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Best CTEV Treatment In Delhi NCR.

CTEV TREATMENT AT ARUNALAYA
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What Does CTEV Mean?

It is also known as Congenital Talipes Equinovarus/ Club foot.
It is rotatory subluxation of talocalneonavicular joint (Sub-talar) complex with talus in plantar
flexion and subtalar complex in medial rotation and inversion.

Deformities

4 clinical components:- CAVE
• C-Cavus:- Exaggerated medial longitudinal arch at midfoot
• A-Adduction:- Forefoot in adduction at Tarsometatarsal junction
• V-Varus:- Hindfoot rotated inward at talonavicular joint
• E-Equinus:- Foot fixed in plantar flexion at ankle joint

Epidemiology
  • Incidence:- 1-2 per 1000 live birth
  • Incidence in 1st degree relation:- 2%
  • Incidence in 2nd degree relation:- 0.6%
  • Incidence in male:female:- 2.5:1
  • Laterality:- >50% cases are bilateral
  • In unilateral affliction:- Right>Left
Etiology
  • Most common cause of CTEV is idiopathic.
  • Other than idiopathic is secondary CTEV which is associated with underlying cause.
Clinical Features
  • Heel is small and in equinus.
  • Foot inverted on end of tibia.
  • Deep creases on medial and posterior aspect.
  • Abnormal thin calf.
  • Varying degree of resistance/fixed deformity when try to dorsiflex and evert the foot.
  • Lack of correctability.
  • Other joint abnormality.
  • Associated anomalies and neuromuscular condition.
Classification
  1. Idiopathic and non-idiopathic
  2. Cumin classification
  3. Ponseti and smoley classification:- Based on extent of deformity
  4. Harrold and walker classification:- Based on ability to correct the deformity.
  5. Browne’s classification:- Based on type of deformity
  6. Dimeglio et al scoring system:- Based on severity of the deformity
  7. Pirani scoring system
Treatment

Goal to achieve:

  • Plantigrade foot
  • Flexibility.
  • Cosmetically acceptable functional and pain free foot in shortest treatment time.

Principles:

  • Soft tissue contracture release or stretching to restore normal tarsal relationship.
  • Once normal tarsal relationship attained, correction should be maintained till tarsal
    bones remoulds stable articular surface.

Non-operative treatment:

  • Several regime have been proposed including splinting taping and casting.
  • Kite’s method
  • Ponseti’s technique
  • Percutaneous tenotomy
  • CTEV shoes
  • Foot abduction orthosis also known as Denis brown splint.

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