CTEV Imaging, Classification, Pirani scoring system, conservative management

CTEV Imaging, Classification, Pirani scoring system, conservative management
Talocalacaneal angle
Kites angle
Tibiocalcaneal angle
Pirani scoring system
Ponseti method
Ponseti technique
Percutaneous tenotomy
Ponseti cast
Denis brown splint
CTEV shoes

1. CTEV Imaging, Classifications, Pirani scoring system, Conservative Management By Dr Kota Gandhi II yr PG Orthopaedics Kamineni Institute Of Medical Sciences

2. R adi ographic evaluation In nonambulatory child : AP, and stress dorsiflexion views In older child : AP and standing lateral views X-rays should be taken on both feet for comparison Important angles to consider in the evaluation of club foot are talocalcaneal angle (Kite angle)on AP and Lateral views, talus-1 st metatarsal angle,tibiocalcaneal angle.

3. Talocalcaneal angle on AP view Normal :30 -55degrees In club foot this angle progressively decreases with increasing heel varus .

4. Talocalcaneal angle on stress dorsiflexion lat.view Normal : 25-50 degrees This angle progressively decreases with the severity of the deformity to an angle of zero.

5. Kite’s angle

6. Tibiocalcaneal angle Measured in lateral view Normal :10-40degrees In club foot this angle generally nagative, indicating equinus of thecalcaneus in ralation to the tibia.

7. Talus first metatarsal angle It is the radiographic measurement of fore foot adduction. In AP view : Normal: 5-15degrees In clubfoot it is negative indicating fore foot adduction

8. C lassification Determing the initial severity of the deformity is an important assessment of each component of CTEV, alerting the surgeon to the need for an earlier surgical release. Dimeglio scoring system is more objective and reproducible . Pirani et al and Dimeglio et al are based solely on the physical examination and not require radiographs.

9. Dimeglio scoring system

10. Pirani scoring system Mid foot score : upto 3 (0=normal;3=severe deformity) Hind foot score: upto 3 (0=normal;3=severe deformity) Total score – 6 (0= Normal,6=severe deformity)

11. Signs of Midfoot Contracture (MC) Curvature of Lateral Border of Foot (CLB ) More than 30 degrees ------------ 1 0 – 30 degrees ------------------------ 0.5 0 degrees --------------------------------- 0 Medial crease (MC) Deep ----------------1 Shallow ------------ 0.5 Absent -------------- 0 Lateral part of the Head of Talus (LHT) covered by navicular No coverage ---------------------------1 Partial coverage --------------------- 0.5 Full coverage -------------------------- 0

12. Signs of Hind foot Contracture (HFC) Posterior crease (PC) - deepcrease above the heelpad Deep-------------------- 1 Shallow---------------- 0.5 Absent------------------ 0 Empty Heel (EH) If calcaneal tuberosity not felt -------------------1 Felt with difficulty ----------------------------------------0.5 Felt easily -----------------------------------------------------0 Rigid equinus If ankle cannot be corrected upto neutral --------1 Upto neutral -------------------------------------------------------- 0.5 Beyond neutral ---------------------------------------------------- 0

13. Thank You!