Congenital Talipes EquinoVarus (CTEV)

Question 1

What is the more common name for congenital talipes equinovarus?

Answer 1

Club foot

Question 2

What is CTEV?

Answer 2

This is a congenital condition in which a newborns foot or feet are rotated internally at the ankle

Question 3

What proportion of live births will be affected by CTEV?

Answer 3

1 in 1000

Question 4

What most commonly causes CTEV?

Answer 4

Club foot is most commonly caused by the abnormal alignment of the talus, calcaneus and navicular during the 7th week of embryo development, with around 50% of cases being bilateral

Question 5

What causes some of the more severe cases of CTEV?

Answer 5

Underlying syndromes such as spina bifida

Question 6

What are some risk factors of a child developing CTEV?

Answer 6

• More common in males
• Family history
• Breech presentation
• Oligohydramnios

Question 7

What are the 3 anatomical changes present in CTEV?

Answer 7

Ankle equinus (Plantarflexion)
Supination of the forefoot
Varus alignment of the forefoot

Question 8

Describe the pathophysiology of CTEV

Answer 8

The abnormal alignment of the joints between the talus, calcaneus and navicular result in contractures of the soft tissue (Ligaments, capsule and tendons)

Question 9

How does CTEV usually present?

Answer 9

Clinical presentation is often down to observation of the problem at birth

These problems can cause pain when walking

Question 10

What is the first line management of CTEV?

Answer 10

Ponsetti technique

Question 11

What occurs in the Ponsetti technique

Answer 11

The foot is stretched into a correct position, splinted and then casted

These plaster casts are changes every week and are kept on for around 6 weeks

They are then switched to boots and bars until their 5th birthday, which are worn day and night

Question 12

What surgery is often required after the Ponsetti technique to allow or full correction?

Answer 12

A percutaneous tenotomy of the Achilles tendon