1. Congenital talipes equinovarus (CTEV), also known as clubfoot, is a congenital deformity characterized by four components - cavus, adduction, varus, and equinus (CAVE). 2. Non-operative treatment involves serial casting using the Ponseti technique, which aims to correct the deformity through soft tissue manipulation and serial plaster casts over 5-6 weeks. 3. The Ponseti technique addresses each component of the deformity in order, using the head of the talus as a fulcrum to manipulate the foot into corrected position.

1. CONGENITAL TALIPES
EQUINOVARUS (CTEV)/CLUB
FOOT
DR BAIJNATH AGRAHARI
RESIDENT
ORTHOPAEDICS DEPARTMENT
LMC,PALPA,NEPAL

2. CONGENITAL TALIPES EQUINOVARUS (CTEV)
• TALUS- ankle
PES- Foot
EQUINO- like a horse
VARUS- turned inward
Club foot is congenital deformity of
the foot and ankle characterised by
4 basic deformity
1. fore foot : adduction
2. Hind foot(SUBTALAR joint) :
inversion or varus
3. Hind foot : equinus
4. Mid foot : cavus

3. DEFORMITIES
4 Clinical components CAVE
• C - CAVUS : Exaggerated Medial
Longitudinal arch at midfoot
• A - ADDUCTION : Forefoot in adduction in
tarsometatarsal junction
• V - VARUS : Hind foot rotated inward at
talocalcaneonavicular joint
• E - EQUINUS : Foot fixed in plantar flexion at
ankle joint

4. EPIDEMIOLOGY
 Relatively common 1-2 per 1000 Births
 Incidence in 1st degree relative =2%
 Incidence in 2nd degree relative in = 0.6%
 Incidence in MALE:FEMALE - 2.5:1
 LATERALITY- >50% CASES ARE BILATERAL
 IN UNILATERAL AFFLICTION- RIGHT> LEFT

5. ETIOLOGY
• MOST COMMON CAUSE OF CTEV IS
IDIOPATHIC (PRIMARY)
• OTHER THAN IDIOPATHIC IS SECONDARY
CTEV WHICH IS ASSOCIATED WITH
UNDERLYING CAUSE

6. IDIOPATHIC CTEV
1. PRIMARY GERM PLASMA DEFECT: WAISBROD SUGGESTED DEFECT IN
PRIMARY GERM PLASMA OF CARTILAGINOUS TALAR ANALGE RESULTING IN
DYSMORPHIC TALAR NECK AND NAVICULAR SUBLUXATION.
2. ARRESTED FETAL DEVELOPMENT: BOHM PROPOSED ARREST OF FETAL
DEVELOPMENT OF THE LOWER LIMB IN 6-8 WKS SO CALLED CLUB FOOT
EMBRYONIC STAGE. HOWEVER DYSMORPHIC TALAR HEAD AND MEDIAL
DISPLACEMENT OF NAVICULAR IS NOT SEEN IN ANY STAGE OF NORMAL FETAL
DEVELOPMENT

7. IDIOPATHIC CTEV
3. OTOGENIC THEORY / ARREST THEORY : ARREST OF DEVELOPMENT RELATED
TO A CHANGE IN GENETIC FACTOR KNOWN AS “ CRONON”. CRONON MAY
CHANGED BY CERTAIN ELEMENTS ( TERATOGENIC) LEADS TO A NORMAL
DEVELOPMENT OF LIMBS.
4. VASCULAR HYPOTHESIS: KEITH SUGGESTED TEMPORARY CESSATION OF
CIRCULATION IN DEVELOPING FETUS RESULTED IN CONTRACTURES OF SOFT
TISSUES AND DEFECTIVE DEVELOPMENT OF CARTILAGE.
5. MUSCULOLIGAMENTOUS FIBROSIS: IPPOLITO AND PONSETI FOUND
CONSIDERABLE INCREASE IN COLLEGEN FIBRES AND FIBROBLASTIC CELLS IN
LIGAMENTS AND TENDONS OF CLUBFOOT. THEY CONSIDERED TO BE PRIMARY
DEFECT, CARTILAGINOUS AND BONY CHANGES BEING SECONDARY

8. IDIOPATHIC CTEV
5. MECHANICAL FACTOR IN UTERO: OLDEST THEORY PROPOSED BY
HIPPOCRATES SUGGESTING FOOT HELD IN EQUINO VARUS BY EXTERNAL
UTERINE COMPRESSION. SOME INVESTIGATOR OPINE DIMINUTION OF
AMNIOTIC FLUID AS CAUSE OF CLUB FOOT.
6. HEREDITARY: WYNNE- DAVIES SUGGESTED CLUB FOOT ARE PART OF
NUMEROUS SYNDROMES FOLLOWING MANDELIAN PATTERN OF EITHER
AUTOSOMAL DOMINANT OR AUTOSOMAL RECESSIVE INHERITANCE

9. SECONDARY CTEV
ASSOCIATED WITH NEUROMUSCULAR OR SYNDROMIC ETIOLOGIES
1. ARTHROGRYPOSIS MULTIPLEX CONGENITA
2. DIASTROPHIC DYSPLASIA
3. STREETER SYNDROME (CONSTRICTION BAND SYNDROME)
4. FREEMAN SHELDON SYNDROME (whistling face)
5. MOBIUS SYNDROME
6. NAIL PATELLA SYNDROME
7. DIASTROPHIC DWARFISM
ASSOCIATED WITH PARALYTIC DISORDER
1. POLIOMYELITIS
2. SPINA BIFIDA
3. MYELODYSPLESIA
4. FREIDRICH’S ATAXIA

11. PATHOLOGICAL ANATOMY
1. BONES-
• TALUS-
HEAD AND NECK DEVIATED MEDIALLY AND
DOWNWARD.
MEDIAL AND PLANTAR DEVIATION OF NAVICULAR
ARTICULATION.
BODY ROTATED EXTERNALLY AND IS IN EQUINUS OF
NECK IN ANKLE MORTISE.
BODY EXTRUDED ANTERIORLY
SMALLER THAN NORMAL
NECK- BODY ANGLE IS 90-110* (NORMAL- 150*)
DISLOCATION OF HEAD OF TALUS OUT OF ITS SOCKET.

12. NAVICULAR-
MEDIALLY AND PLANTAR DISPLACEMENT
CLOSE TO MEDIAL MALLEOLUS
ARTICULATES WITH MEDIAL SURFACFE
OF DYSMORPHIC TALUS
TALONAVICULAR JOINT SUBLUXATION

13. CALCANEUM-
OFTEN SMALL IN SIZE
MEDIALLY ROTATED
ANTERIOR PORTION LIES BENEATH THE HEAD OF
TALUS CAUSING VARUS AND EQUINUS OF HEEL.
SUSTENTACULUM TALI IS UNDERDEVELOPED.
CUBOID-
MEDIALLY SUBLUXATED OVER CALCANEUM HEAD

14. MUSCLES AND TENDONS-
ATROPHY OF PERONEAL GROUP OF
MUSCLES
CONTRACTURE OF TRICEP SURAE,TIBIALIS
POSTERIOR,FLEXOR DIGITORUM LONGUS
AND FLEXOR HALLUCIS LUNGUS.
NUMBER OF FIBRES IN MUSCLE IS NORMAL
BUT ARE SMALLER IN SIZE.
THICKENING AND CONTRACTURE OF
TENDON SHEATHS ESPECIALLY OF TIBIALIS
POSTERIOR AND PERONEAL.

15. LIGAMENTS
THICKENING AND CONTRACTURES ARE
SEEN IN
CALCANEOFIBULAR LIGAMENT
TALOFIBULAR LIGAMENT
DELTOID LIGAMENT
LONG AND SHORT PLANTAR LIGAMENT
SPRING LIGAMENT
BIFURCATE LIGAMENT
INTEROSSEOUS TALO CALCANEUM
LIGAMENT
MASTER KNOT OF HENRY

16. JOINTS CAPSULE AND FASCIA
CONTRACTURES ARE SEEN IN
POSTERIOR ANKLE CAPSULE
SUBTALAR CAPSULE
TALONAVICULAR JOINT CAPSULE
CALCANEOCUBOID JOINT CAPSULE
PLANTAR FASCIA CONTRACTURE ARE SEEN WHICH IS RESPONSIBLE
CAVUS DEFORMITY

17. SKIN CHANGES-
DEEP CREASE ON MEDIAL SIDE
DIMPLES IN LATERAL ASPECT OF ANKLE
AND MID FOOT.
SHORTENING ON MEDIAL SIDE OF SOLE
CALLOSITIES AND BURSA ON LATERAL
SIDE OF FOOT
VASCULAR CHANGES-
HYPOPLASIA OR ABSENCE OF DORSALIS
PAEDIS AND ANTERIOR TIBIAL ARTERY

18. CLINICAL FEATURES
HEEL IS SMALL AND IN EQUINUS
FOOT INVERTED ON END OF TIBIA
DEEP CREASES ON MEDIAL AND POSTERIOR
ASPECT
ABNORMAL THIN CALF
VARYING DEGREE OF RESISTANCE/ FIXED
DEFORMITY WHEN TRY TO DORSIFLEX AND
EVERT THE FOOT.
LACK OF CORRECTABILITY
OTHER JOINT ABNORMALITY
ASSOCIATED ANOMALIES AND
NEUROMUSCULAR CONDITION.

19. Deformity
 Heel equinus
 Heel varus
 Midfoot cavus
 Forefoot adduction

20. CLASSIFICATION
1. IDIOPATHIC AND NON-IDIOPATHIC
2. CUMMIN CLASSIFICATION
3. PONSETI AND SMOLEY CLASSIFICATION- BASED ON EXTENT OF
DEFORMITY
4. HARROLD AND WALKER CLASSIFICATION- BASED ON ABILITY TO
CORRECT THE DEFORMITY.
5. BROWNE’S CLASSIFICATION- BASED ON TYPE OF DEFORMITY
6. DIMEGLIO ET AL SCORING SYSTEM BASED ON SEVERITY OF THE
DEFORMITY
7. PIRANI SCORING SYSTEM

21. CUMMIN CLASSIFICATION
 SUPPLE: FOOT CAN BE BROUGHT TO NORMAL POSITION AND ALL
JOINTS ARE MOBILE.
 NEGLECTED: NO TREATMENT FOR 1 YR.
 RELAPSED: CORRECTED DEFORMITIES APPEARS AGAIN.
 RECCURENT: TYPE OF RELAPSE DUE TO MUSCLE IMBALANCE
 RESISTANT: NO CORRECTION AFTER CONSERVATIVE MANAGEMENT.
 RIGID: AFTER CONSERVATIVE TREATMENT FOREFOOT DEFORMITY
CORRECTED AND HINDFOOT DEFORMITY REMAIN UNCORRECTED.

22. PIRANI SCORING SYSTEM:
• SIMPLE AND RELIABLE SYSTEM TO DETERMINE SEVERITY AND MONITOR
PROGRESS IN THE ASSESSMENT AND TREATMENT OF CLUBFOOT.
• SIX “SIGNS” ARE ASSESSED
 3 SIGNS IN MIDFOOT
 3 SIGNS IN HINDFOOT
• BASED ON 6 WELL-DESCRIBED CLINICAL SIGNS OF CONTRACTURE
CHARACTERIZING A SEVERE CLUBFOOT:
 IF THE SIGN IS SEVERELY ABNORMAL IT SCORES 1
 IF IT IS PARTIALLY ABNORMAL IT SCORES 0.5
 IF IT IS NORMAL IT SCORES 0
• TOTAL SCORE (TS) VARIES FROM 0 TO 6 AND IS THE SUM OF MIDFOOT AND
HINDFOOT CONTRACTURE SCORES

23. PIRANI SCORING SYSTEM

24. DIMEGLIO SCORING SYSTEM

25. RADIOGRAPHIC EVALUATION:
FOR NON AMBULATORY CHILD-
• ANTEROPOSTERIOR
• STRESS DORSIFLEXION LATERAL VIEW
FOR OLDER CHILD-
• STANDING ANTEROPOSTERIOR
• STANDING LATERAL
IMPORTANT ANGLE WE MEASURE-
•TALOCALCANEAL ANGLE ON AP AND LAT VIEW
•TIBIOCALCANEAL ANGLE ON LAT VIEW
•TALUS-FIRST METATARSAL ANGLE

26. RADIOGRAPHIC EVALUATION:
TALOCALCANEAL ANGLE-
• ON AP VIEW-
1ST LINE THROUGH THE CENTRE OF
LONG AXIS OF TALUS (PARALLEL TO
MEDIALBORDER)
2ND LINE THROUGH LONG AXIS OF
CALCANEUM (PARALLEL TO LATERAL
BORDER)
 NORMAL 25-40*
• ON LATERAL VIEW-
1ST LINE MIDPOINT OF HEAD AND
BODY OF TALUS
2ND LINE ALONG BOTTOM OF
CALCANEUM
NORMAL 35-50*

27. RADIOGRAPHIC EVALUATION:
RADIOLOGICAL FINDING SEEN-
• ON LATERAL VIEW-
DECREASED TALOCALCANEAL ANGLE
(TALOCALCANEAL PARALLELISM)
DISRUPTED TALAR FIRST METATARSAL
ANGLE
LONG AXIS OF TALUS AND CALCANEUM
PASSES INFERIOR TO CUBOID
(NORMALLY CROSSES CUBOID)
• ON ANTEROPOSTERIOR VIEW-
 DECREASED TALOCALCANEAL ANGLE
 DECREASED TALAR FIRST METATARSAL
ANGLE
LONG AXIS OF TALUS DEVIATE
LATERALLY AND PASSES ALONG 3RD OR
4TH METATARSAL BONE

29. TREATMENT:
GOAL: TO ACHIEVE
PLANTIGRADE FOOT
FLEXIBILTY
COSMETICALLY ACCEPTABLE FUNCTIONAL AND PAIN FREE FOOT IN SHORTEST
TREATMENT TIME
PRINCIPLES:
SOFT TISSUE CONTRACTURE RELEASE OR STRETCHING TO RESTORE NORMAL
TARSAL RELATIONSHIP.
ONCE NORMAL TARSAL RELATIONSHIP ATTAINED, CORRECTION SHOULD BE
MAINTAINED TILL TARSAL BONES REMOULDS STABLE ARTICULAR SURFACE.

30. • SEVERAL REGIME HAVE BEEN PROPOSED INCLUDING SPLINTING TAPING AND CASTING.
• KITE’S METHOD:
 CORRECTION OF EACH COMPONENT SEPARATELY
 CORRECTION WAS DONE IN FOLLOWING ORDER
KITE ERRORS:
 PRONATION/ EVERSION OF 1ST METATARSAL.
 PREMATURE DORSIFLEXION OF HEEL.
 USED CALCANEOCUBOID JOINT AS FULCRUM THAT BLOCKS ABDUCTION OF CALCANEUS
, THERBY PREVENTS EVERSION OF CALCANEUS.
NONOPERATIVE TREATMENT:

33. NONOPERATIVE TREATMENT:
• PONSETI TECHNIQUE:
2 PHASE- TREATMENT AND MAINTENANCE PHASE
1. TREATMENT PHASE-
BEGINS AS EARLY AS POSSIBLE. DURING FIRST WEEK OF LIFE ONLY
MANIPULATION IS CARRIED OUT BUT CAST IS NOT APPLIED.
ORDER OF CORRECTION-
TALUS HEAD IS USED AS FULCRUM.
5-6 SERIAL CASTING WITH MANIPULATION IS GENERALLY ENOUGH TO
CORRECT THE DEFORMITY. MAXIMUM UPTO 1O CASTING CAN BE DONE.

34. PONSETI TECHNIQUE:
CORRECTION OF CAVUS DEFORMITY:
CORRECTED BY FOREFOOT SUPINATION
RELATIVE TO HINDFOOT ALONG WITH
ADDUCTION OF FOREFOOT.
TENDS TO EXAGGERATE FOOT
INVERSION.
PRONATION OF FOREFOOT SHOULD NOT
BE DONE AS IT INCREASES CAVUS
DEFORMITY BECAUSE 1st METATARSAL IS
FURTHER PLANTAR FLEXED. E- RIGHT MANEUVER TO CORRECT CAVUS DEFORMITY
F- WRONG MANEUVER TO CORRECT CAVUS DEFORMITY

35. PONSETI TECHNIQUE
A: THUMB IS POSITIONED OVER LATERAL ASPECT OF HEAD OF TALUS AND FINGER CORRECT THE
FOREFOOT.
B: CAVUS AND ADDUCTION ARE CORRECTED BY SLIGHT SUPINATION OF FOREFOOT IN RELATION TO
HINDFOOT.

36. PONSETI TECHNIQUE
CORRECTION OF VARUS AND ADDUCTION:
CORRECTION OF CAVUS BRINGS METATARSAL, CUNIEFORM,
NAVICULAR, AND CUBOID IN SAME PLANE OF SUPINATION.
NOW FOOT IS ABDUCTED AND HELD IN FLEXION AND SUPINATION
TO ACCOMMODATE THE INVERSION OF TARSAL BONES WHILE
COUNTER PRESSURE IS APPLIED WITH THUMB ON LATERAL ASPECT
OF HEAD OF TALUS.
THIS MANEUVER NECESSITATES PROLONG STRETCHING OF MEDIAL
TARSAL LIGAMENTS AND TENDONS.

37. PRESSURE EXERTED ON METATARSAL AND COUNTERPRESSURE ON LATERAL ASPECT
OF HEAD OF TALUS.
FURTHER ABDUCTION OF FOOT HELD IN FLEXION AND SUPINATION.

38. FOOT IS
FURTHER
ABDUCTED
AND
SUPINATION
DECREASED
BUT
WITHOUT
PRONATING
THE FOOT

39. PONSETI TECHNIQUE
CORRECTION OF EQUINUS:
SHOULD BE ATTEMPTED WHEN HINDFOOT IS IN NEUTRAL POSITION
TO SLIGHT VALGUS AND FOOT IS ABDUCTED 70* RELATIVE TO LEG.
EQUINUS IS COORECTED BY PROGRESSIVE DORSIFLEXING THE FOOT.
TO FACILITATE RAPID CORRECTION SUBCUTANEOUS TENOTOMY IS
DONE.
 CARE SHOULD BE TAKEN WHILE DORSIFLEXING FOOT BY APPYLING
PRESSURE UNDER ENTIRE SOLE AND NOT UNDER METATARSAL
HEADS.

40. FOOT IS FURTHER ABDUCTED UPTO 70* TO
STRETCH TO STRETCH MEDIAL TARSAL
LIGAMENT.
NOTE: HEEL IS NOT GRASPED BY HAND THUS
ALLOWING CALCANEUS TO ABDUCT WITH
FOOT AND HEEL VARUS TO CORRECT

41. EQUINUS CORRECTED BY
SUBCUTANEOUS SECTION OF
TENDO ACHILLES

42. PERCUTANEOUS TENOTOMY

43. PERCUTANEOUS
ACHILLES
TENOTOMY FROM
MEDIAL TO
LATERAL

46. PONSETI TECHNIQUE
MAINTAENANCE PHASE:
 AFTER REMOVAL OF CAST INFANT IS PLACED IN FOOT ABDUCTION ORTHOSIS.
 BRACE IS WORN FOR 23HRS PER DAY FOR FIRST 3 MONTH THEN ONLY WHILE
SLEEPING FOR 3-4 YEARS.
 FREQUENT FOLLOW UP IS IMPORTANT TO DETECT EARLY RECCURENCE.
 IT PREVENT RECURRENCE OF DEFORMITY
 IT FAVORS REMODELLING OF JOINTS WITH THE BONES IN PROPER ALINGMENT
AND TO INCREASE LEG AND FOOT MUSCLE STRENGTH.

47. FOOT ABDUCTION ORTHOSIS
ALSO KNOWN AS DENIS BROWN SPLINT.
 CONSIST OF SHOES MOUNTED TO
CROSSBAR IN POSITION OF 70* EXTERNAL
ROTATION AND 15* DORSIFLEXION.
 DISTANCE BETWEEN SHOES IS SET AT
ABOUT 1INCH WIDER THAN THE WIDTH
OF INFANT’S SHOULDER.
 IN UNILATERAL CASES NORMAL FOOT
SHOULD IN 40* OUTWARD ROTATION.

48. CTEV SHOES
• MODIFIED SHOES FOR
CHILD WHO START
WALKING.
• THESE SHOES ARE USE
UNTILL 5 YEARS OF AGE.
• SPECIAL FEATURES:
STRAIGHT INNER
BORDER
OUTER SHOE RISE
NO HEEL

49. NONOPERATIVE TREATMENT
STRETCHING AND ADHESIVE STRAPPING(ROBERT JONES):
. PRINCIPLE- APPLY EVERSION CORRECTION FORCE ON FOOT WITH HELP OF
ADHESIVE STRAPPING
FRENCH TECHNIQUE:
GOAL IS TO REDUCE TALONAVICULAR JOINT, STRETCH OUT MEDIAL
TISSUES AND THEN SEQUENTIALLY CORRECT FOREFOOT ADDUCTION,
HINDFOOT VARUS AND EQUINUS OF CALCANEUM.

50. COMPLICATIONS OF NONOPERATIVE TREATMENT
 ROCKER BOTTOM FOOT
 BEAN SHAPED FOOT
 FRACTURES
 PRESSURE SORES
 FLAT TOP TALUS
 FAILURE OF CORRECTION
 RECCURENCE OR
RELAPSE OF DEFORMITY

51. SURGICAL TREATMENT
• INDICATION:
 IN CASE OF NEGLECTED CTEV, RELAPSED CTEV, RECCURENT CTEV, RESISTANT CTEV, RIGID CTEV.
• CHOICE OF SURGERY:
 1-4 YEARS-
 SOFT TISSUE RELEASE
 4-11 YEARS-
 SOFT TISSUE RELEASE WITH OSTEOTOMY PERFORMED ACCORDING TO THE DEFORMITIES
 >11YRS- SALVAGE PROCEDURES
 TRIPLE ARTHRODESIS
 TALECTOMY

52. SOFT TISSUE RELEASE OPERATION
 TURCO’S OPERATION- IT IS ONE STAGE POSTEROMEDIAL RELEASE. HE
EMPHASIZED ON SUBTALAR RELEASE ALONG WITH CALCANEOFIBULAR
LIGAMENT.
CAROLL’S INCISION- CAROLL EMPHASIZED ON PLANTAR FASCIA RELEASE
AND CAPSULOTOMY OF CALCANEOCUBOID JOINT. IT INCLUDE 2 INCISIONS,
MEDIAL AND POSTERO-LATERAL INCISION.
CINCINATTI INCISION- IT IS DONE FOR POSTEROMEDIAL AND
POSTEROLATERAL SOFT TISSUE RELEASE. PREFFERED TECHNIQUE FOR
INITIAL SURGICAL MANAGEMENT OF CLUB FOOT.
TENDOACHILLES TENDON RELEASE WITH POSTERIOR CAPSULOTOMY- TO
CORRECT RESIDUALHIND FOOT EQUINUS

54. ACHILLES TENDON LENTHENING AND
POSTERIOR CAPSULOTOMY
CINCINATTI INCISION

55. TENDON TRANSFER
• INDICATION- PASSIVELY CORRECTABLE
DEFORMITY RESULTING FROM MUSCLE
IMBALANCE.
• ANTERIOR TIBIALIS TENDON TRANSFER
-TENDON IS TRANSFERRED EITHER TO
MIDDLE CUNIEFORM OR TO BASE OF 5TH
METATARSAL.
• SPLATT (SPLIT ANTERIOR TIBIALIS
TENDON TRANSFER)- LATERAL PART OF
TENDON IS SPLIT AND INSERTED TO
CUBOID.

56. DWYER OSTEOTOMY
INDICATION-
PERSISTENT VARUS DEFORMITY
OF HEEL WHEN SOFT TISSUE
SURGERIES ARE
CONTRAINDICATED.
AGE- 3-4YRS
DONE BY MEDIAL OPEN WEDGE
OSTEOTOMY OR BY LATERAL
CLOSED WEDGE OSTEOTOMY

57. LATERAL COLUMN SHORTENING PROCEDURE
• INDICATION- RECURRENCE OF
CLUBFOOT DEFORMITY AFTER SURGICAL
RELEASE IS MOSTLY DUE TO DISPARITY
BETWEEN MEDIAL AND LATERAL BORDER
OF FOOT. ANY ATTEMPT TO CORRECT
DEFORMITY IS RESISTED BY MEDIAL
CONTRACTURE AND EXCESSIVE LENGTH
OF LATERAL COLUMN.
• DIFFERENT PROCEDURE TO DO
SHORTEN LATERALCOLUMN ARE-
DILLWYNN EVANS PROCEDURE
LICHTBLAU PROCEDURE
FOWLER PROCEDURE

59. FOWLER PROCEDURE
• INDICATION- SUFFICIENT
SCARRING THAT MEDIAL SOFT
TISSUE AND SUBTALAR RELEASE
WOULD BE INEFFECTIVE.
• AGE- 6-8 YEARS
• PROCEDURE- LATERAL COLUMN
SHORTENING COMBINING WITH
MEDIAL COLUMN LENGTHING BY
REMOVING WEDGE FROM CUBOID
AND TRANSFERING IT TO AN
OPENING WEDGE.

60. SALVAGE PROCEDURE
• INDICATION-
UNCORRECTED CLUBFOOT OR WITH RESIDUAL DEFORMITY AFTER THE AGE OF
10 YRS.
PAINFUL STIFF FOOT WITH POOR FUNCTION
DIFFICULT TO ACCOMMODATE TO FOOT WEAR
• GOAL-
CORRECT RESIDUAL DEFORMITY WHICH IS RESISTANT TO SOFT TISSUE RELEASE.
TO ATTAIN FUNCTIONALLY AND COSMETICALLY ACCEPTABLE FOOT.
• PROCEDURE-
TRIPLE ARTHRODESIS
TALECTOMY

61. TRIPLE ARTHRODESIS
• INDICATION-
PAINFUL STIFF FOOT WITH POOR
FUNCTION
DIFFICULT TO ACCOMMODATE TO FOOT
WEAR
ALL OTHER CORRECTION FAILED
• AGE – 10 – 12 YEARS
• PROCEDURE-
OSTEOTOMY FOLLOWED BY FUSION
OF TALONAVICULAR, TALOCALCANEUM
AND CALCANEOCUBOID JOINT.

62. TALECTOMY
• INDICATION-
 RESERVED FOR SEVERE UNTREATED CLUBFOOT
• AGE - <6 YEARS
• PROCEDURE-
 COMPLETE EXCISION OF TALUS
 DEROTATE THE FOOT AND DISPLACE THE
CALCANEUS POSTERIORLY INTO ANKLE MORTISE
UNTIL NAVICULAR ABUTS THE ANTERIOR EDGE OF
TIBIAL PLAFOND.
• COMPLICATION-
 LOSS OF LIMB LENGTH
 LIMITATION OF ANKLE MOVEMENT

63. EXTERNAL FIXATOR
• INDICATION-
IN CASE OF NEGLECTED AND RECCURENT DEFORMITY WITH SEVERE
SCARRING
• MODALITIES-
 ILLIZAROV’S EXTERNAL FIXATOR
 JESS (JOSHI EXTERNAL STABILIZING SYSTEM)
• ADVANTAGE-
 PREVENT CRUSHING OF THE TISSUES ON CONVEX SIDE
 LENGHTENS THE LIMB
 EFFECTIVELY CORRECT THE DEFORMITY AT SAME TIME

65. JESS
• PRINCIPLE- DIFFERENTIAL
DISTRACTION
• ADVANTAGE-
 LENTHENS ALL CONTRACTED TISSUES
PREVENTING HISTIOGENESIS AND
THUS AVOID CUTTING OF THESE
IMMINENT SCARRING.
 POSSIBLE TO CONTROL MAGNITUDE
OF CORRECTION.
 NO FURTHER SHORTHENING OF FOOT
 RESULTANT FEET IS VERY SUPPLE.

66. SUMMARIZING PLAN OF TREATMENT

69. Thank You