Congenital Tallipes Equino Varus (CTEV)
Congenital Tallipes Equino Varus | CTEV | Club Foot |
CTEV also called Club foot. This is most significant congenital deformity of the foot characterized by hindfoot equinus & varus, forefoot Adduction and midfoot Supination. The foot is in inversion, adduction and equinus position. There is Adduction of forefoot (talonavicular+calcaneocuboid joints), Supination of the entire foot (calcaneovarus) and foot equinus (planter flexed ankle).
Latin: Talus (ankle), Pes(foot), Equinus (horse like).
- The incidence of CTEV varies widely with race and geography.
- It is relatively common; the incidence is 1 to 2 per 1000 births.
- The condition is bilateral in one-third of cases.
- Boys are affected twice than girls.
The exact cause is usually unknown. However possible causes are;
- Or combination of both environmental and congenital.
- Genetic associations include mendelian inheritance.
- Associations of CTEV with neurological disorders, e.g.
- Spina bifida
- Cerebral palsy
- Muscular dystrophies
- Spinal muscular atrophy
- Arthrogryposis (teratogenic)
CTEV/Club foot Clinical Features
The deformity is usually obvious at birth; the foot is both twisted and turned inward. The heel is usually small and high while deep creases appear posteromedially.
In a normal baby the foot can be dorsiflexed and everted until the toes almost touch the front of the leg. In club foot this manoeuvre meets with varying degrees of resistance and in severe cases the deformity is fixed.
The infant must always be examined for associated disorders such as congenital hip dislocation and spina bifida.
The tarsal bones are incompletely ossified at this age and the anatomy is therefore difficult to define. However the shape and position of the tarsal ossific centres are helpful in assessing progress after treatment.
Treatment plan to be followed for the purpose to prevent the deformity from further progression and to keep the foot in neutral position during the first week of life after birth. Treatment of Congenital Tallipes Equino Varus is carried out as:
- Intensive stretching
- Serial Casting
- Off-shell Orthosis (need to review after every week for 24 weeks)
- AFO (Ankle Foot Orthosis) in neutral position and forefoot in abduction.
- Surgery for tissue release.