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CTEV UG

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This document provides an outline on clubfoot (CTEV), including its epidemiology, causes, anatomy, pathoanatomy, clinical features, imaging, and treatment. CTEV is a relatively common birth defect affecting 1-2 per 1000 births. It involves four deformities: cavus, adductus, varus, and equinus (CAVE). The causes are unknown but may involve genetic or positional factors. Treatment focuses on serial manipulation and casting, especially the Ponseti method, to gradually correct the deformities in a specific order and avoid the need for invasive surgery. The goal is to produce a functional, plantigrade foot.

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HETA PATEL (R2)
Outline • What is CTEV? • Epidemiology • Causes • Anatomy and pathoanatomy • Clinical features • X-rays • Treatment
What is CTEV?? • Idiopathic clubfoot • Causing CAVE - midfoot Cavus/ increase in height -forefoot Adductus -hindfoot Varus -hindfoot Equinus/ plantarflex
Hind foot equinus Heel in varus Midfoot cavus
Epidemiology • Relatively common- 1 to 2 per thousand births • Boys affected twice • Bilateral in 1/3 of cases
Causes-unknown • germ defect • arrested development • neuromuscular disorder in neurological disorders and neural tube defect • postural deformity
Common Types 1. Congenital - uncommon bony problems present upon childbirth not related to any neuromuscular factor or symptoms. 2. Teratologic -a/w neurological conditions (eg: spina bifida) 3. Positional - in contorted position in utero 4 Syndromic -a/w standard hereditary issue, which includes arthrogryposis.
Anatomy • Hindfoot -calcaneum, talar • Midfoot -cuboid, navicular, cuneiform • Forefoot - metatarsals, phalanges
Pathological Anatomy Neck of Talus -pointing downward and deviates medially Body of Talus - 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)
Pathological Anatomy • Skin and soft tissue of calf and medial side of foot are short and underdeveloped • If not corrected early, secondary growth changes occur in the bones-PERMANENT
Clinical Features • Heel is small and high • Deep creases appear posteriorly and medially • Abnormal thin calf
• Varying degree of resistance / fixed deformity when try to dorsiflex and evert the foot Normal baby foot
• Associated disorders - congenital hip dislocation - spina bifida -arthrogryposis : absent of creases • Look if other joints are affected
How to differentiate true and postural clubfoot? • True clubfoot – fixed deformity • Postural talipes – easily correctable by gentle passive movement
IMAGING X-ray to assess progress of treatment
Anterioposterior view Kite’s angle (talocalcaneal angle): normal 20-40 degree clubfoot angle almost parallel 30 degree plantarflex
Lateral Film (Turco view) Normal angle : 40 degree If less 20 degree: rocker bottom deformity - calcaneum seem to be dorsiflexed but it had broken at midtarsal level Foot dorsiflex
TREATMENT
Vision & Mission • Since CTEV can purely be therapeutic work we would not only treat also HABILITATE club foot to be normal. • Increase awareness and confidence of society with therapeutic staff.
Aim To produce and maintain a PLANTIGRADE, supple foot that will function well
Non Operative Operative • Serial Manipulative and Casting (Ponsetti’s method) • -Posteromedial tissue release and tendon lengthening • -medial opening or lateral column- shortening osteotomy, or cuboidal decancellation • -triple arthrodesis • -tallectomy
Serial Manipulative and Casting (Ponsetti’s method) • Goal-rotate leg laterally around the fixed tallus • Order of correction (CAVE) -midfoot cavus -forefoot adductus -hindfoot varus -hindfoot equinus
Increase the supination deformity of forefoot
CTEV UG
CTEV UG
CTEV UG
DON’T SLEEP. TQ
CTEV UG

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CTEV UG

  • 2. Outline • What is CTEV? • Epidemiology • Causes • Anatomy and pathoanatomy • Clinical features • X-rays • Treatment
  • 3. What is CTEV?? • Idiopathic clubfoot • Causing CAVE - midfoot Cavus/ increase in height -forefoot Adductus -hindfoot Varus -hindfoot Equinus/ plantarflex
  • 4. Hind foot equinus Heel in varus Midfoot cavus
  • 5. Epidemiology • Relatively common- 1 to 2 per thousand births • Boys affected twice • Bilateral in 1/3 of cases
  • 6. Causes-unknown • germ defect • arrested development • neuromuscular disorder in neurological disorders and neural tube defect • postural deformity
  • 7. Common Types 1. Congenital - uncommon bony problems present upon childbirth not related to any neuromuscular factor or symptoms. 2. Teratologic -a/w neurological conditions (eg: spina bifida) 3. Positional - in contorted position in utero 4 Syndromic -a/w standard hereditary issue, which includes arthrogryposis.
  • 8. Anatomy • Hindfoot -calcaneum, talar • Midfoot -cuboid, navicular, cuneiform • Forefoot - metatarsals, phalanges
  • 9. Pathological Anatomy Neck of Talus -pointing downward and deviates medially Body of Talus - 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)
  • 10. Pathological Anatomy • Skin and soft tissue of calf and medial side of foot are short and underdeveloped • If not corrected early, secondary growth changes occur in the bones-PERMANENT
  • 11. Clinical Features • Heel is small and high • Deep creases appear posteriorly and medially • Abnormal thin calf
  • 12. • Varying degree of resistance / fixed deformity when try to dorsiflex and evert the foot Normal baby foot
  • 13. • Associated disorders - congenital hip dislocation - spina bifida -arthrogryposis : absent of creases • Look if other joints are affected
  • 14. How to differentiate true and postural clubfoot? • True clubfoot – fixed deformity • Postural talipes – easily correctable by gentle passive movement
  • 15. IMAGING X-ray to assess progress of treatment
  • 16. Anterioposterior view Kite’s angle (talocalcaneal angle): normal 20-40 degree clubfoot angle almost parallel 30 degree plantarflex
  • 17. Lateral Film (Turco view) Normal angle : 40 degree If less 20 degree: rocker bottom deformity - calcaneum seem to be dorsiflexed but it had broken at midtarsal level Foot dorsiflex
  • 19. Vision & Mission • Since CTEV can purely be therapeutic work we would not only treat also HABILITATE club foot to be normal. • Increase awareness and confidence of society with therapeutic staff.
  • 20. Aim To produce and maintain a PLANTIGRADE, supple foot that will function well
  • 21. Non Operative Operative • Serial Manipulative and Casting (Ponsetti’s method) • -Posteromedial tissue release and tendon lengthening • -medial opening or lateral column- shortening osteotomy, or cuboidal decancellation • -triple arthrodesis • -tallectomy
  • 22. Serial Manipulative and Casting (Ponsetti’s method) • Goal-rotate leg laterally around the fixed tallus • Order of correction (CAVE) -midfoot cavus -forefoot adductus -hindfoot varus -hindfoot equinus

Editor's Notes

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