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Congenital Tallipes Equino Varus (CTEV)

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Congenital Tallipes Equino Varus (CTEV)

  1. 1. PAEDIATRIC ORTHOPAEDICS
  2. 2. Outline • Congenital Talipes Equino Varus • DDH • Perthes • SCURFY • Limb Length Discrepancy • Angular Deformity
  3. 3. AMALINA MOHD DAUD 0917298 IIUM
  4. 4. Outline • What is CTEV? • Epidemiology • Causes • Anatomy and pathoanatomy • Clinical features • X-rays • Treatment
  5. 5. What is CTEV?? • Idiopathic clubfoot • Causing CAVE - midfoot Cavus/ increase in height -forefoot Adductus -hindfoot Varus -hindfoot Equinus/ plantarflex
  6. 6. Hind foot equinus Heel in varus Midfoot cavus
  7. 7. Epidemiology • Relatively common- 1 to 2 per thousand births • Boys affected twice • Bilateral in 1/3 of cases
  8. 8. Causes-unknown • germ defect • arrested development • neuromuscular disorder in neurological disorders and neural tube defect • postural deformity
  9. 9. 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.
  10. 10. Anatomy • Hindfoot -calcaneum, talar • Midfoot -cuboid, navicular, cuneiform • Forefoot - metatarsals, phalanges
  11. 11. 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)
  12. 12. 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
  13. 13. Clinical Features • Heel is small and high • Deep creases appear posteriorly and medially • Abnormal thin calf
  14. 14. • Varying degree of resistance / fixed deformity when try to dorsiflex and evert the foot Normal baby foot
  15. 15. • Associated disorders - congenital hip dislocation - spina bifida -arthrogryposis : absent of creases • Look if other joints are affected
  16. 16. How to differentiate true and postural clubfoot? • True clubfoot – fixed deformity • Postural talipes – easily correctable by gentle passive movement
  17. 17. IMAGING X-ray to assess progress of treatment
  18. 18. Anterioposterior view Kite’s angle (talocalcaneal angle): normal 20-40 degree clubfoot angle almost parallel 30 degree plantarflex
  19. 19. Lateral Film (Turco view) Normal angle : 40 degree If less 20 degree: rocker bottom deformity - calcaneum seem to be dorsiflexed but it had broken at midtarsal level Foot dorsiflex
  20. 20. TREATMENT
  21. 21. Aim To produce and maintain a plantigrade, supple foot that will function well
  22. 22. 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
  23. 23. 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
  24. 24. Increase the supination deformity of forefoot
  25. 25. DON’T SLEEP. TQ

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