Club Foot ; an Orthopedic Abnormalities

1. CLUB FOOT/ TALIPES
EQUINOVARUS/CONGENITAL
TALIPES EQUINOVARUS (CTEV).
[ORTHOPEDIC ABNORMALITIES]
BY
M JYOTIRMAYEE
MSC NURSING (PEDIATRIC)
SISTER TUTOR, N.T.I.

2. Introduction
• A birth defect in which a
newborn's foot or feet appear to be rotated
internally at the ankle or twisted out of shape
or position.

3. CTEV – congenital talipes equino-
varus
• Talipes - The term talipes is derived from
a contraction of the Latin words for ankle,
talus, and foot
• Causing CAVE
• - midfoot Cavus/ increase in height
• -forefoot Adductus
• -hindfoot Varus/ oblique displacement
• -hindfoot Equinus/ plantarflex

4. Hind foot equinus
Heel in varus
Midfoot cavus

5. Epidemiology
• Relatively common- 1 to 4 of every 1,000 live
births
• most common birth defects affecting the legs
• more common in firstborn children and males
• Boys affected twice
• 50 % cases are bilateral
• In unilateral cases right side is more often
involved

6. Causes-unknown
• germ defect
• arrested development
• Smoking in pregnancy
• neuromuscular disorder
in neurological disorders
and neural tube defect
• Abnormal position of
fetus

7. Anatomy
• Hindfoot
-calcaneum, talar
• Midfoot
-cuboid, navicular,
cuneiform
• Forefoot
- metatarsals, phalanges

9. 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)

13. TYPES : 3 different types
1. idiopathic (unknown cause),
2. neurogenic (caused by condition of the
nervous system, e.g, poliomyelitis,
meningitis) and
3. syndromic (related to an underlying
syndrome).

14. Terminologies

15. four COMMON variations of clubfoot
• talipes varus,
• talipes valgus,
• talipes equines, and
• talipes calcaneus.

16. TALIPES VARUS
• the most common form of clubfoot,
• the foot generally turns inward so that the leg
and foot look somewhat like the letter J (when
looking at the left foot head-on).

17. TALIPES VALGUS
• a congenital deformity of the foot in which it
is rotated inward so that walking is done on
the inner side of the sole.

18. TALIPES EQUINES
• a congenital deformity of the foot in which the
sole is permanently flexed so that walking is
done on the toes without touching the heel to
the ground.
•

19. TALIPES CALCANEUS
• A deformity due to weakness or absence of
the calf muscles in which the axis of
the calcaneus becomes vertically oriented.

20. symptoms
• The physical appearance of a clubfoot may vary:-
• at birth, an affected foot usually turns inward and
points downward.
• It resists realignment.
• The calf muscle may be smaller and less well
developed than normal.
• One or both feet may be affected.
• The affected foot may be up to ½ inch
(1cm) shorter than the other foot.

23. DIAGNOSIS
1.physical examination

24. Cavus:
• the foot has a high arch, or a caved
appearance.

25. Adductus:
• the forefoot curves inwards toward the big
toe.

26. Varus:
• the heel is inverted, or turned in, forcing one
to walk on the outside of the foot.
• This is a natural motion but in clubfoot the
foot is fixed in this position.

27. Equinus:
• the foot is pointed downward, forcing one to
walk on tiptoe. This motion occurs naturally,
but in clubfoot the foot is fixed in this
position.
• This is because the Achilles tendon is tight
and pulls the foot downwards.

28. Prenatal diagnosis
• ultrasound
• More testing and imaging is typically not
needed, unless there is concern for other
associated conditions.

29. Treatment
• combination of the Ponseti method and
French method.

30. Steps of Ponseti method
1. Serial casting
2. Achilles tendon release
3. Bracing

32. Surgical treatment
• If non-operative treatments are unsuccessful
or achieve incomplete correction of the
deformity, surgery is sometimes needed
• Posteromedial Release (PMR) surgery.
•

34. Other foot abnormalities
• Hypermobile pesplanus: Hypermobile or
pronated feet are seen in 15% of adults.
• The child with flatfeet is usually
asymptomatic

35. tarsal coalition
• is an abnormal connection of two or more bones in
the foot.
• The bones affected — called tarsal bones — are
located toward the back of the foot and in the heel,
and the connection of the bones can result in a
severe, rigid flatfoot.

36. Pes cavus
• also known as high arch,
• in which the sole of the
foot is distinctly hollow
when bearing weight.
• cause, there is a fixed
plantar flexion of the
foot.

37. LEGS ABNORMALITIES
• Genu varum
• Genu valgum
• Leg length

38. Genu varum
(Bowleggedness/bandiness/ bandy-
leg/tibia vara)
• knees stay apart even when standing with feet
and ankles together.
• normal condition in children up to 18 months
of age.
• Cause may exclude rickets, night splint or
osteotomy if severe.

40. Genu valgum
(knock knees)
• can be surgically corrected.
• The surgical technique used may vary
depending on age.
• Knock knees can affect the ankles
and knees as well as the hips.
• This is a form of misalignment and
it can cause increasing pressure and pain in
the front of the knee because the knee cap is
off center.

41. Leg length discrepancy (LLD) or
anisomelia
• a condition in which the paired lower
extremity limbs have a noticeably
unequal length.
• average discrepancy is less than 1.1 cm
• In minor case wearing a lift in one
shoe.
• Treatment depends upon the severity.

42. HAND & FINGERS
• POLYDACTYLY
• SYNDACTYLY
• CAUSE: due to thickening
of the tendons or muscles
just below the first pulley
of the digit
• Surgical (percutaneous
)release is curative