PATHOLOGY AND MANAGEMENT OF CONGENITAL

TALIPES EQUINOVARUS (CTEV)

DR.EVESHOYAN D.E
REGISTRAR DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY ,UUTH UYO.
ANATOMY OF THE FOOT
BONES OF THE FOOT
ANATOMY OF THE FOOT
ARCHES OF THE FOOT
PATHOGENESIS OF CTEV
• Arrest of fetal development in the fibular stage
• Defective cartilaginous anlage of the talus
• Neurogenic factors
• Retracting fibrosis
• Anomalous tendon insertions
• Seasonal variations
ETIOLOGY
• The true etiology of CTEV is unknown.
• Most infants who have clubfoot have no identifiable genetic ,
syndromic or extrinsic cause.
A. Extrinsic associations include:
1. Teratogenic agents e.g sodium aminopterin
2.Oligohydraminos
3. Congenital constriction rings
ETIOLOGY
B. Genetic associations include:
1.Mendenlian inheritance e.g diastrophic dwarfism; autosomal
recessive pattern of clubfoot inheritance
2.Cytogenetics abnormalities .e.g trisomy 15{ CTEV}
3.Idiopathic CTEV in otherwise healthy infants is the result of a
multifactorial system of innheritance
 ETIOLOGY CONT’D
• EVIDENCE OF MULTIFACTORIAL SYSTEM OF INHERITANCE OF IDIOPATHIC CTEV IS AS FOLLOWS:

- Evidence in the general population is 1 per 1000 live births

- Incidence in first degree relation is approximately 2%

- Incidence in second degree relation is approximately 0.6%

- If one monozygotic twin has CTEV , the second twin has only a 32% chance of having CTEV
 ETIOLOGY CONT’D

Other Etiological Theories Include;

-Chromosomal
-Embryonic
-Otogenic
-Fetal

-Neurological
-Muscular
Complications of surgical clubfoot release
• Infection
• Wound breakdown
• Stiffness and restricted ROM
• AVN of the talus
• Persistent intoeing
• Overcorrection which is associated with the following:
- Release of the interosseous ligament of the subtalar joint
- Excess lateral displacement of the navicular on the talus
- Overlengthening of the tendon unit
PROGNOSIS
• Approximately 50% of clubfoot in the new born can be corrected non-
operatively.
• Ponseti reported an 89% success rate using his technique.
• The current rate of deformity were reported at around 25% with a
range of 10-50%
• The best results were obtained from children older than 3-4months.
• Relapses occur in 37% of Ponseti method. Yet Ponseti method
remains a gold standard world wide, though with replicable similar
outcomes with the French PT method
CONCLUSION
• In conclusion, the Ponseti method is gaining mainstream acceptance
all over the world as evident by the comparatively painfree supple
feet. However, longterm monitoring and follow up is advocated for.
REFERENCES
• Bailey and Love 27th Edition( 680- 690)
• BAJA 4th Edition (735-800)
• Physeopaedia
• Tutorials in Orthopaedic ad Trauma SB AGAJA ( 223-230)
• Medscape