Ortho foot conditions

Question 1

Anatomy of Congenital Talipes Equino Varus (CTEV)

Answer 1

Equinus (PF) at the talocrural joint
Adduction and inversion ( supination) at the subtler and mid tarsal joints. Navicular tuberosity is close to medial malleolus
Metatarsals are adducted

Question 2

Postural TEV - can you correct

Answer 2

Stimulate (sweep/vibrate) the muscles that will correct the foot position actively - it is easily corrected
gently try to correct foot passively - it is easily corrected

Question 3

Postural TEV - management

Answer 3

AROM - encourage DF + eversion
PROM - gentle passive stretches
Taping - may include maintaining correct alignment of foot and ankle
Follow up - once corrected no potential for relapse so can discharge

Question 4

Structural CTEV

Answer 4

Cannot be corrected actively or passively - requires urgent specialised treatment 
Unusual looking foot
- thick medial crease
- tight lateral skin
- poorly developed 'tucked up' heel

Question 5

Structural CTEV - assessment: observe posture

Answer 5

Shape and position of feet, ankles, legs, hips and spine

Any evidence of abnormal creases, tucked up heels, torsion of bone, asymmetry of muscle mass

Question 6

Pirani and Outerbridge evaluation

Answer 6

Posterior contractures (hind foot contracture)
- posterior crease
- empty heel
- rigid equines
Medial contractures (mid foot contracture)
- curvature of lateral border of foot
- medial crease 
- lateral part of the head of the talus

Question 7

Ponseti casting

Answer 7

Structural CTEV treatment
Correct the cavus
Re-align the forefoot, mid foot and hindfoot
Dorsiflexion
Over-correction - just getting to neutral isn’t enough

Question 8

Postural Talipes Calcaneovalgus

Answer 8

Ankle held in marked DF
Heel in valgus
Assess AROM and PROM to distinguish with fixed/neurological TCV

Question 9

PTCV management

Answer 9

Gentle passive mobilisation
Encouragement of active PF
Encouragement of active inversion
A dorsolateral splint is sometimes applied

Question 10

Congenital vertical talus

Answer 10

Hindfoot is in equinus
Talus is vertical
Talonavicular joint subluxed
Forefoot s abducted and DF
Surgical correction is required to re-align the congenital anomaly