Congenital talipes equinovarus ( CTEV )





Congenital talipes equinovarus is most common Congenital foot disorder.

– Males are commonly affected then females.

– Talipes , Talus – ankle , PES – foot, causes patient to walk on ankle.

– Club foot : club like appearance.



(1) Osseus : Club foot associated with absence of tibia.

(2) Muscular : Arthrogryposis multiplex congenital or multiple congential contracture.

(3) Neuropathic : Due to spina bifida

(4) Idiopathic : No apparent cause.

• Etiology


✓ Primary club foot :

(A) mechanical theory

(B) ischemic theory

(C) Genetic theory

✓ Secondary clubfoot : paralytic disorders

• Pathoanatomy


✓ Bones : bones of foot are smaller than normal bones

✓ joint : equinus deformity, cavus deformity , inversion deformity, adduction deformy.

✓ muscle and tendons : muscles are underdeveloped and muscle – tendon unit is contracted.

✓ ligaments : shortened.

• Examination :

(1) Dorsiflexion test

– Normally the foot of a newborn child can be Dorsiflexed until the dorsum touches the anterior aspect of shin of the tibia.

– In case of CTEV dorsum of foot unable to touch shin of tibia.

(2) Plumb line test

(3)Scratch test

(4) Foot is in equinus , varus, and adduction

(5) Heel is small in size

(6) deep skin crease

(7) Bony prominences felt on lateral side of foot.

•Method of Maintainance of correction


(1) CTEV splints

– These are splints made of plastic, moulded in such a way that when tied with straps, it keeps the foot in corrected position .

(2) Dennis – Brown splint

– This is a splint to hold the foot in corrected position.

– It is used throughout the day before the child starts walking.

– Once he starts walking, Dennis brown splints can be used at night and CTEV shoes during day time.

(3) CTEV shoes


– These are modified shoes, used once child start walking .

• PT management


– When reported early , passive manipulation can be done.

– Immobilization is done by strapping or by POP cast .

• Manipulation

– 3 components of the deformity

✓ Pes cavus

✓ Adduction and inversion of forefoot and heel

✓ Plantar flexion of the ankle.

– Graded manipulation by passive movements is done in opposite direction of the deformity.

– Pes cavus can be corrected by strectching contracted soft tissues of foot until the correction is achieved.

– Addiction deformity can be corrected by keeping the thumb of both hands over talus and distal hand will abduct and Evert the foot, turning sole downwards and outwards ( eversion and Dorsiflexion )

– Plantar flexion can be achieved by raising the foot to Dorsiflexion.

– Maintainance of correction is important

– mother should be educated to identify if any distortion is occurs.

– Immobilization can be done by a adhesive strapping for mild cases.

– If no correction is achieved then ,

(1) Serial POP cast

(2) DB splints

(3) CTEV splint

– With plaster cast only toe movements and the movements to hip and knee can be encouraged by tickling or just holding child high.

– In surgical cases, if children are of walking age, gradual walking with walkers can be given

– Maintenance of correction of deformity after removal of cast is important and it also helps in preventing recurrence.

– Night splints maintains the foot in overcorrected position and prevent recurrence.

– Active movements

– Ambulatory training : For free walking , correct BK orthosis should be given so that the foot is maintained in corrected position.

– The child should be seen at least once a week , then every month and also at later stages.

– The treatment depends upon how effectively the mother is taught the home care programe.





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