- caused by the position of the fetus in utero. Often referred to as apackaging problem. This foot can be corrected manually by the examiner. It responds well andquickly to serial casting and rarely will relapse.
tatarsus adductus (or varus)
- is a deformity of the metatarsals only. The forefootpoints to the midline of the body, or the "adductus" position. It can be corrected by manipulation also and responds to serial casting.
The anatomical deformities in CTEV are many: equinus of the heel, varus and cavus of themidfoot, and adductus and supination of the forefoot. (See Diagram One). There are changes inbone, skin, tendons and ligaments. The bones actually become distorted due to contractures of the soft tissues. (Crenshaw)
The bones chiefly deformed are the talus, calcaneus, navicular and cuboid. The ankle joint isseverely affected with significant malrotation. (See Diagrams One, Two and Three).
Upon clinical examination, the "true clubfoot" (CTEV) appears to have the above-describedmalformations and is stiff. It will not correct upon manipulation manually because the fixedcontractures cause gross stiffness.
It is evident that this anomaly is very complicated and a serious problem facing the orthopaedicsurgeon!
escription of the deformities
There is a dislocation of the talonavicular joint. The talus is deviated medially and plantarward. Itis locked in the ankle mortise and cannot rotate. The rest of the foot rotates around it.
The calcaneus is in varus and the distal end is displaced medially. When seen from above, its long axis is the same as the talus. In other words, the talus and calcaneus in CTEV are parallel. In thenormal foot, these two bones diverge: the talus aligns with the first metatarsal and the calcaneus with the fifth. In CTEV, they overlap and face laterally, aligning toward the fifth metatarsal. (SeeDiagram Two).
In the lateral view, again the talus and calcaneus in CTEV appear to be parallel. In the normalfoot, upon dorsiflexion, these two bones form a converging angle. (See Diagram Three).
The navicular, cuboid and metatarsals are also deformed and displaced and articulate improperly. The tendo Achilles is shortened. Muscular atrophy is generalized and inherent.
Upon examination, the surgeon will also note: atrophy of the lower leg, an empty heel pad, as thecalcaneus is high, pronounced creases on the medial, posterior aspect of the heel and ankle, andno skin creases on the dorsolateral aspect of the foot.