CTEV Imaging, Classification, Pirani scoring system, conservative management Talocalacaneal angle Kites angle Tibiocalcaneal angle Pirani scoring system Ponseti method Ponseti technique Percutaneous tenotomy Ponseti cast Denis brown splint CTEV shoes

1. CTEV Imaging, Classifications,
Pirani scoring system,
Conservative Management
By Dr Kota Gandhi
II yr PG Orthopaedics
Kamineni Institute Of Medical Sciences

2. Radiographic evaluation
• In nonambulatory child : AP, and stress dorsiflexion
views
• In older child : AP and standing lateral views
• X-rays should be taken on both feet for comparison
• Important angles to consider in the evaluation of
club foot are talocalcaneal angle (Kite angle)on AP
and Lateral views, talus-1st metatarsal
angle,tibiocalcaneal angle.

3. Talocalcaneal angle on AP view
• Normal :30 -55degrees
• In club foot this angle
progressively
decreases with
increasing heel varus.

4. Talocalcaneal angle on stress dorsiflexion lat.view
•Normal : 25-50 degrees
•This angle progressively
decreases with the severity
of the deformity to an angle
of zero.

5. Kite’s angle

6. Tibiocalcaneal angle
Measured in lateral
view
Normal :10-40degrees
In club foot this angle
generally nagative,
indicating equinus of
thecalcaneus in ralation
to the tibia.

7. Talus first metatarsal angle
It is the radiographic
measurement of fore foot
adduction.
In AP view :
Normal: 5-15degrees
In clubfoot it is negative
indicating fore foot
adduction

8. Classification
• Determing the initial severity of the deformity is an
important assessment of each component of CTEV,
alerting the surgeon to the need for an earlier
surgical release.
• Dimeglio scoring system is more objective and
reproducible .
• Pirani et al and Dimeglio et al are based solely on
the physical examination and not require
radiographs.

10. Dimeglio scoring system

13. Pirani scoring system
a) Mid foot score : upto 3 (0=normal;3=severe
deformity)
b) Hind foot score: upto 3 (0=normal;3=severe
deformity)
 Total score – 6
(0= Normal,6=severe deformity)

14. • Signs of Midfoot Contracture (MC)
• Curvature of Lateral Border of Foot (CLB)
• More than 30 degrees ------------ 1
• 0 – 30 degrees ------------------------ 0.5
• 0 degrees --------------------------------- 0
• Medial crease (MC)
• Deep ----------------1
• Shallow ------------ 0.5
• Absent -------------- 0
• Lateral part of the Head of Talus (LHT) covered by
navicular
• No coverage ---------------------------1
• Partial coverage --------------------- 0.5
• Full coverage -------------------------- 0

18. Signs of Hind foot Contracture (HFC)
• Posterior crease (PC)- deepcrease above the heelpad
• Deep-------------------- 1
• Shallow---------------- 0.5
• Absent------------------ 0
• Empty Heel (EH)
• If calcaneal tuberosity not felt -------------------1
• Felt with difficulty ----------------------------------------0.5
• Felt easily -----------------------------------------------------0
• Rigid equinus
• If ankle cannot be corrected upto neutral --------1
• Upto neutral -------------------------------------------------------- 0.5
• Beyond neutral ---------------------------------------------------- 0

39. Thank You!