Congenital Talipes Equino Varus (CTEV)
Congenital Talipes Equinovarus Varus (CTEV) commonly known as Clubfoot is one of the most common congenital musculoskeletal deformity among newborns.
Although it’s called congenital, it is not an embryonic malformation but is developmental deformation occurring during 2nd trimester.
• Equinus: (derived from ‘equine’ i.e., a horse
who walNs on toes). This is a deformity where
the foot is fixed in plantar-flexion.
• Calcaneus (reverse of equinus): This is a
deformity where the foot is fixed in dorsiflexion.
• Varus: The foot is inverted and adducted at the
mid-tarsal joints so that the sole ‘faces’ inwards.
• Valgus: The foot is everted and abducted at the
mid-tarsal joints so that the sole ‘faces’ outwards.
• Cavus: The logitudinal arch of the foot is
exaggerated.
• Planus: The longitudinal arch is flattened.
• Splay: The transverse arch is flattened.
,nvariably, the foot has a combination of above
mentioned deformities; the commonest being
equino-varus. The next most common congenital
foot deformity is calcaneo-valgus.
● In the vast majority of cases, aetiology is not Known, hence it is termed idiopathic.
● In others,the so called secondary clubfoot, some underly ingcause such as arthrogryposis multiplex congenita(AMC) can be found.
● Idiopathic clubfoot Following are some of the theories proposed for the aetiology of idiopathic clubfoot:
a) Mechanical theory: The raised intrauterine
pressure forces the foot against the wall of the
uterus in the position of the deformity.
b) Ischaemic theory: is chaemia of the calf muscles
during intrauterine life, due to some unknown
factor, results in contractures, leading to foot
deformities.
c) Genetic theory: Some genetically related
disturbances in the development of the foot
have been held responsible for the deformity.
Secondary clubfoot Following are some of the causes of secondary clubfoot:
a) Paralytic disorders: in a case where there
is a muscle imbalance i.e., the invertors and
plantar flexors are stronger than the evertors
and dorsiflexors, an equino-varus deformity
will develop. This occurs in paralytic disorders
such as polio, spina bifida.
b) Arthrogryposis multiplex congenita (AMC):
This is a disorder of defective development of
themuscles. Themuscles are fibrotic andresultin
foot deformities, and deformities at other joints.
Secondary Clubfoot Following are some of the causes of Secondary Clubfoot:
Pathoanatomy:
All the tissues of the foot i.e., the bones, joints, ligaments and muscles have developmental
abnormality.
Clinical Features:
Presenting complaints Though, the history dates backto birth, a child with CTEV may present some timeafter birth, often as late as adulthood. Followingare some of the common presentations:
a) Detected at birth: At places where delivery is
conducted by trained medical personnel, CTEV
is detected at the time of routine screening of
newborns for congenital mal-formations. At
times, the deformity is very mild, the so-called
postural equino-varus.
b) Brought during early infancy: At places where
delivery is conducted at primary health centres,
the child is generally brought to the hospital
around the age of 3- weeks.
c) Brought during late infancy and early
childhood: In these cases, the child has
received treatment elsewhere, orthe deformity
has recurred, or it has never been corrected.
Unfortunately, in developing countries, a large
number of cases report to the hospital late.
d) Brought during late childhood: it is not
uncommon in developing countries to have aò
grown up child, or sometimes an adult with
clubfoot, reporting to the hospital for the first
time. Ignorance, poverty and illiteracy are
generally the reasons for such late presentations.
Features: The Feet are usually inwards (Varus) and downwards (Equinus) .
Congenital Talipes Equinovarus Varus
It can be Unilateral/ Bilateral, and the severity could vary from mild postural to severe atypical.
