AMALINA Presented

INA MOHD by : AUD

MOHD DDAUD
Athaya Hafizhah
090917298
IIUM
 What is CTEV??
• Idiopathic clubfoot

• Causing CAVE
- midfoot Cavus/ increase in height
-forefoot Adductus
-hindfoot Varus
-hindfoot Equinus/ plantarflex
Pathological Anatomy
Navicular and forefoot
-shifted medially
-rotated into
supination
(composite varus
deformity)

Neck of Tallus
-pointing downward
Posterior part of calcaneum and deviates
-held close to fibula by CF ligt medially
-tilted into equinus and varus
-rotated medially beneath Body of Tallus
ankle - Rotated outward
Anatomy
• Hindfoot
-calcaneum, talar

• Midfoot
-cuboid, navicular,
cuneiform

• Forefoot
- metatarsals, phalanges
 Epidemiology
• Relatively common- 1 to 2 per thousand births
• Boys affected twice
• Bilateral in 1/3 of cases
 Causes-unknown
• germ defect
• arrested development

• neuromuscular disorder in neurological

disorders and neural tube defect
• postural deformity
 Common Types
1. Congenital
- uncommon bony problems present upon childbirth not
related to any neuromuscular factor or symptoms.
2. Teratologic
-a/w neurological conditions (eg: spina bifida)

3. Positional
- in contorted position in utero

4 Syndromic
-a/w standard hereditary issue, which includes
arthrogryposis.
 Pathological Anatomy
• Skin and soft tissue of calf and medial side of
foot are short and underdeveloped

• If not corrected early, secondary growth

changes occur in the bones-PERMANENT
 Clinical Features

• Heel is small and high

• Deep creases appear posteriorly and medially
• Abnormal thin calf
• Varying degree of resistance / fixed deformity
when try to dorsiflex and evert the foot

Normal baby foot

• Associated disorders
- congenital hip dislocation
- spina bifida
-arthrogryposis : absent of creases

• Look if other joints are affected

How to differentiate true and postural
clubfoot?
• True clubfoot – fixed deformity
• Postural talipes – easily correctable by gentle
passive movement
X-ray to assess progress of treatment
IMAGING
 Anterioposterior view
30 degree
plantarflex

Kite’s angle (talocalcaneal angle): normal 20-40 degree

clubfoot angle almost parallel
 Lateral Film (Turco view)
Foot dorsiflex

Normal angle : 40 degree

If less 20 degree: rocker bottom deformity
- calcaneum seem to be dorsiflexed but it had
broken at midtarsal level
 Aim
To produce and maintain a plantigrade, supple
foot that will function well
 Serial Manipulative and Casting
(Ponsetti’s method)
• Goal-rotate leg laterally around the fixed tallus
• Order of correction (CAVE)
-midfoot cavus
-forefoot adductus
-hindfoot varus
-hindfoot equinus
Increase the
supination
deformity of
forefoot
THANK YOU