TEV-Clubfoot

Question 1

What are the 3 supination type podopediatric deformities?

Answer 1

TEV-Clubfoot
Cavus Foot
Metatarsus Adductus

Question 2

What are the appendageal long axis changes from embryonic inception to adult form

Answer 2

~180 degrees (arm to leg)

Question 3

What changes does the lower extremity foot go through from embryonic inception to adult form>

Answer 3

• abduction
• extension (DF)
• medial rotation embryology of bone

Question 4

Club foot is a Quadra planar deformity. What is the appearance?

Answer 4

• equinus
• hindfoot varus
• forefoot adductus
• forefoot cavus

Question 5

____% of club foot is an isolated deformity

Answer 5

80%

Question 6

What are the classifications for club foot

Answer 6

• idiopathic TEV/ typical
• Complex idiopathic CITEV/atypical

Question 7

What are some causes of ITEV/typical club foot

Answer 7

• positional (intrauterine molding)
• delayed treated club foot
• recurrent typical club foot
• alternatively treated typical clubfoot

Question 8

What are some causes of CITEV/ atypical clubfoot

Answer 8

• rigid (high recurrence and can need more procedures)
• syndromic (associated with other genetic abnormalities)
• teratologic (associated with arthrogryposis/myelomeningocele)
• neurogenic

Question 9

What are the points dimeglio based clubfoot on

Answer 9

• equinus
• varus deviation
• decoration around he talus-calcaneo-forefoot
• abduction forefoot on hindfoot in horizontal plane
• foot crease

Question 10

What is 15-20 on Dimeglio scoring system?

Answer 10

Very severe

Question 11

What is 10-15 on Dimeglio scoring system?

Answer 11

Severe

Question 12

What is 5-10 on Dimeglio scoring system?

Answer 12

Moderate

Question 13

What is 0-5 on Dimeglio scoring system?

Answer 13

Postural

Question 14

What are their criteria for Pirani Scoring

Answer 14

• lateral foot
• dorsiflexion
• medial fold
• palpation of calcaneus
• palpation of the talar head
• posterior fold

Question 15

What is the Pirani scoring system composed of?

Answer 15

Hindfoot and midfoot contracture score

Question 16

What does the Pirani hindfoot contracture score consist of

Answer 16

• posterior crease
• empty heel
• rigid equinus

Question 17

What does the Pirani midfoot contracture score consist of

Answer 17

• media crease
• curvature of lateral border
• position of head of talus

Question 18

White is the Kite method

Answer 18

Gradual manipulation and casting
However did not allow heel to swing around talus

Question 19

What are the characteristics of clubfoot

Answer 19

Equnivarus
Posterior skin crease
Medial skin crease
Navicular close to medial malleolus**
Short great toe
Hypoplastic skin over sinus tarsi

Question 20

What happens to talocalcaneal angle on AP radiograph in TEV patient

Answer 20

It id decreased

Question 21

What is normal talocalcaneal angle on AP film

Answer 21

30-55

Question 22

What is normal talocalcaneal angle on lateral film

Answer 22

25-50

Question 23

What happens to talocalcaneal angle on lateral film in TEV patient

Answer 23

Decrease toward an angle of 0

Question 24

What is normal tibiocalcaneal angle on lateral film

Answer 24

10-40

Question 25

What happens to tibiocalcaneal angle on lateral film in TEV patients

Answer 25

Angle is negative

Question 26

What is the normal talo-first metatarsal angle on AP view

Answer 26

15-20

Question 27

What happens to talocalcaneal-first metatarsal angle in TEV patients

Answer 27

Angle is negative (abduction of forefoot)

Question 28

How did Kite define clubfoot

Answer 28

Irreducible and reducible

Question 29

What did the Kite’s method emphasize about the benefits of casting

Answer 29

CORA is at the CC joint

Question 30

What is the manipulation sequence in Kite’s method

Answer 30

1 - correction of forefoot abduction 2 - correction of heel varus 3 - correction of hindfoot equinus

Question 31

How many times did casting fail with the Kite method

Answer 31

More than 50% of times

Question 32

What types of clubfoot deformities are not reducible without major surgery

Answer 32

- arthrogryphosis multiplex - spinal bifida - phaecomyelias

Question 33

How did Poseti describe clubfoot

Answer 33

As a Quadra planar deformity flexed about a normal talus but with abnormal fibroblastic hyperplasia of the posteriomedial tendons and ligaments that created equino varus foot deformity

Question 34

When to start clubfoot manipulation with casting

Answer 34

Fibrous hyperplasia most rapid at birth until 4-5 years - intervene before 5 years - technique harder with smaller feet - no difference in results in children even up to 8 yrs - typically start casting around 4 weeks of age

Question 35

What is the treatment for recurrent club foot

Answer 35

Tib anterior transfer

Question 36

What is Posenti magic movie

Answer 36

A dorsiflexory force is applied beneath the first metatarsal dead with counter pressure applied to the lateral talar head. This maneuver reduces the cavus and medial crease. This is performed as the forefoot is not inverted as compared to the hindfoot

Question 37

How much degrees is needed abduction bar in Ponseti treatment

Answer 37

50-70 degrees of affected foot, externally rotated 30-40 degrees of unaffected foot

Question 38

When do you perform a achilles tenotomy in clubfoot patients

Answer 38

If not able to dorsiflex the foot 15-20 degrees

Question 39

What structural features causes equinus to be improved in clubfoot patients,

Answer 39

- once foot is abducted 60-70 degrees, because of kinetic coupling sometimes the equinus is improved a lot — this is because the anterior portion of the calcaneus is dorsiflexed as it swings under the talus with manipulations

Question 40

Post casting and Achilles tenotmy what is the angle foot orthosis protocol

Answer 40

Patient will wear an ankle foot orthosis with abduction bar at 70 degrees of abduction for 2-4 years

Question 41

If patient has a unilateral clubfoot, how much abduction on the orthosis bar is there

Answer 41

45 degrees

Question 42

What is the treatment for forefoot adductus in clubfoot relapse

Answer 42

Tib anterior tendon transfer

Question 43

What is the tib anterior attached to in a tendon transfer

Answer 43

Cuboid or lateral cuneiform

Question 44

How do you treat equinus in recurrent clubfoot

Answer 44

- open Achilles tendon lengthening with posterior ankle joint capsulotomy if needed - z lengthening of Achilles tendon - V-Y lengthening of Achilles at musculo tendinoud junction - transverse ankle joint and subtalar capsulotomy

Question 45

What are the common surgical goals in club football surgery

Answer 45

- posterior release - medial release - plantar release - lateral release - ‘fixation - soft tissue repair

Question 46

What are the pos op care for kite method for club foot

Answer 46

- cast for 6 weeks - therapy dependent on age - less than 6 months = manipulative - greater than 2 years = ambulatory assistance - night splints until 4-7 years

Question 47

What is the best consistent long-term outcome result for clubfoot

Answer 47

Ponseti method

Question 48

What are the two minor surgical procedures which in resolution of clubfoot

Answer 48

- percutaneous TAL - Percutaneous tibialis anterior tendon transfer for recalcitrant cases

Question 49

How to treat mature clubfoot

Answer 49

- start Ponseti casting therapy ASAP post partum - Ponseti reductions possible up to age 7

Question 50

How do you treat neglected or recurrent clubfoot

Answer 50

- talectomy - triple arthrodesis - pan-talar arthrodesis