Many people who read this post may have ever seen that picture. However, do you know what's the name of that abnormality? yes that is called C.T.E.V (Congenital Talipes Equino Varus) or clobfoot.
Congenital Talipes Equino Varus is congenital defects which marked by combination of abnormality consisting of: forefoot adduction and supination through midtarsal joints, Varus heel through subtalar joint and equinus beyond ankle and foot is deviated to medial if viewed from knee joint.
So what are causes of C.T.E.V? there are many theories, etc: genetic, mechanical, cessation of fetal growth, displasia of muscles causes muscle imbalance, primary defects of talus (caput and column talus deviation to medial and plantar, and the last is rotation of calcaneus to medial at subtalar.
What are symptoms and signs of C.T.E.V?
- smaller calves,
- frequent rotation of the medial leg,
- equinus at the ankle,
- location of high heels, sometimes smaller,
- varus at the subtalar
- adduction and varus at the midtarsal and "forefoot"
In naeonatus (age 24 hours), the diagnosis must be determined whether the physiological shape of the foot (because the current position in the uterus); tests on ankle dorsiflexion, if my toes could touch the tibia crest, this is not CTEV.
Children running slow, if it is running, the form of equinus varus foot, callocity on the lateral or lateral front of the foot.
In neonatus, the diagnosis must be determined whether the physiological shape of the foot (because the current position in the uterus); tests on ankle dorsiflexion, if my toes could touch the tibia crest, this is not CTEV
Children running slow, if it is running, the form of equinus varus foot, callocity on the lateral or lateral front of the foot.
How to treatment of C.T.E.V?
the medical therapy for C.T.E.V are two kinds, they are conservative and surgical treatment. Medical therapy as early as possible, golden periode is 24 hours. if delayed will make therapy is complicated.
1. Conservative
a. manipulation correction, systematically, use Gips (plaster/cast), step by step, without anesthesia
b. Adduction and varus are must be corrected first then equinus
c. PLASTER installation until the above knee, knee flexion of 90 degrees
d. duration of plaster is step by step, until stable.
2. Surgical
indications:
a. Recurrance C.T.E.V
b. failed conservative in 3 months
c. late C.T.E.V
Children running slow, if it is running, the form of equinus varus foot, callocity on the lateral or lateral front of the foot.
In neonatus, the diagnosis must be determined whether the physiological shape of the foot (because the current position in the uterus); tests on ankle dorsiflexion, if my toes could touch the tibia crest, this is not CTEV
Children running slow, if it is running, the form of equinus varus foot, callocity on the lateral or lateral front of the foot.
How to treatment of C.T.E.V?
the medical therapy for C.T.E.V are two kinds, they are conservative and surgical treatment. Medical therapy as early as possible, golden periode is 24 hours. if delayed will make therapy is complicated.
1. Conservative
a. manipulation correction, systematically, use Gips (plaster/cast), step by step, without anesthesia
b. Adduction and varus are must be corrected first then equinus
c. PLASTER installation until the above knee, knee flexion of 90 degrees
d. duration of plaster is step by step, until stable.
2. Surgical
indications:
a. Recurrance C.T.E.V
b. failed conservative in 3 months
c. late C.T.E.V
The operative procedure includes:
(1) Z-lengthening of the heel cord with release of the medial fibers distally;
(2) capsulorrhaphy of the tibiotalar and fibulotalar joints complete;
(3) capsulorrhaphy of the deltoid ligament and plantar calcaneonavicular ligament maintaining a small tongue of capsule attached to the tibia;
(4) capsulorrhaphy of the talonavicular ligaments:
(5) capsulorrhaphy of the anterior tibiotalar ligament from medial to lateral malleolus. (The talocalcaneal ligament and the posterior compartment to the foot should be avoided.)
(6) The talus is then rotated laterally in the ankle mortise and the calcaneus with it. If derotation is not complete and if the scaphoid does not glide readily to the lateral side, a second incision is made laterally, opening the calcaneocuboid joint and the cuboid metatarsal joints. The sinus tarsi is entered and the lateral talonavicular and calcaneonavicular ligaments are released, as are the tibulotalar ligaments laterally. This procedure usually allows full external rotation of the talus and the calcaneus as a unit and reestablishes the lateral border of the foot - the calcaneocuboid angle being changed from convex to neutral. The relationship between the talus and the calcaneus is reestablished and the foot is then lined up with the fibula and medial malleolus.
(7) The anterior tibial tendon is detached from the first metatarsal on the medial side and transferred to the dorsum of the first metatarsal where it is reinserted into soft tissue and periosteum in the infant, or into a hole in the first cuneiform in the older patient.
(1) Z-lengthening of the heel cord with release of the medial fibers distally;
(2) capsulorrhaphy of the tibiotalar and fibulotalar joints complete;
(3) capsulorrhaphy of the deltoid ligament and plantar calcaneonavicular ligament maintaining a small tongue of capsule attached to the tibia;
(4) capsulorrhaphy of the talonavicular ligaments:
(5) capsulorrhaphy of the anterior tibiotalar ligament from medial to lateral malleolus. (The talocalcaneal ligament and the posterior compartment to the foot should be avoided.)
(6) The talus is then rotated laterally in the ankle mortise and the calcaneus with it. If derotation is not complete and if the scaphoid does not glide readily to the lateral side, a second incision is made laterally, opening the calcaneocuboid joint and the cuboid metatarsal joints. The sinus tarsi is entered and the lateral talonavicular and calcaneonavicular ligaments are released, as are the tibulotalar ligaments laterally. This procedure usually allows full external rotation of the talus and the calcaneus as a unit and reestablishes the lateral border of the foot - the calcaneocuboid angle being changed from convex to neutral. The relationship between the talus and the calcaneus is reestablished and the foot is then lined up with the fibula and medial malleolus.
(7) The anterior tibial tendon is detached from the first metatarsal on the medial side and transferred to the dorsum of the first metatarsal where it is reinserted into soft tissue and periosteum in the infant, or into a hole in the first cuneiform in the older patient.