CTEV Flashcards
What is Congenital Talipes Equinovarus (CTEV)?
A rotatory subluxation of the talocalcaneonavicular joint with the talus in plantar flexion and the subtalar complex in medial rotation and inversion.
What are the four main clinical components of CTEV?
CAVE: Cavus, Adduction, Varus, Equinus.
What does ‘Cavus’ refer to in CTEV?
Exaggerated medial longitudinal arch at the midfoot.
What does ‘Adduction’ refer to in CTEV?
Forefoot adduction at the tarsometatarsal junction.
What does ‘Varus’ refer to in CTEV?
Hindfoot rotated inward at the talonavicular joint.
What does ‘Equinus’ refer to in CTEV?
Foot fixed in plantar flexion at the ankle joint.
What is the incidence of CTEV?
1-2 per 1000 live births.
What is the male-to-female ratio for CTEV?
2.5:1 (more common in males).
Which foot is more commonly affected in unilateral CTEV?
Right foot.
What is the most common cause of CTEV?
Idiopathic CTEV.
Who proposed the ‘arrested fetal development’ theory of CTEV?
Bohm.
Who proposed the ‘mechanical factor in utero’ theory of CTEV?
Hippocrates.
What is the vascular hypothesis of CTEV?
Keith suggested that temporary cessation of circulation in the fetus results in soft tissue contractures and defective cartilage development.
What did Ippolito and Ponseti find in the muscles and ligaments of CTEV patients?
Increased collagen fibers and fibroblastic cells.
Which genetic factors are associated with CTEV?
NAT1, NAT2, CYP1A1, HOXA, HOXD, IGF BP3, CAN D2, WNT7A, TBX4.
What syndromes are associated with secondary CTEV?
Arthrogryposis multiplex congenita, diastrophic dysplasia, Streeter syndrome, Freeman-Sheldon syndrome, Mobius syndrome.
What paralytic disorders are associated with secondary CTEV?
Poliomyelitis, spina bifida, myelodysplasia, Friedreich’s ataxia.
What is the key bony deformity in CTEV?
Medial and plantar deviation of the talus and navicular bones.
What is the angle between the talus neck and body in CTEV?
90-110° (normal is 150°).
How is the calcaneum affected in CTEV?
It is small, medially rotated, and lies beneath the head of the talus.
What is the most commonly atrophied muscle group in CTEV?
Peroneal group.
Which tendons are contracted in CTEV?
Triceps surae, tibialis posterior, flexor digitorum longus, flexor hallucis longus.
What ligamentous contractures are seen in CTEV?
Calcaneofibular, talofibular, deltoid, plantar, spring, bifurcate, interosseous talocalcaneal ligament.
What is the classical skin finding in CTEV?
Deep creases on the medial side, dimples on the lateral ankle and midfoot, shortening of the medial sole.
What vascular change is seen in CTEV?
Hypoplasia or absence of dorsalis pedis and anterior tibial artery.
What classification system is based on the ability to correct CTEV?
Harrold and Walker classification.
What classification system scores CTEV severity?
Dimeglio et al. scoring system and Pirani scoring system.
What is the purpose of the Pirani scoring system?
To determine the severity of CTEV and monitor treatment progress.
What angles are measured in radiographic evaluation of CTEV?
Talocalcaneal angle (AP and lateral), tibiocalcaneal angle (lateral), talus-first metatarsal angle.
What is the normal talocalcaneal angle in AP view?
25-40°.
What is the normal talocalcaneal angle in lateral view?
35-50°.
What are the goals of CTEV treatment?
Achieve a plantigrade, flexible, cosmetically acceptable, functional, and pain-free foot in the shortest treatment time.
What is the gold standard treatment for CTEV?
Ponseti technique.
What is the first step in the Ponseti technique?
Manipulation without casting during the first week of life.
How many casts are typically needed in the Ponseti method?
5-6 serial casts (maximum of 10).
What is the role of foot abduction orthosis in CTEV treatment?
Prevents recurrence and allows joint remodeling.
What is the other name for a foot abduction orthosis?
Denis-Browne splint.
What are the special features of CTEV shoes?
Straight inner border, outer shoe rise, no heel.
What is the Kite’s method for CTEV correction?
Correction of each component separately, but has limitations like blocking calcaneal eversion.
What are complications of nonoperative CTEV treatment?
Rocker bottom foot, bean-shaped foot, fractures, pressure sores, flat-top talus, recurrence.
What are indications for surgical treatment in CTEV?
Neglected, relapsed, recurrent, resistant, or rigid CTEV.
What surgery is preferred for CTEV in 1-4 years of age?
Soft tissue release.
What surgery is preferred for CTEV in 4-11 years of age?
Soft tissue release with osteotomy.
What is the preferred surgical management for severe CTEV after 11 years?
Salvage procedures like triple arthrodesis or talectomy.
What is Turco’s operation?
One-stage posteromedial release focusing on subtalar release and calcaneofibular ligament.
What is the role of external fixators in CTEV treatment?
Used for neglected or recurrent cases with severe scarring.
What is Ilizarov’s external fixator used for?
Fractional distraction in severe CTEV with trophic ulcers or high risk of necrosis.
