Club foot, also known as talipes, is a condition where one or both feet are twisted into an abnormal position. The causes are generally multifactorial and may include genetic and environmental factors. Clinical features are usually obvious at birth and can be assessed using the Pirani scoring system. Treatment primarily involves the Ponseti method of serial casting to correct deformities in the order of cavus, adduction, varus, and equinus. This is often followed by an Achilles tendon release. Bracing is then used long-term to prevent recurrence of the deformity. For more severe cases, soft tissue releases or bony procedures such as osteotomies may be required.

1. WELCOME TO TOPIC PRESENTATION
PRESENTED BY
DR. ASIF SARWAR
IMO, DEPT OF ORTHOPAEDICS, JRRMCH

2. CLUB FOOT
Club Foot is a condition in which one or both feet are twisted into
an abnormal position. This condition is also called Talipes.
• The term ‘talipes’ is derived from talus (Latin = ankle bone) and
pes (Latin = foot). There are several deformities in which Equino
varus is the most important talipes deformity. (CTEV)

4. Etiology
• Causes of CTEV is unknown.
• Generally considered to be multifactorial
• Evidence for a genetic contribution* (chromosome 17)
• Prevalence varies among ethnic groups
• Evidence for environmental contribution
• Smoking

5. Epidemiologic Features of Talipes Equinovarus

6. Clinical features
• The deformity is usually obvious at birth. The clinical features
have been classified by Pirani. So that the severity can be assessed
at birth and the progress of treatment can be monitored. The
scoring system allocates 0, 0.5 or 1.0 for each of six clinical
features:
• medial crease
• lateral border of the foot
• lateral head of talus
• posterior crease
• empty heel
• ankle dorsiflexion

7. CTEV

8. Deformities
• Forefoot- adducted and apparently supinated
• Midfoot- cavus
• Hindfoot- equinus and varus

9. Investigations
X-RAY

10. TREATMENT
• The most common and widely use methods is Ponseti method.
• The three main components of the deformity are corrected in the
following order.
• Firstly, the first metatarsal is elevated to correct the cavus and
create a flat longitudinal medial border of the foot. Next, the
forefoot is abducted in the plane of the metatarsals which rotates
and everts the hindfoot and corrects the forefoot out of
supination. Finally, equinus is corrected by dorsiflexing the foot at
the ankle joint.
• At the end of the serial casting, most children have corrected
cavus, adductus and varus deformities, but continue to have
equinus deformity. To correct this, a surgical procedure is
performed called an Achilles tendon release (commonly called
Achilles tenotomy) . 3-4 weeks in a cast after tenotomy.

11. Cont.

12. Cont.
• In short we correct the CTEV by doing plaster in following order:-
(CAVE)
• CAVUS--ADDUCTION—VARUS—EQUINUS

13. Cont.
• Bracing: After successful correction is achieved through serial
casting and Achilles tenotomy, the foot must be kept in a brace to
prevent it from returning to the deformed position over the first
few years of a child's life. The brace is made up of two shoes or
boots that are connected to each other by a bar that is bent under
the shoes. This device is also called a foot abduction brace. At
first, the brace is worn full-time. After 3 months of wearing, the
brace is worn less frequently by gradually reduce, every couple
months for 12-14hr per day at or around a year old. From this
point on until at least 4–5 years, or even longer the brace is worn
mostly while sleeping at night and during naps (12–14 hours per
day). Bracing is essential in preventing recurrence of the
deformity.

14. Surgical procedure:-
• SOFT TISSUE PROCEDURE (1-4 YEARS OLD)
• Posterio-medial soft tissue release
• Z- Plasty ( tendo Achilles lenghthening )
• Posterior capsulotomy and tenotomy
• Tendon transfer
• BONY PROCEDURE ( 4-10 YEARS OLD)
• Dwyer’s procedure– wedge osteotomy of calcaneum. ( correct the varus
deformity)
• Litchblau’s procedure – distal calcaneum osteotomy
• Dilwyn-evan’s procedure- osteotomy and fusion of calcaneocuboid joint

15. Cont.
• AGE >10 YEARS ( FAILED CONSERVATIVE TREATMENT OR RELEPSE
CTEV OR DELAYED TREATMENT OR NON TREATED CASES)
• TRIPLE ARTHRODESIS
FUSION OF THREE JOINT ( SUB TALER JOINT, TALO-NAVICULAR JOINT & CALCANEO-
CUBOID JOINT)
MOST COMMON COMPLICATION - TALONAVICULAR PSEUDOARTHROSIS

16. Thank You!