Best CTEV Treatment In Delhi NCR.
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
- Idiopathic and non-idiopathic
- Cumin classification
- Ponseti and smoley classification:- Based on extent of deformity
- Harrold and walker classification:- Based on ability to correct the deformity.
- Browne’s classification:- Based on type of deformity
- Dimeglio et al scoring system:- Based on severity of the deformity
- 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.