Understanding CTEV: Causes, Symptoms, and Treatment Options

Definition: A deformity where the foot is twisted out of shape or position.
Types:
Idiopathic: No known cause; most common form.
Neuromuscular: Associated with conditions like spina bifida or muscular dystrophy.
Postural: Resulting from positioning in the womb.
Symptoms
Foot Position: The affected foot appears shorter and may be rotated inward.
Limited Movement: Reduced range of motion in the ankle and foot.
Appearance: The affected foot may have a high arch or be smaller than the other.
Causes
Genetics: Family history can increase the risk.
Environmental Factors: Certain conditions during pregnancy, such as oligohydramnios (low amniotic fluid), may contribute.
Diagnosis
Physical Examination: Noted at birth; doctors assess foot position and movement.
Imaging: X-rays may be used to evaluate the severity.
Treatment Options
Ponseti Method: A series of gentle manipulations and casting to correct the foot position.
Surgery: Required in severe cases or if non-surgical methods fail.
Bracing: Worn after casting to maintain the corrected position.
Prognosis
Most children treated for clubfoot go on to lead normal, active lives. Early intervention is crucial for the best outcomes.

1. CTEV/Clubfoot Explained Everything You Need to Know Dr. Monsur Rahman Musculoskeletal disorders & Rehabilitation Specialist

2. Introduction Definition : Clubfoot is a complex congenital deformity in where the baby's foot is turn inward that can significantly limit mobility if untreated. When you look at their foot, the bottom often faces sideways or even up. Deformity Features : Adductus and Cavus: Inward turning of the midfoot. Varus Hind foot: The hind foot turns inward. Equinus Position: The foot is fixed in a downward pointing position at the subtalar joint. Physical Attributes : Affected foot is typically shorter. Calf circumference is less than that of a normal, unaffected foot.

3. Epidemiology Gender Ratio : More common in  males  with a ratio of  2.5 to 2.8:1  ( Male:Female ). Incidence Rates : Varies by region, ranging from  1 to 1.5 per 1000 live births . Can rise up to  3 per 1000 live births  in certain areas. Ethnic Differences : Lowest incidence observed in the  Chinese population  at  0.6% . Highest incidence reported in the  Polynesian region  at  6.8% . Approximately  1 per 1000 live births  among  Caucasians . Global Context : Around  80%  of children born with clubfoot are in  low- and middle-income countries .

4. Types of clubfoot There are two main types of clubfoot : Isolated or Idiopathic Clubfoot: The most common type and it o ccurs without any other medical issues. Cause: The exact cause is unknown (idiopathic). Nonisolated Clubfoot: Occurs in conjunction with other health conditions. Associated Conditions: Arthrogryposis: A joint problem that affects flexibility. Spina Bifida: A neural tube defect impacting the brain, spine, and spinal cord.

5. Symptoms Common Signs of Clubfoot Foot Position : One or both feet turning inward, with the foot facing the opposite leg. Physical Characteristics Kidney Shape : The foot may appear kidney-shaped. Deep Crease : A noticeable deep crease on the inside of the foot. Higher Arch : The foot may have a higher arch than normal, known as  cavus foot deformity . Additional Symptoms Smaller Calf Muscle : The affected leg may have a smaller calf muscle. Shorter Foot : The foot may appear shorter than the other. Ankle Stiffness : There may be stiffness in the ankle. Limited Range of Motion : Lack of full range of motion in the affected foot.

6.   Risk factors and effects of clubfoot on babies Risk Factors for Developing Clubfoot Gender : Babies assigned male at birth (AMAB) are up to  twice as likely  to develop clubfoot compared to those assigned female at birth (AFAB). Family History : A family history of clubfoot increases the risk for your baby. Increased Risk Due to Other Conditions Birth Defects : Higher risk if the baby has another birth defect, such as: Spina Bifida Cerebral Palsy Genetic Conditions : Conditions like  Trisomy 18  (Edward syndrome) elevate the risk.

7. Continue… Maternal Factors Increasing Risk Oligohydramnios : Insufficient amniotic fluid during pregnancy. Infections :  Zika virus infection during pregnancy. Substance Use : Smoking, alcohol consumption, or recreational drug use during pregnancy. Effects of Clubfoot on Your Baby Pain : Clubfoot is  not painful  for most babies and often goes unnoticed in the early months. Impact on Mobility : It can hinder standing and walking, requiring treatment to correct before the baby reaches walking age.

8. Potential Complications if Left Untreated Walking Problems : Unusual walking patterns; babies may walk on the sides or tops of their feet instead of the soles. Foot Infections : Increased risk of infections in the feet. Foot Problems : Development of calluses, which are thick skin layers on the soles of the feet. Arthritis : Joint pain, stiffness, and swelling due to untreated clubfoot.

9. Diagnosis of Clubfoot During Pregnancy Prenatal Ultrasound : Clubfoot is often detected during a  prenatal ultrasound , which provides images of the developing fetus. If diagnosed, parents can begin planning for the necessary treatments after birth. After Birth Physical Examination : Healthcare providers typically notice clubfoot during one of the baby's  first physical exams . Confirmation : In some cases, an  X-ray  may be recommended to confirm the diagnosis.

10. Management and Treatment When Should Clubfoot Treatment Start? Early Intervention : It’s recommended to start treatment as soon as possible. Optimal Timing : The best time to begin treatment is during your baby’s  first two weeks of life . Early treatment can help prevent future complications. Who Treats Clubfoot? Your baby will likely be treated by a specialized team, including: Pediatric Orthopedist : Focuses on bone and joint issues in children. Orthopedic Surgeon : Specializes in surgical interventions for bones and joints. Physical Therapist : Aids in building strength and mobility in your child’s foot.

11. How is Clubfoot Treated? There are several methods for treating clubfoot, and your care team will help determine the best approach for your child: Ponseti Method : Involves gentle stretching and casting to correct the foot's position. French Method : Uses stretching and splinting techniques to realign the foot. Bracing : Involves special shoes to maintain the foot at the correct angle. Surgery : May be considered if non-surgical methods are ineffective.

12. Ponseti method The  Ponseti method  is indeed the most widely used treatment for clubfoot. It involves a process of  serial casting  and is typically initiated within the  first two weeks  after birth . Length of Treatment : Approximately  2 to 3 months  of casting. Treatment Steps Initial Foot Stretching : An  orthopedic surgeon  stretches your baby’s foot toward the correct position. Casting : The foot is placed in a cast that extends from the toes to the upper thigh. This process is repeated every  four to seven days , with each new cast gradually moving the foot closer to the correct alignment.

13. Continue… Achilles Tenotomy : Before the final cast, the surgeon performs a procedure called an  Achilles tenotomy : The  Achilles tendon  (heel cord) is cut in a quick procedure. This tendon connects the heel to the calf muscles. The incision is small and generally does not require stitches. A new cast is applied as the tendon heals, which typically takes about  three weeks .

14. Continue.. Goals and Follow-Up Care The goal of the Achilles tenotomy  is to allow the tendon to grow to its normal length. Once the last cast is removed, the tendon should be at a typical length, positioning the foot correctly. Post-Treatment Care After the final cast is off, your baby may need: Stretching Exercises : To maintain proper foot positioning. Special Shoes or Foot Brace : Typically needed for a few years to prevent recurrence.

15. French method The  French method  is an alternative approach to treating clubfoot. It focuses on  splinting and taping  rather than casting, and it’s performed by a  physical therapist  soon after birth. Here are the key details: Treatment Overview Frequency : This method requires daily treatment rather than weekly visits. Home Involvement : Parents are taught how to perform the splinting and taping at home, with the therapist checking progress a few times a week. Steps to Implement the French Method Foot Stretching : Gently stretch your baby’s foot toward the correct position. Using Tape and Splints : Hold the foot in place using tape and splints.

16. Continue.. Daily Routine : Repeat the stretching and splinting process  every day for two months . After two months, the frequency will decrease until your baby reaches  three months old . Your physical therapist will provide specific guidance on how often to continue. Potential Need for Achilles Tenotomy : Similar to the  Ponseti method, babies undergoing the French method may also require an  Achilles tenotomy .

17. Continue.. Long-Term Care Progress Monitoring : After three months, you should see improvements in your baby’s foot position. Continued Regimen : To maintain correct foot positioning and prevent regression, parents typically continue the regimen until the child is  2 to 3 years old . Bracing After Treatment Following either the Ponseti or French method, your care team may recommend a  brace  to prevent the foot from reverting to its original position. Here’s what you need to know about bracing: Bracing Details Design : The brace usually consists of a pair of shoes connected by a metal bar, often referred to as “ boots and bar .”

18. Continue.. Wearing Schedule : Wear the brace  every day for three months . After this period, the brace is typically worn only at night or during naps for about  four years . Important Considerations Compliance : It’s crucial to follow the wearing instructions diligently. If the brace isn’t used as directed, there’s a risk of the foot returning to the clubfoot position. Brace Options : There are various types of braces available, and your healthcare provider will discuss the best options for your child.

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