CAVE) -midfoot cavus -forefoot adductus -hindfoot varus -hindfoot equinus

Increase the supination deformity of forefoot

DON’T SLEEP. TQ