CTEV UG

tORTHOPAEDIC PHYSIOTHERAPY

1. CTEV HETA PATEL (R 2 )

2. Outline What is CTEV? Epidemiology Causes Anatomy and pathoanatomy Clinical features X-rays Treatment

3. What is CTEV?? Idiopathic clubfoot Causing CAVE - midfoot   C avus / increase in height -forefoot   A dductus   - hindfoot   V arus   - hindfoot   E quinus / plantarflex

4. Hind foot equinus Heel in varus Midfoot cavus

5. Epidemiology Relatively common- 1 to 2 per thousand births Boys affected twice Bilateral in 1/3 of cases

6. Causes-unknown germ defect arrested development neuromuscular disorder in neurological disorders and neural tube defect postural deformity

7. Common Types Congenital - uncommon bony problems present upon childbirth not related to any neuromuscular factor or symptoms . Teratologic -a/w neurological conditions ( eg : spina bifida) Positional - in contorted position in utero 4 Syndromic -a/w standard hereditary issue, which includes arthrogryposis .

8. Anatomy Hindfoot - calcaneum , talar Midfoot -cuboid, navicular , cuneiform Forefoot - metatarsals, phalanges

9. Pathological Anatomy Neck of Talus -pointing downward and deviates medially Body of Talus - Rotated outward Posterior part of calcaneum -held close to fibula by CF ligt -tilted into equinus and varus -rotated medially beneath ankle Navicular and forefoot -shifted medially -rotated into supination (composite varus deformity)

10. Pathological Anatomy Skin and soft tissue of calf and medial side of foot are short and underdeveloped If not corrected early, secondary growth changes occur in the bones-PERMANENT

11. Clinical Features Heel is small and high Deep creases appear posteriorly and medially Abnormal thin calf

12. Varying degree of resistance / fixed deformity when try to dorsiflex and evert the foot Normal baby foot

13. Associated disorders - congenital hip dislocation - spina bifida - arthrogryposis : absent of creases Look if other joints are affected

14. How to differentiate true and postural clubfoot ? True clubfoot – fixed deformity Postural talipes – easily correctable by gentle passive movement

15. Imaging X-ray to assess progress of treatment

16. Anterioposterior view Kite’s angle ( talocalcaneal angle): normal 20-40 degree clubfoot angle almost parallel 30 degree plantarflex

17. Lateral Film ( Turco view) Normal angle : 4 0 degree If less 20 degree: rocker bottom deformity - calcaneum seem to be dorsiflexed but it had broken at midtarsal level Foot dorsiflex

18. treatment

19. Vision & Mission Since CTEV can purely be therapeutic work we would not only treat also HABILITATE club foot to be normal. Increase awareness and confidence of society with therapeutic staff.

20. Aim To produce and maintain a PLANTIGRADE , supple foot that will function well

21. Non Operative Operative Serial Manipulative and Casting ( Ponsetti’s method) -Posteromedial tissue release and tendon lengthening -medial opening or lateral column-shortening osteotomy, or cuboidal decancellation -triple arthrodesis - tallectomy

22. Serial Manipulative and Casting ( Ponsetti’s method) Goal-rotate leg laterally around the fixed tallus Order of correction (CAVE) - midfoot   c avus -forefoot   a dductus - hindfoot   v arus - hindfoot   e quinus

23. Increase the supination deformity of forefoot

24. DON’T SLEEP. TQ

25. THANK YOU