TREATMENT OF CONGENITAL TALIPES

EQUINO VARUS (CTEV)

Amalina Aminuddin 0820121000 67

Content Method of correction

Non-operative Operative

Method of maintenance

methods

- operative methods Manipulation

Done by mother For minor deformities

Manipulation and casting Kite’s philosophy Ponsetti’s philosophy

Kite’s Philosophy Begin at month

Adduction inversion equinus Below knee cast , every 2 weeks Within 6-9 months

Ponsetti’s Philosophy Within week of life Cavus Adduction Varus Equinus Above knee cast, every 5-7

days Within 6 weeks

Operative methods Indicated in

Resistant clubfeet Recurrent clubfeet Neglected clubfeet

a) PMSTRb) Limited soft tissue

releasec) Tendon transfersd) Dwyer’s osteotomye) Dilwyn Evan’s

proceduref) Wedge tarsectomyg) Triple arthrodesish) Ilizarov’s technique

a) Postero-Medial Soft Tissue Release

i.Posterior side: Lengthen

tendonachilles by Z-plasty

Release posterior capsule of ankle and subtalar joint

Release posterior talo- fibular and calcaneo-fibular ligament

ii. Medial side Lengthen

ligaments Tibialis

posterior Flexor

digitorum longus

Flexor hallucis longus

Release ligaments Talo-

navicular Superficial

part of deltoid ligament

Spring ligament

Release more structure Interosseous talo-calcaneal ligament, capsules of

naviculo-cuneiform, cuneiform-first metatarsal joints

iii.Plantar side Plantar fascia release Flexor digitorum brevis and abductor hallucis

release

Partially corrected foot Equinus : posterior Adduction : medial Cavus : plantar

Transfer tibialis anterior to act as everter

Minimun age : 5 years old

b) Limited Soft Tissue Release c) Tendon Transfers

d) Dwyer’s osteotomy Correct varus At least 3 years old

e)Dilwyn Evan’s procedure For recurrent/ neglected

cases between 4- 8 years old

PMSTR + calcaneo-cuboid fusion

After 12 years old Between 8 – 11 years old

f) Wedge tarsectomy g) Triple arthrodesis

h) Ilizarov’s technique Neglected /

recurrent cases

a) CTEV Splints b) Denis Brown Splints

c) CTEV Shoes

(A)Fresh case at birth Ponsetti method

Tenotomy of tendoachilles

Correct

Not corrected till 4-6 months

Follow up till 10-12 years old

All deformities left : PMSRTOnly equinus: Posterior releaseOnly heel varus : Dwyer’s osteotomy

Congratulations

Treat as (B)

(B) Old, neglected cases< 3 years old 4-8 years old 8 – 11 years old

>12 years old Already operated

Soft tissue release

Reference Maheswari and Mhaskar ‘s Essential Orthopedics

5th edition,2015 Louis Solomon, David Warwick and Selvadurai

Nayagam , Apley’s System of Orthopaedics and Fracture, 9th edition