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Monday, February 14, 2011

CONGENITAL TALIPES EQUINOVARUS (CTEV)

Club foot is a congenital contracture of he joints of the foot. The main clinical signs of congenital talipes equinovarus are

  • Equinus (plantar flexion of the foot in the ankle joint),
  • Supination (the plantar surface of the foot is turned inward)
  • Forefoot adduction (the anterior part of the foot is displaced medially).
Congenital clubfoot presents in two clinical forms, namely typical (75 percent) and Atypical (25 percent)

In addition to the deformity of the foot children with congenital clubfoot have a leg rotated inward and restricted movement of the ankle joint. The degree of deformity is aggravated as soon as the child begins to walk, and skin on the outer border of the foot becomes rough, and callosities develop with bursae.
Adults with neglected CTEV walk on the outer borders of their feet.

Causes
  1. Mechanical theory- due to abnormal intrauterine position of the fetus.
  2. Ischaemic theory- ischaemia of calf muscles during intrauterine life results in contracture, leading to foot deformities.
  3. Genetic theory- some genetically related disturbances in the development of foot leads to deformity.
  4. Neuromuscular deficit.
Secondary club foot
  1. Paralytic disorders- polio
  2. UMN disorders-rare
  3. Post trauma
Conservative treatment of Club foot
Passive movements to ankle and foot joints, and followed by gentle passive stretching to the posterolateral tight structures; if possible active movements should be encouraged during therapy. These are done three or four times a day for three to five minutes, with intervals for stroking and massaging the foot and leg. After each procedure the foot is immobilised by means of a soft bandage in the corrected position attained.
a. In the new born, the mother is taught to manipulate the foot.
b. In a three-month-old child, the surgeon manipulates the foot once in two weeks an dthe foot is held in the corrected position by strapping with above knee plaster cast.
The older of correction of deformity is
  • Adduction deformity
  • Varus deformity
  • Equinus deformity
Children up to two years of age who are bought late to doctors should be immediately put in plaster casts which makes the subsequent operation on the tendo-ligamentous structures much easier.
Massage, baths, and corrective exercises are also prescribed and, in cases with weakend muscles, rythmic faradic stimulation of the anterior peroneal muscles may be given. When conservative treatment proves ineffective an operation on the tendo-ligamentous tissues is indicated at the age of two to two-and-a-half years.

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