mellss yr5 ortho treatment of congenital talipes equino varus (ctev)
TRANSCRIPT
TREATMENT OF CONGENITAL TALIPES
EQUINO VARUS (CTEV)
Amalina Aminuddin 0820121000 67
Content Method of correction
Non-operative Operative
Method of maintenance
methods
- operative methods Manipulation
Done by mother For minor deformities
Manipulation and casting Kite’s philosophy Ponsetti’s philosophy
Kite’s Philosophy Begin at month
Adduction inversion equinus Below knee cast , every 2 weeks Within 6-9 months
Ponsetti’s Philosophy Within week of life Cavus Adduction Varus Equinus Above knee cast, every 5-7
days Within 6 weeks
Operative methods Indicated in
Resistant clubfeet Recurrent clubfeet Neglected clubfeet
a) PMSTRb) Limited soft tissue
releasec) Tendon transfersd) Dwyer’s osteotomye) Dilwyn Evan’s
proceduref) Wedge tarsectomyg) Triple arthrodesish) Ilizarov’s technique
a) Postero-Medial Soft Tissue Release
i.Posterior side: Lengthen
tendonachilles by Z-plasty
Release posterior capsule of ankle and subtalar joint
Release posterior talo- fibular and calcaneo-fibular ligament
ii. Medial side Lengthen
ligaments Tibialis
posterior Flexor
digitorum longus
Flexor hallucis longus
Release ligaments Talo-
navicular Superficial
part of deltoid ligament
Spring ligament
Release more structure Interosseous talo-calcaneal ligament, capsules of
naviculo-cuneiform, cuneiform-first metatarsal joints
iii.Plantar side Plantar fascia release Flexor digitorum brevis and abductor hallucis
release
Partially corrected foot Equinus : posterior Adduction : medial Cavus : plantar
Transfer tibialis anterior to act as everter
Minimun age : 5 years old
b) Limited Soft Tissue Release c) Tendon Transfers
d) Dwyer’s osteotomy Correct varus At least 3 years old
e)Dilwyn Evan’s procedure For recurrent/ neglected
cases between 4- 8 years old
PMSTR + calcaneo-cuboid fusion
After 12 years old Between 8 – 11 years old
f) Wedge tarsectomy g) Triple arthrodesis
h) Ilizarov’s technique Neglected /
recurrent cases
a) CTEV Splints b) Denis Brown Splints
c) CTEV Shoes
(A)Fresh case at birth Ponsetti method
Tenotomy of tendoachilles
Correct
Not corrected till 4-6 months
Follow up till 10-12 years old
All deformities left : PMSRTOnly equinus: Posterior releaseOnly heel varus : Dwyer’s osteotomy
Congratulations
Treat as (B)
(B) Old, neglected cases< 3 years old 4-8 years old 8 – 11 years old
>12 years old Already operated
Soft tissue release
Reference Maheswari and Mhaskar ‘s Essential Orthopedics
5th edition,2015 Louis Solomon, David Warwick and Selvadurai
Nayagam , Apley’s System of Orthopaedics and Fracture, 9th edition