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CTEV

CTEV

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Published by Vishwas Mohan
Congenital talipes equinovarus (CTEV)
Congenital talipes equinovarus (CTEV)

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Categories:Types, Research, Science
Published by: Vishwas Mohan on Dec 04, 2010
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06/09/2013

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Paediatric Clubfoot
 
Congenital talipes equinovarus (CTEV) is the medical term applied to the true clubfootdeformity in the newborn. If untreated, the foot would have no definition and would appear likea club and thus has its common name - clubfoot. (Williams & Cole).
 
 The condition varies in severity from mild, which is correctable by the examiner, to severe, in which the deformity is rigid. Treatment will reflect this.
 
"Congenital" means before or at birth. Talipes, literally "ankle-foot", refers to the talus.Equinovarus refers to the position of the clubfoot, in equinus and varus or adductus. (SeePhotos One and Two).
 
Photo One Photo Two
 
 The diagnosis can easily be made by clinical examination. The true CTEV deformity is a"manufacturing defect". It is the most common foot defect known, affecting one to two per1,000 population. Note that this condition is not painful. It is twice as common in males and canbe unilateral or bilateral 50/50%.
 
 Another reference sites the incidence as 1:400 population, but perhaps these figures refer toCTEV as well as the less severe foot deformities described below. (West & Bakewell)
 
D
ifferential diagnosis
 
 Two other deformities that have similar features are:
 
 
Postural clubfoot
- 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.
 
Me
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.
 
CTEV
 
 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!
 
D
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.
 
 
Clearly, clubfoot is "a variable three-dimensional deformity of a complex system of joints".(D.Evans, AORNJ)
 
The causes
 
 The causes of CTEV are unknown, but many factors may play a part.
 
 The child may have other anomalies such as spina bifida or arthrogryposis, in which case theclubfeet are considered teratologic deformities. (AORNJ)
 
Heredity is a factor, but the means of transmission are unknown. A baby born to a parent withclubfeet has a 1:10 chance of inheriting the disorder.
 
 A combination of genetic and environmental factors in utero appear to be the cause of CTEV. Itseems linked to arrested skeletal development during the ninth to tenth week of embryonic life.(AORNJ)
 
Brockman believes that the primary deformity is caused chiefly by congenital atresia of thearticulation of the head of the talus and that other changes are secondary to this abnormality.(Crenshaw)
 
Other theories propose neuromuscular dysfunction or muscle abnormality, primary germ plasmdefect causing dysplasia of the ankle and that the other changes are secondary to this. (AORNJ)
 

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