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    CTEV

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    amal.fathullah
    This document discusses clubfoot (CTEV), including its definition, etiology, diagnosis, and treatment. CTEV is a congenital foot deformity where the foot is twisted inward and downward. Its exact cause is unknown but may involve genetic and environmental factors. Diagnosis is based on the characteristic deformities of the hindfoot and forefoot. Treatment goals are to obtain a functional, painless foot and involves gentle manipulation and casting in infants, with surgery as needed for severe or recurrent cases.

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    CTEV

    Uploaded by

    amal.fathullah
    746 views17 pages
    This document discusses clubfoot (CTEV), including its definition, etiology, diagnosis, and treatment. CTEV is a congenital foot deformity where the foot is twisted inward and downward. Its exact cause is unknown but may involve genetic and environmental factors. Diagnosis is based on the characteristic deformities of the hindfoot and forefoot. Treatment goals are to obtain a functional, painless foot and involves gentle manipulation and casting in infants, with surgery as needed for severe or recurrent cases.

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    CTEV

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    This document discusses clubfoot (CTEV), including its definition, etiology, diagnosis, and treatment. CTEV is a congenital foot deformity where the foot is twisted inward and downward. Its exact cause is unknown but may involve genetic and environmental factors. Diagnosis is based on the characteristic deformities of the hindfoot and forefoot. Treatment goals are to obtain a functional, painless foot and involves gentle manipulation and casting in infants, with surgery as needed for severe or recurrent cases.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    746 views17 pages

    CTEV

    Uploaded by

    amal.fathullah
    This document discusses clubfoot (CTEV), including its definition, etiology, diagnosis, and treatment. CTEV is a congenital foot deformity where the foot is twisted inward and downward. Its exact cause is unknown but may involve genetic and environmental factors. Diagnosis is based on the characteristic deformities of the hindfoot and forefoot. Treatment goals are to obtain a functional, painless foot and involves gentle manipulation and casting in infants, with surgery as needed for severe or recurrent cases.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 17

    dr.

    Andi Dwihantoro, SpB, SpBA


    sub Bagian Bedah Anak
    FK UGM/RSUP Dr Sardjito YK

    THE NORMAL FOOT


    Complex organ that is required to be
    Stable: for supporting the body weight in

    standing

    Resilient: for walking and running


    Mobile: to accommodate variations of surface
    Cosmetic

    CTEV

    Definitions
    Talipes:
    Equinus:

    Talus (Latin = ankle bone)


    Pes (Latin = foot)
    (Latin = horse)
    Foot that is in a position of
    planter flexion at the ankle,
    looks like that of the horse.

    Calcaneus: Full dorsiflexion at the ankle

    Planus:

    flatfoot

    Cavus:

    highly arched foot

    Varus:

    heel going towards


    the midline
    heel going away
    from the midline
    forefoot going
    Forefoot
    towards the midline
    forefoot going away
    From the midline

    Valgus:
    Adduction:
    Abduction:

    Hind foot

    Etiology
    Exact cause unknown
    Genetic defect
    Multifactorial

    although many of these factors are


    speculative
    Some of these factors are :
    Abnormal intrauterine forces
    Arrested fetal development
    Abnormal muscle and tendon insertions
    Abnormal rotation of the talus in the mortise
    Germ plasm defects

    Basic Pathology
    Abnormal Tarsal Relation

    Congenital Dislocation /
    Subluxation
    Talo Calcaneo Navicular Joint
    Soft Tissue Contracture
    Congenital Atresia

    Incidence
    Occurs approximately in 1-2 of every

    1000 live birth


    In affected families, clubfeet are
    about 30 times more frequent in
    offspring
    Male are affected in about 50% of
    cases
    Bilateral cases are as high as 30 40
    %

    CTEV Diagnosis
    At birth &
    Characteristic Deformity :
    Hind foot
    Equinus (Ankle joint)
    Varus
    (Subtalar joint)
    Fore foot
    Adduction (Med tarsal joint)
    Supination fore foot
    Cavus some times
    Heel : small, high, deep
    creases appear post and medialy

    Diagnosis

    Hind foot
    Equinus, Varus

    Fore foot
    Adduction, Supination, Cavus

    Diagnosis

    Diagnosis
    X-Ray needed to assess progress of
    treatment
    Abnormal: angle > decrease
    Normal:
    Lateral: talocalcaneal angle 40

    AP: talocalcaneal angle 20-40

    Adaptive Changes

    Bony : Change in the shape of tarsal and metatarsal


    bones especially after walking

    Soft Tissue : Shortening ? Contracture in the


    Concave Side
    1- Muscles
    2- Tendons
    3- Ligaments
    4- Joints Capsule
    5- Skin
    6- Nerves & Vessels

    Normal baby the foot can be dorsoflexed and everted


    until the
    toes touch the front of the leg > in CTEV; this
    manoeuvre meet
    varying degree resistance/fixed

    Diagnosis
    General Examination :
    Exclude
    Neurological lesion that can cause the

    deformity Spina Bifida


    Other abnormalities that can explain the
    deformity Arthrogryposis, Myelodysplasia
    Presence of concomitant congenital
    anomalies
    Proximal femoral focal deficiency
    Syndromatic clubfoot
    Larsens syndrome, Amniotic band
    Syndrome

    Treatment
    The goal is to obtain a plantigrade
    foot that is functional, painless, and
    stable over time
    A cosmetically pleasing appearance

    Treatment
    Non operatif treatment should begin shortly after birth
    Gentle manipulation
    2. Immobilization > Technique Ponseti
    - Strapping
    - synthetic cast > long leg casts, change
    weekly
    until 8-12 weeks
    3. Splints to maintain correction
    - Ankle-foot orthosis
    - Dennis Brown splint
    1.

    Surgical Treatment
    Indications
    Late presentation, after 6 months of age

    !
    Complementary to conservative
    treatment
    Failure of conservative treatment
    Residual deformities after conservative
    treatment
    Recurrence after conservative treatment
    Severe/rigid deformities

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