Ctev Power Point

7/26/2019 Ctev Power Point

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Congenital Talipes Equino-Varus(Congenital Clubfoot)

PROF. SOHA! "#A! SHE$H

HO%&ORTHOPAE%CS'CT&PRH


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At te en of tis le*ture+ ,ousoul be able to

%ene CTEV

%ene talipes algus Enlist etiologi*al fa*tors

%es*ribe Clini*al features

Enlist treat/ent /oalities.


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THE NORMAL FOOT

Complex organ that is required to be

Stable:for supporting te bo0 1eigt in

staning

Resilient:for 1al2ing an running

Mobile: to a**o//oate ariations of surfa*e

Cosmetic


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CLUB FOOT

Gross deformity of the foot that isgiving it the stunted lumpy

appearance


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%enition


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CLUB FOOT

Definitions

Talipes: Talus an!le"es foot

Equinus: #$atin horse%

&oot that is in a position of

planter 'exion at the an!le(

loo!s li!e that of the horse)Calcaneus: &ull dorsi'exion at the an!le


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CLUB FOOT

Planus: 'atfoot

Cavus: highly arched foot

Varus: heal going to*ardsthe midline

Valgus: heel going a*ay

from the midlineAdduction: forefoot goingto*ards the midline

Abduction: forefoot going a*ay&rom the midline

Forefoot Hind foot


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CLUB FOOT

TypesPostural :

Cal*aneo-Valgus Equino-Varus

!oo2 for C%H 'inor an*orre*table


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fa*tors


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CLUB FOOT

Etiological Factors

Idiopathic (Unknown Etiolog! :

Congenital Talipes +quino,-arus CT+-Acquired" #econdar to :

C.S /isease : Spina bi0da(

"oliomyelitis 1rthrogryposis

1bsent 2one : 0bula 3 tibia


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Congenital Talipes Equino-Varus

CTEVCongenital *lubfoot or CTEV o**urs

t0pi*all0 in an oter1ise nor/al *il.


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CTEV

Etiology

Some of these factors are :

1bnormal intrauterine forces

1rrested fetal development

1bnormal muscle and tendon insertions

1bnormal rotation of the talus in themortise

Germ plasm defects


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CTEV

Incience 4ccurs approximately in one of every

5666 live birth

7n a8ected families( clubfeet are about 96times more frequent in o8spring

Male are a8ected in about ;< of cases

2ilateral cases are as high as 96 = >6 , ?oints Capsule

;, S!in , .erves F-essels


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CTEV


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CTEV

DiagnosisGeneral +xamination :

+xclude .eurological lesion that can cause thedeformity @Spina 2i0daA

4ther abnormalities that can explain thedeformity @1rthrogryposis( MyelodysplasiaA

"resence of concomitant congenitalanomalies@"roximal femoral focal de0ciencyA

Syndromatic clubfoot @$arsens syndrome( 1mniotic band

SyndromeA


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CTEV

Diagnosis

Spina Bifida = Paralytic TEVSpina Bifida = Paralytic TEV


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CT+-

DiagnosisCharacteristic /eformity :

Hind foot +quinus #1n!le Ioint%

-arus #Subtalar Ioint%

&ore foot 1dduction #Med tarsal Ioint%

Supination fore foot

Cavus


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CT+-

Diagnosis


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CT+-

Diagnosis

Hind foot Fore footHind foot Fore foot

Equinus, Varus Adduction, Supination, CavusEquinus, Varus Adduction, Supination, Cavus


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CT+-

Diagnosis


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CT+-

Diagnosis Short 1chilles tendon

High and small heel .o creases behind Heel 1bnormal crease in middle of the foot &oot is smaller in unilateral a8ection

Callosities at abnormal pressure areas 7nternal torsion of the leg Calf muscles *asting /eformities dont prevent *al!ing


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CT+-

Diagnosis


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CT+-

Diagnosis

)*+aneeded to assess progress of

treatment


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'oalities


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CT+-

Treat%ent

The goal of treatment for clubfoot

is to obtain a plantigrade foot thatis functional( painless( and stable

over time

1 cosmetically pleasing appearanceis also an important goal sought by

the surgeon and the family


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CT+-

Treat%entNon s$rgical treat%ent s"o$l &egin s"ortly after &irt"

5) Gentle manipulation

E) 7mmobiliJation

, Strapping DDDD

, "4" or synthetic cast


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CT+-

Treat%entNon s$rgical treat%ent s"o$l &egin s"ortly after &irt"

9) Splints to maintain correction , 1n!le,foot orthosis DDDD

, /ennis 2ro*n splint


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C i l T li E i V


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CT+-

Treat%ent

Manip$lation an serial casts

Valiity' $p to ( %ont"s )

Tec"ni*$e +!onseti,

A#oi false correction

-"en to stop .

Maintaining t"e correction

Follo/ $p to /atc" an a#oi rec$rrence

C it l T li E i V


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CT+-

Treat%ent!onseti tec"ni*$e

5) 1l*ays use long leg casts( change*ee!ly)

E) &irst manipulation raises the 5stmetatarsal to decrease the cavus

9) 1ll subsequent manipulations include

pure abduction of forefoot *ith counter,pressure on nec! of talus)>) .ever pronate K;) .ever put counter pressure on calcaneus

or cuboid)

C it l T li E i V


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CT+-Treat%ent

!onseti tec"ni*$e 0cont12) Cast until there is about 6 degrees of external

rotation #about >, casts%L) "ercutaneous tendo 1chilles tenotomy in cast

room under local anesthesia( follo*ed by 0nalcast #9 *ee!s%

) 1fter 0nal cast removal( apply .ormal lastshoes *ith /enis 2ro*ne bar set at L6 degrees

external rotation #>6 degrees on normal side%N) /enis 2ro*ne splint full time for t*o months(

then night time only for t*o,four years)56)9;< need 1nterior Tibialis tendon transfer at

age E,9

C it l T li E i V


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CT+-

3$rgical Treat%ent

7ndications

$ate presentation( after months of age K Complementary to conservative treatment

&ailure of conservative treatment

Residual deformities after conservative

treatment

Recurrence after conservative treatment

C it l T li E i V


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CT+-

3$rgical Treat%ent

Types 0soft tiss$e an &ony operations2

Ti%e of s$rgery

3election of t"e proce$re an t"e incision

!ost operati#e care

Follo/ $p

Co%plications

C it l T li E i V


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CT+-

3$rgical Treat%ent

Soft tissue operations

5) Release of contractures

E) Tenotomy

9) Tendon elongation

>) Tendon transfer;) Restoration of normal bony

relationship

C it l T li E i V


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CT+-

3$rgical Treat%ent

C it l T li E i V


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CT+-

3$rgical Treat%ent

C it l T li E i V


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CT+-3$rgical Treat%ent

Bony operations Inications

Us$ally acco%panie /it" soft tiss$e operation

Types4

5 Osteoto%y' to correct foot efor%ity or int1 ti&ial torsion

5 -ege e6cision

5 Art"roesis 0$s$ally after &one %at$rity2

one or se#eral 7oints

5 3al#age operation to restore s"ape

C it l T li E i V


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Congenital Talipes Equino Varus


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"uestions

A. Club foot in a ne1 born is treateb0

a. Surger0

b. 'anipulation b0 /oter

C. %ennis bro1n splint

%. Strapping


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n *orre*tion of *lubfoot b0/anipulation+ 1i* efor/it0 soulbe *orre*te rst

9(a) Forefoot au*tion.

(b) Varus.

(*) :pper en tibia.

(). Cal*aneu/


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Club foot seen in a 3; 0ear ol bo0*oul be treate su**essfull0 b0

9(a) Appropriate foot1ear.

(b)Soft tissue operation

.(*) Triple artroesis

() "uariple fusion


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'ost i/portant patolog0 in *lub footis

9(a). Congenital talonai*ular

islo*ation.+

(b) Tigtening of Tenoa*illes.

(* ) Cal*aneal fra*ture.

() !ateral erange/ent


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Foru/ is open for questions


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Tan20ou

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