CTEV OR CONGENITAL Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby's foot is twisted out of shape or position. In clubfoot, the tissues connecting the muscles to the bone (tendons) are shorter than usual. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn.

1. Congenital Talipes Equino Varus

2.  Commonest congenital foot deformity
 Once in every 1000 live births
 Tendons related to the pathology are
those on the medial side – Tibialis
posterior (most important)

3. AETIOLOGY
 Idiopathic
a) mechanical theory : raised intrauterine
pressure forces the foot against the wall of
the uterus in the position of the deformit
b) ischaemic theory : ischaemia of the claf
muscles during intrauterine life, due to
unknown factors, results in contractures,
leading to foot deformities
c) genetic theory : genetically related
disturbances in the development of the foot

4.  Secondary clubfoot
a) paralytic disorders : muscle imbalance –
invertors and plantar flexors are stronger
than the evertors and dorsiflexors. Occurs
in paralytic disorders such as polio, spina
bifida, myelodysplasia, and Friedreich's
ataxia
b) arthrogryposis multiplex congenita (AMC)
: defective development muscles. Muscles
are fibrotic and result in foot deformities at
other joints.

5. PATHOANATOMY
 BONE : Bones are smaller than normal;
neck of talus is angulated such that head
faces downwards and medially;
calcaneum is small and concave medially
 Joints :
1) Equinus : primarily at the ankle joint;
other tarsal joints contribute to it.
2) Inversion : primarily at the subtalar joint.
Sole faces medially due to the inverted
calcaneum.

6. 3) Forefoot adduction : primarily at talo-
navicular joint
4) Forefoot cavus : due to excessive
arching of foot at the mid-tarsal joint.
 MUSCLES AND TENDONS
1) posteriorly – tendoachilles
2) medially – tibialis posterior, FDL, FHL

7.  CAPSULE AND LIGAMENTS : all
ligamentous structures on the postero-
medial side of the foot are shortened
1) Posterior : Posterior capsule of ankle
joint, post. capsule of the subtalar joint,
post. Talofibular and calcaneo-fibular
ligaments
2) Medial : Talo-navicular lig, spring lig,
deltoid lig
3)Plantar : plantar fascia, plantar ligs.
4)Others : interosseous lig btw the talus and
calcaneum

8.  SKIN : develpos adaptive shortening on
the medial side of the sole. Deep creases
on the medial side. Dimples on the lateral
aspect of the ankle and midfoot
 SECONDARY CHANGES : occur when
child starts walking on deformed foot.
Weight bearing exaggerates the deformity.
Callosities and bursae develop over the
bony prominences on the lateral side of
the foot.

9. CLINICAL FEATURES
 PRESENTING COMPLAINTS :
1) Presentations
a) Detected at birth
b) During early infancy
c) During late infancy and early childhood
d) During late childhood

10. EXAMINATION
 Foot examination – foot of the newborn
child can be dorsiflexed until the dorsum
touches the anterior aspect of the shin
 B/L foot deformity – 60%
 Foot is equinus, varus and adduction –
inability to bring the foot in opposite
direction; cavus may be present
 Heel is small; calcaneum felt with great
difficulty
 Deep skin creases on the back of heel and
medial side of sole.

11.  Bony prominences on the lateral side of
foot – head of talus and lateral malleolus
 Outer side of the foot is generally convex.
Dimples on the outer aspect of ankle
 Child presenting late may have callosities
over the lateral aspect of foot. Calf
muscles are wasted.

12. GENERAL EXAMINATION
 To find the underlying cause of deformity-
residual polio, sensory deficit points to a
neurologic cause, other joint deformities
indicate possible AMC

13. DIAGNOSIS
 X- Ray foot (AP & lateral) with the foot in
whatever corrected way as possible
 Talo- calcaneo angle – reduced ( normal -
35o)

14. Thank you