CTEV (Congenital Talipes Equino Varus) Treatment

What is Clubfoot:

Club foot is also known as Talipes Equino Varus. It is a common condition, in which new born feet points medially and downward. This condition is diagnosed at birth. More common in males than females. Incidence is 1 per 1000 live birth.

Types of Clubfoot:

Club feet can be classified in three different ways –

Etiological:

1) idiopathic, 2) neurological 3) syndromic (related to an underlying syndrome)

Severity wise:

1. Postural CTEV 2. Structural CTEV

Idiopathic:

1-benign (postural) feet, 2- moderate feet 3- stiff feet 4- very sever stiff- stiff feet

Signs and Symptoms of Clubfoot:

  1. One or both feet in new born
  2. Stiff, rigid foot deformity
  3. High heel due to short tendoachilis
  4. Heel and fore foot both turned in with deep mid sole crease, small feet size

    Causes of Clubfoot:

    Most of the time, causes are not known. But sometimes, they can be a part of a syndrome in which many other systems of the body are affected. In mild variety, it may be due to intrauterine compression; otherwise, usually in moderate to severe variety is because of shortening of muscle, capsule, and bony deformity.

How to Prevent Clubfoot:

We can’t prevent the occurrence of ctev because it occurs because of unknown reasons and some time by genetic issues.

Complications of Clubfoot: 

CTEV, as per say don’t cause crate any trouble except a progressive increase in deformity if not managed initially. If not managed, then the child will learn to stand and walk with a deformed foot. With an increase in age and weight, foot deformity can progress to extent that child can have pain, abnormal walking pattern, and shoe wear and tear

CTEV Treatment Options:

The main goal of ctev treatment is to correct the way your child’s foot looks and works before your child learns to walk. ctev treatment start as child born. In the past, very few ctev treatments were there to fix this condition.Postural CTEV is self revolving, but sometimes massage, stretching & manipulation may be required. Other stiff & rigid variety need manipulation and plaster application. Universal ctev treatment process is the Ponsetty methods of manipulation and repeated plaster application for 5-6 times at 7-10 days interval followed by Percutaneous tenotomy & plaster for 1 month. The child has to wear special shoes (Dennis brown splint) day and night till the age of 18 months. Some they need to wear for a longer time. Stretching exercise, planter stimulation, and oil massage are also advised to continue till the child start walking.

Final Outcome: 

Most of the CTEV can have completely normal feet if correct methods of manipulation, precaution, Longer and persistent use of brace with strict follow-up. Recurrences are common with very stiff and syndromic club feet & the feet of child where strict guideline of wearing shoes were not followed. Recurrence will be of a milder variety if reported early and again can be corrected with same methods of Ponsetty plaster technique. In some cases, these CTEV feet require surgery in the form of muscle joint release, but it is not preferred now due to fear of stiff foot post-operatively. Now a days recurrence are being manage by tendon transfer, osteotomy with before, and afterward plaster application.

 

Frequently Asked Questions

Which Doctor Should I see for Ctev Treatment?

You should consult a Pediatric Orthopedic Surgeon. They provide the best clubfoot treatment for your child.

How much time clubfoot take to heal?

The majority of the Clubfoot problem can be corrected in the childhood period in about 6 to 8 weeks of time under the proper guidance.

Can Clubfoot surgery need to be done immediately as soon as the clubfoot is detected in the newborn child?

No, Surgery is done, only if in case conservative treatment fails for the child. Most of the club foot can be managed by plaster along with very minor surgery . surgery only in recurrent and relapse and also after plaster application

What happens if the clubfoot is left untreated?

If clubfoot is left untreated, then your child’s foot will be automatically turned inwards, and your child will find difficulty in walking as the child will not be able to place his foot flat on the ground. Wearing shoes will also become tough.

CTEV Treatment - Before
CTEV Treatment - After

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Dr. Jitendra Kumar Jain
Trishla Orthopedic Clinic & Rehab center, 182C / 350A, Tagore Town, Prayagraj (Allahabad) U.P-211002, India

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