CTEV in paediatrics. Introduction and Management.

1. PAEDIATRIC ORTHOPAEDICS

2. Outline
• Congenital Talipes Equino Varus
• DDH
• Perthes
• SCURFY
• Limb Length Discrepancy
• Angular Deformity

3. AMALINA MOHD DAUD
0917298
IIUM

4. Outline
• What is CTEV?
• Epidemiology
• Causes
• Anatomy and pathoanatomy
• Clinical features
• X-rays
• Treatment

5. What is CTEV??
• Idiopathic clubfoot
• Causing CAVE
- midfoot Cavus/ increase in height
-forefoot Adductus
-hindfoot Varus
-hindfoot Equinus/ plantarflex

6. Hind foot equinus
Heel in varus
Midfoot cavus

7. Epidemiology
• Relatively common- 1 to 2 per thousand births
• Boys affected twice
• Bilateral in 1/3 of cases

8. Causes-unknown
• germ defect
• arrested development
• neuromuscular disorder in neurological
disorders and neural tube defect
• postural deformity

9. Common Types
1. Congenital
- uncommon bony problems present upon childbirth not
related to any neuromuscular factor or symptoms.
2. Teratologic
-a/w neurological conditions (eg: spina bifida)
3. Positional
- in contorted position in utero
4 Syndromic
-a/w standard hereditary issue, which includes
arthrogryposis.

10. Anatomy
• Hindfoot
-calcaneum, talar
• Midfoot
-cuboid, navicular,
cuneiform
• Forefoot
- metatarsals, phalanges

11. Pathological Anatomy
Neck of Tallus
-pointing downward
and deviates
medially
Body of Tallus
- Rotated outward
Posterior part of calcaneum
-held close to fibula by CF ligt
-tilted into equinus and varus
-rotated medially beneath
ankle
Navicular and forefoot
-shifted medially
-rotated into
supination
(composite varus
deformity)

12. Pathological Anatomy
• Skin and soft tissue of calf and medial side of
foot are short and underdeveloped
• If not corrected early, secondary growth
changes occur in the bones-PERMANENT

13. Clinical Features
• Heel is small and high
• Deep creases appear posteriorly and medially
• Abnormal thin calf

14. • Varying degree of resistance / fixed deformity
when try to dorsiflex and evert the foot
Normal baby foot

15. • Associated disorders
- congenital hip dislocation
- spina bifida
-arthrogryposis : absent of creases
• Look if other joints are affected

16. How to differentiate true and postural
clubfoot?
• True clubfoot – fixed deformity
• Postural talipes – easily correctable by gentle
passive movement

17. IMAGING
X-ray to assess progress of treatment

18. Anterioposterior view
Kite’s angle (talocalcaneal angle): normal 20-40 degree
clubfoot angle almost parallel
30 degree
plantarflex

19. Lateral Film (Turco view)
Normal angle : 40 degree
If less 20 degree: rocker bottom deformity
- calcaneum seem to be dorsiflexed but it had
broken at midtarsal level
Foot dorsiflex

20. TREATMENT

21. Aim
To produce and maintain a plantigrade, supple
foot that will function well

22. Non Operative Operative
• Serial Manipulative and Casting
(Ponsetti’s method)
• -Posteromedial tissue release and
tendon lengthening
• -medial opening or lateral column-
shortening osteotomy, or cuboidal
decancellation
• -triple arthrodesis
• -tallectomy

23. Serial Manipulative and Casting
(Ponsetti’s method)
• Goal-rotate leg laterally around the fixed tallus
• Order of correction (CAVE)
-midfoot cavus
-forefoot adductus
-hindfoot varus
-hindfoot equinus

24. Increase the
supination
deformity of
forefoot

28. DON’T SLEEP. TQ