Introduction
Congenital Talipes Equinovarus(CTEV) is one of the commonest congenital anomalies seen. The word talipes is derived from ‘talus’ and ‘pes’ and was applied to those walking on their neglected deformities wherein the talus rested on the ground as the foot (pes). It is characterized by plantar flexion (equinus) at the ankle joint, inversion at the subtalar joint and adduction at the forefoot.
Definition
Congenital Talipes Equinovarus (CTEV) is a complex, three-dimensional deformity of the foot and ankle, present at birth. It involves a combination of deformities that give the foot a characteristic twisted appearance.
Etiology
The etiology of Congenital Talipes Equinovarus (CTEV) is often multifactorial, involving both genetic and environmental factors. While the precise cause remains elusive in many cases, it’s thought to stem from a combination of:
- Genetic predisposition: A family history of clubfoot increases the risk.
- Neuromuscular issues: Some theories suggest underlying nerve or muscle development problems
- Syndromic associations: CTEV can occasionally be associated with other genetic syndromes.
- Intrauterine positioning: Compression within the womb may contribute.
Signs & Symptoms
The signs of CTEV are typically apparent at birth. The affected foot or feet will appear-
- The inner border of the foot is raised and shortened with cavus.
- The longitudinal arch is exaggerated.
- The outer border of the foot is convex and bears weight.
- The skin in this region eventually gets thickened and callosities and false bursae develop.
- The heel remains inverted and small with thin skin.
- The foot may be small with shortening of the leg.
- In bilateral cases the gait is awkward and waddling.
- There is marked limitation of eversion and dorsiflexion.
Investigation
Clubfoot is usually detected antenatally, by ultrasound scan, or at birth. The examination after birth consists of taking the foot and manipulating it gently to see if it can be brought into normal position. If not, there is a positive diagnosis of clubfoot.
Physiotherapy Management
The gold standard for CTEV treatment is the Ponseti method, a non-surgical approach primarily managed by physiotherapists or orthopedic specialists. This method involves:
Manipulation:
Passive manipulation should be taught to the mother for children below 2 months of age. The heel is stabilized by one hand and by the other hand the forefoot adduction is corrected first. This is followed by correction of inversion by exerting pressure over the undersurface of the 4th and 5th metatarsal heads.
Serial Casting:
1. Serial POP casts may be applied.
2. Dennis Browne splint could be given .
Bracing and Splint:
Maintenance of correction of the deformity after removal of the cast is very important. It also helps in preventing recurrence. Night splints or resting posterior corrective splints are ideal in the prevention of recurrence as the foot is maintained in an overcorrected position.
Achilles Tenotomy:
The tendoachilles is lengthened by Z-plasty . This procedure will give adequate overcorrection of the deformity. Following this, the foot is immobilized in a POP cast for 4–6 weeks.
Parent Education:
Integral to the success of the Ponseti method, educating parents on potential issues, brace application and the importance of adherence.
Conclusion
Congenital Talipes Equinovarus (CTEV) is a treatable condition with excellent long-term outcomes when managed appropriately, primarily through the Ponseti method. Early diagnosis and consistent physiotherapy intervention are key to enabling children with clubfoot to lead active, healthy lives.