Congenital Talipes Equino-Varus (Congenital Clubfoot)

By William Roy S. Agoncillo CLUB FOOT Gross deformity of the foot that is giving it the stunted lumpy appearance

Planus: Cavus: Varus: Valgus: Adduction: Abduction:

flatfoot highly arched foot heal going towards the midline heel going away from the midline forefoot going towards the midline forefoot going away From the midline

Types Idiopathic (Unknown Etiology):

 Congenital Talipes Equino-Varus CTEV Acquired, Secondary to: CNS Disease : Spina bifida, Poliomyelitis Arthrogryposis
The cause is unknown, although several mechanisms have been suggested. This includes hyperthermia of the fetus, prenatal virus, fetal vascular compromise, septum of the uterus, decreased amniotic fluid, muscle and connective tissue developmental abnormalities. In general, the causes can be classified into extrinsic and intrinsic factors.

Absent Bone : fibula / tibia Congenital clubfoot or CTEV occurs typically in an otherwise

Adaptive Changes

 Bony : Change in the shape of tarsal and metatarsal Soft Tissue : Shortening Contracture in the Concave Side 1- Muscles 3- Ligaments 5- Skin 2- Tendons 4- Joints Capsule 6- Nerves & Vessels

Characteristic Deformity :

Equinus

(Ankle joint)

Varus

(Subtalar joint)

Adduction

(Med tarsal joint)

Supination fore foot

Cavus (arched)

Non surgical treatment should begin shortly after birth

1.

Gentle manipulation

2.

Immobilization - Strapping - Synthetic cast

3.

Splints to maintain correction - Ankle-foot orthosis - Dennis Brown splint

Ponseti method

The manipulative treatment of clubfoot deformity is based on the inherent properties of the connective tissue, cartilage, and bone, which respond to the proper mechanical stimuli created by the gradual reduction of the deformity. The ligaments, joint capsules, and tendons are stretched under gentle manipulations. A plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments. The displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency. After two months of manipulation and casting the foot appears slightly over-corrected. After a few weeks in splints however, the foot looks normal.