CLUB FOOT ( CONGENITAL TALIPES EQUINO VARUS )

Question 1

EQUINUS

Answer 1

FOOT FIXED IN PLANTAR FLEXION.

Question 2

CAVUS

Answer 2

ARCH OF FOOT EXAGGERATED

Question 2

VARUS

Answer 2

FOOT INVERTED AND ADDUCTED SO THAT SOLE FACES INWARDS

Question 3

ETIOLOGY

Answer 3

IDIOPATHIC CLUB FOOT
SECONDARY CLUB FOOT

Question 4

IDIOPATHIC CLUB FOOT

Answer 4

1. MECHANICAL THEORY = DUE TO INCREASED INTRAUTERINE PRESSSURE , THE FOOT FORCED AGAINST THE WALL OF UTERUS IN POSITION OF DEFORMITY
2. ISCHAEMIC THEORY = ISCHAEMIA OF CALF MUSCLES DURING INTRAUTERINE LIFE.
3. GENETIC THEORY .

Question 5

SECONDARY CLUB FOOT

Answer 5

NEUROGENIC DISORDER =
OCCURS IN PARALYTIC DISORDERS LIKE POLIO, SPINA BIFIDA.
ARTHROGRYPOSIS MULTIPLEX CONGENITA =
MUSCLES ARE FIBROTIC AND RESULT IN DEFORMITY OF FOOT AND OTHER JOINTS

Question 6

CLINICAL FEATURES

Answer 6

MAY BE DETECTED AT BIRTH IN HOSPITALS
CHILD MAY BE PRESENTED WITH
-CAVUS
-ADDUCTION AND SUPINATION OF FOREFOOT
-VARUS
-EQUINUS
-TALUS PROTRUDE ON DORSOLATERAL SURFACE OF FOOT
-MEDIAL ROTATION OF TIBIA
-CALF MUSCLE ATROPHY

Question 7

EXAMINATION

Answer 7

DORSIFLEXION TEST =
THE FOOT OF NORMAL CHILD CAN BE DORSIFLEXED UNTIL THE DORSAL SURFACE TOUCHES THE SHIN OF TIBIA . THIS IS NOT POSSIBLE IN CLUB FOOT
PLUMB LINE TEST
SCRATCH TEST

Question 8

MORE FINDINGS

Answer 8

HEEL SMALL IN SIZE
CALCANEUM FELT WITH GREAT DIFFICULTY
DEEP SKIN CREASES ON BACK OF FEET AND ON MEDIAL SIDE OF SOLE
BONY PROMINENCES FELT ON LATERAL SIDE OF FOOT BY HEAD OF TAULS AND LATERAL MALLEOLUS
OUTER SIDE OF FOOT GENTLY CONVEX
ON ATTEMPTED CORRECTION = TIGHT STRUCTURES CAN BE FELT ; TENDOACHILLES AND PLANTAR FASCITIS
CHILDD PRESENTING LATE MAY HAVE CALLOSITES OVER LATERAL ASPECT OF FOOT .

Question 9

GENERAL EXAMINATION

Answer 9

PRESENCE OF DEFORMITIES AT OTHER JOINT INDICATES AMC ( ARTHOGRYPOSIS MULTIPLEX CONGENITA )

Question 10

AP VIEW

Answer 10

TALO CALCANEAL ANGLE =
LINE DRAWN FROM LONG AXIS OF TALUS AND CALCANEUM. THE LINES MAKE AN ANGLE OF 20 TO 40 DEGREE ( KITES ANGLES )
IN CTEV LINES ALMOST PARALLEL.

Question 10

X RAY

Answer 10

AP VIEW
LATERAL VIEW

Question 11

LATERAL VIEW

Answer 11

TAKEN WITH FOOT IN FORCED DORSIFLEXION
TALOCALCANEAL ANGLE
LINE DRAWN THROUGH LONGITUDINAL AXIS OF TALUS AND LOWER BORDER OF CALCANEUM
NORMALLY ABOUT 40 DEGREE ANGLE FORMED.
IN CTEV LESS THAN 20 DEGREE FORMED .

Question 12

TREATMENT

Answer 12

PRINCIPLE-
CORRECTION BY OPERATIVE OR NON OPERATIVE METHOD
MAINTAINENCE CONTINUED TILL BONE GROWS SO DEFORMITY DOESNT OCCUR
HAS NON OPERATIVE AND OPERATIVE METHODS

Question 13

NON OPERATIVE METHOD

Answer 13

MANIPULATION ALONE -
IN NEW BORN , MOTHER TAUGHT TO MANIPULATE FOOT AFTER EVERY FEED .
FOOT DORSIFLEXED AND EVERTED
SUFFICIENT PRESSURE TO BE APPLIED AN D MAINTAINED FOR 5 SECCONDS
REPEATED SEVERAL TIMES OVER PERIOD OF 5 MINUTES
MINOR DEFORMITY CORRECTED BY THIS .
MANIPULATION AND POP - DISCUSSED IN NEXT FLASH CARD

Question 14

MANIPULATION AND POP

Answer 14

SURGEON MANIPULATES FOOT AFTER SEDATION , FOOT HELD IN PROPER POSITION WITH PLASTER CAST . PONSETTI PHILOSOPHY APPLIED .

Question 15

PONSETTI PHILOSOPHY

Answer 15

TREATMENT STARTED WITHIN 1ST WEEK OF LIFE
CAVUS IS CORRECTED FIRST , THEN ADDUCTION , VARUS AND EQUINUS .
CAVUS = SUPINATION OF FOOT IN RESPECT TO HIND FOOT
ADDUCTION = ABDUCTION OF FOREFOOT AND MID FOOT
VARUS = ABDUCTION OF FOOT
EQUINUS = CORRECTIVE DORSIFLEXION THROUGH ENTIRE SOLE DONE . USUALLY REMAINS UNTREATED SO PERCUTANEOUS TENOTOMY OF TENDOACHILLES DONE.

Question 16

OPERATIVE METHOD

Answer 16

LESS THAN 3 YEAR = PMSTR ( POSTERO MEDIAL SOFT TISSUE RELEASE
MORE THAN 3 YEAR = DWYERS OSTEOTOMY
MORE THAN 5 YEARS = TENDON TRANSFER
4 TO 8 YEARS = EVANS PROCEDURE
8 TO 11 = WEDGE TARSECTOMY
MORE THAN 12 = TRIPLE ARTHRODESIS
IN SOME CASES WHERE CLUB FOOT AFTER CONSERVATIVE TREATMENT IS PARTIALLY CORRECTED , LIMITED SOFT TISSUE RELEASE DONE.

Question 17

POSTERO MEDIAL SOFT TISSUE RELEASE

Answer 17

ON POSTERIOR SIDE =
LENGTHENING OF TENDOACHILLES
RELEASE OF POSTERIOR CAPSULE OF ANKLE AND SUB TALAR JOINT
RELEASE OF POSTERIOR TALOFIBULAR AND CALCANEOFIBULAR LIGAMENT

ON MEDIAL SIDE =
LENGTHENIG OF 3 TENDONS = TIBIALIS POSTERIOR , FDL , FHL
RELEASE OF 3 LIGAMENTS = DELTOID , SPRING AND TALONAVICULAR
RELEASE OF 3 MORE STRUCTURES

ON PLANTAR SIDE =
PLANTAR FASCIA RELEASE
RELEASE OF FDB AND ABDUCTOR HALLUCIS

Question 18

MAINATAINANCE OF CORRECTION

Answer 18

CTEV SPLINTS
DENIS BROWN SPLNT- USED THROUGHOUT THE DAY UNTIL CHILD STARS WALKING
IN WALKING CHILD USED AT NIGHT AND CTEV SHOES DURING DAY
CTEV SHOES = STRAIGHT INNER BORDER , NO HEEL , OUTER SHOE RAISE