CONGENITAL

TALIPES EQUINO
VARUS (CTEV)

Muhammad Sayyid
Zulwaqar Bin Saffie
1001335818
Year 5 Group 3

NOMENCLATURE
Equinus: (derived from
equine i.e., a horse - walks
on toes). This is a deformity
where the foot is fixed in
plantar-flexion. Reverse calcaneus
Varus: Foot inverted and
adducted at the mid-tarsal
joints so that the sole faces
inwards. Reverse valgus
Cavus: Longitudinal arch of
the foot is exaggerated.
Reverse - Planus

CTEV
1-2 in 1000 birth
M > F (2:1)
Bilateral in 1/3 of the cases
Heel = equinus
Entire hindfoot = varus
Mid foot and forefoot = adducted and supinated

ETIOLOGY
Idiopathic
Mechanical theory ( raised intrauterine
pressure )
Ischaemic theory (ischemic contracture)
Genetic theory ( arrested development)

Secondary
Paralytic disorder ( spina bifida, polio)
Arthrogryposis multiplex congenital
(defective development of muscles)

PATHOANATOMY
All the tissue in the foot have
developmental abnormality
Bone:
Neck of talus point downwards and deviates medially
Body of talus rotated slightly outward

Joint:
Equinus: ankle and tarsal joints
Inversion: subtalar joint
Forefoot adduction: mid tarsal joints ( talo-navicular)
Forefoot cavus: mid-tarsal joints

Muscle and Ligaments :

Underdeveloped, short and contracted.

Skin:
short and underdeveloped

Secondary changes:
Occur when starts walking
callosity and bursa at lateral foot

CLINICAL FEATURES
Usually obvious at birth;

Deep creases: posteriorly and medially.

Absence indicating arthrogryposis

Calf is abnormally thin.

 Bilateral foot deformity 60%

cases.
Size of the foot smaller (in
unilateral cases).
Foot is in equinus, varus and
adduction.
Heel is small in size; the
calcaneum may be felt with great
difficulty.
Deep skin creases on the back
of the heel and on the medial
side of the sole.
Bony prominences felt on the
lateral side of the foot, the head
of the talus and lateral malleolus.
Outer side of the foot is gently
convex. There are dimples on the
outer aspect of the ankle

Fixed deformity or varying degrees of resistance in

dorsi-flexing and everting the foot. ( tight tendoachilles
and plantar fascia)

A/w CDH and spina bifida

DIAGNOSIS
easy in cases presenting soon after birth
those presenting late, secondary causes of talipes
equino-varus deformity must be excluded
X-rays of the foot are done (AP and lateral) with the
foot in whatever corrected position possible
talo-calcaneal angles*, in both, AP and lateral views, in
a normal foot are more than 35, but in CTEV these are
reduced
X-rays are used as baseline documentation of the
deformities and a method for assessment of correction
after treatment.

X RAY
Assess progress after
treatment.
AP: reduce Kites angle (TC
angle)

Rocker bottom deformity

TREATMENT
Aim of treatment:

produce and maintain a plantigrade,

supple foot that will function well.

Relapse is common.

CONSERVATIVE
Begin first 2 days of life.
Repeated manipulation and adhesive strapping that
maintains the correction;
light plaster cast
1.
2.
3.

Forefoot brought into rotational alignment with the hindfoot

Both hindfoot and forefoot are together gradually brought
out of varus and supination
Equinus is corrected by bringing the heel down and
dorsiflexing the foot. Percutaneous tendo achilis lengthening.

X-ray: Ensure no rocker-bottom defect

OPERATIVE
(1) the complete release of joint tethers
(2) lengthening of tendons so that the foot can be positioned
normally without undue tension.
Lengthening tendo Achillis and tibialis posterior tendons
through Z-divisions.
Divide posterior capsules of the ankle and subtalar joints to
correct hindfoot equinus.
Release calcaneo-fibular ligament, complete subtalar release.
Release superficial deltoid ligament and preserve deep part
Release the contractures around the talonavicular and
calcaneocuboid joints
Release origin of the intrinsic muscles and plantar fascia from
the calcaneum.

Immobilize corrected foot in a plaster cast with Kwires

hobble boots or a custom-made anklefoot
orthosis is used
Stretching exercises

LATE OR RELAPSED
CLUB-FOOT

Aged 47: revision of the soft tissue

with calcaneo-cuboid fusion or
cuboid enucleation
Calcaneal osteotomies improve
heel varus.
Tendon transfers (tibialis anterior
tendon & tibialis posterior)

Ilizarov method
Triple arthrodesis

THANK
YOU