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Congenital Telipes Equinovarus
Congenital Telipes Equinovarus
TELIPES EQUINOVARUS)
CTEV
WHAT IS CTEV ?
CONGENITAL TELIPES EQUINOVARUS.
TALIPES MEANS ANKLE;
PES MEANS FOOT
A DIFORMITY THAT CAUSES THE PATIENT TO
WALK ON THE ANKLE.
CLUBFOOT :- IT IS CALLED BECAUSE SEVERE
UNTREATED TALIPES EQUINOVARUS HAS A
CLUB LIKE APPEARANCE.
IT IS 1 OR 2 PER 1000 BIRTHS.
MALE AFFECTED MORE THAN FEMALE.
IT IS BILATERAL 1/3 OF CASES.
HIPPOCRATES FIRST DESCRIBED CTEV.
VARIOUS TYPES OF FOOT
DEFORMITY:-
ANATOMY :-
AETIOLOGY:-
IN MAJORITY OF CASES ,
AETIOLOGY IS NOT KNOWN.
SO, IT IS IDIOPATHIC.
BUT SOMETIMES UNDERLYING
CAUSES SUCH AS
ARTHROGRYPOSIS MULTIPLEX
CONGENITA (AMC) IN SECONDARY
CLUBFOOT.
(a)IDIOPATHIC CLUBFOOT
:-
MECHANICAL THEORY:- THE RAISED
INTRAUTERINE PRESSURE FORCES
THE FOOT AGAINST THE WALL OF THE
UTERUS IN THE POSITION OF THE
DEFORMITY.
ISCHAEMIC THEORY:- ISCHAEMIA OF
THE CALF MUSCLES DURING
INTRAUTERINE LIFE DUE TO
UNKNOWN FACTOR LEADING TO FOOT
DEFORMITY.
CONT…
GENETIC THEORY:- SOME
GENETICALLY RELATED
DISTURBANCES IN THE
DEVELOPMENT OF THE FOOT
CAUSE FOOT DEFORMITY.
(b)SECONDARY
CLUBFOOT :-
PARALYTIC DISORDERS:- IN CASE WHERE
THERE IS A MUSCLE IMBALANCE.
e.g. THE INTROVER AND PLANTAR
FLEXORS ARE STRONGER THAN THE
EVERTORS AND DORSIFLEXORS ; AN
EQUINO-VARUS DEFORMITY WILL
DEVELOP.
PARALYTIC DESORDERS SUCH AS, POLIO,
SPINA BIFIDA, MYELODYSPLASIA ..ETC…..
ARTHROGRYPOSIS MULTIPLEX
CONGINITA (AMC):- DEFECTIVE
DEVELOPMENT OF
MUSCLE.MUSCLE ARE FIBROTICAND
RESULT IN FOOT DEFORMITIES AT
OTHE RJT.
PATHOLOGY :-
SECONDARY CHANGES ARE IN THE
BONE ; CAUSE BY ABNORMALITY IN
SOFT TISSUES.
POSTEROMEDIAL ASPECT OF ANKLE
AND FOOT IN CTEV.
SOFT TISSUES SHOULD BE
RELEASED DURING SURGERY TO
BRING BACK THE BONES TO
NORMAL ALIGNMENT.
CLINICAL FEATURES :-
FOOT IS IN EQUINUS, VARUS AND
ADDUCTION. IT IS JUDGED BY THE
INABILITY TO BRING THE FOOT IN
THE OPPOSITE DIRECTION. IN LATE
CASES, CAVUS OF THE FOOT MAY
ALSO BE PRESENT
HEEL IS SMALL IN SIZE.THE
CALCANEUM MAY BE FELT WITH
VERY DIFFICULTLY.
CONT…
DEEP SKIN CREASES ON THE BACK OF
THE HEEL AND ON THE MEDIAL SIDE OF
THE SOLE.
BONY PROMINANCE FELT ON LATERAL
SIDE OF THE FOOT, THE HEAD OF THE
TALUS AND LATERAL MALLEOLUS.
PUTER SIDE OF THE FOOT IS GENTALY
CONVEX.THERE ARE DIMPLES ON THE
OUTER ASPECT OF THE ANKLE.
INVESTIGATION AND DX BY XRAY:-