Club Feet (Congenital Talipes Equinovarus (CTEV))

Introduction
CTEV is an acronym of Congenital Talipes Equinovarus where Congenital means since birth, Talus is ankle, Pes is foot, Equinus is horse like and varus is turned inward. It is a congenital deformity which affect one or both the feet of a child.  

Incidence
It’s a common condition which affects 1 in 1000 live births. It affects boys more than girls and the ratio is approximately 2:1

Symptoms / Clinical Signs
In the initial stage
The forefoot is twisted downward and inward which ultimately increase the arch and turn the heel inward. Sometimes, the foot is so turned that it looks like the up side down.
In the later stage
The affected leg has underdeveloped calf muscles and the foot may be half inch shorter than the affected foot. In case of bilateral involvement, it may have some asymmetry

Types
CTEV can be described in two headings

  • Postural CTEV
  • Structural CTEV

Causes
In most of the cases, the exact cause of the deformity is not known
A few syndromes present CTEV as associated problems such as Edward Syndrome, Compartment Syndrome, Ehler’s-Danlos Syndrome and Loeys-Dietz Syndrome
Children with Spina bifida may have CTEV as associated problems.
Family history with CTEV increases the chances of having a child with CTEV
According to reports, the chances of CTEV increases if the mother smokes during pregnancy
Insufficient amniotic fluid in pregnancy has been reported one of the risk factors.

Diagnosis making / Tests and Investigations
CTEV is commonly identifies at birth. A doctor can recognize the disorder just looking at the shape of the foot / feet. To know the severity of the disorder, the doctor will ask for X-ray of the foot.
In fact bilateral CTEV can be detected by ultrasound during pregnancy only. Although nothing can be done in the pregnancy but parents become aware of the condition which helps the family to cope easily.
In most of the cases, a club foot is an isolated condition but it can be an associated disorder of other problem like Spina bifida.

Management / Treatment
As the condition is detected at birth only, the management starts from birth only. Although, there is no specific drug available which can help the deformity to be corrected but lot of other treatment systems are available. The best available management technique is PONSETI METOHD.

PONSET METHOD (Non Surgical Treatment)
It is a combination technique where the child gets intermittent stretching and casting for a few months. When the foot becomes enough align, a splint called DENIS BROWNE BAR WITH BOOT is used. After DENIS BROWNE BAR WITH BOOT splint, the foot is put under Custom Made Foot Orthosis (CFO) rather than AFO. Generally the CFO is modified according to the need and change in 3-4 months. 80% of the children benefit from this method and rarely require orthopedic surgery.

Surgical Treatment
A few cases of CTEV which are not fully corrected may need tenotomy. Generally, tenotomy of the Achilles Tandon is done. Tenotomy is done under local anesthesia. In some cases, the child required a series of surgery on the basis of severity.

BOTOX
Botulinum Toxin Injection has been used as one of the treatment techniques these days. It is used to relax the stiff muscles. When the stiff muscles are relaxed, it becomes easy to fit the CFO and stretching of the muscles without much pain. Botox can be used along with PONSET METHOD before the surgical procedure.
  
Prognosis
Most of the children with CTEV get deformity correction with available treatment technique and lead normal life. If the child is not treated well, the child will get problem with mobility. The child may have problem with shoe if it is unilaterally affected. Severely affected children can get problems of arthritis in the long run. The scientifically treated children can lead a productive life as others. In case of Spina bifida and other syndromes, the treatment is less successful.

 

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