CTEV Deformity

 

      Photograph of a newborn baby  with club.      foot deformity 
                                              Photograph of Ponseti Casts





Classification

    Pirani 

    Midfoot - Severity of Medial Crease

                    Coverage of Talar Head

                    Curvature of Lateral Border of foot

    Hindfoot  Rigidity of Equinus

                    Severity of Posterior Crease 

                    Emptiness of Heel

How to manage this case ? 

                    History from Parents 

                    Examination    

                    Classification     

                    Treatment

                    Ponseti Cast-Above knee casts - 

                                                            moulding into corrected position. 

                                                           change each week, Pirani scoring done during change of cast

                                                           starts with manipulation and serial casting 

                                          Technique

                                                             Ist - Dorsiflex Ist ray , unlock forefoot and midfoot. 

                                                            elevation of Ist ray leads to supination

                                                            2nd- Abduct at midfoot level using head of talus as the fulcrum.

                                          Achillis tenotomy for residual Equinus.

                                                                Final Cast applied for further 3 weeks. 

                    Dennis Browne Boots with a bar 

                                                           23 hours a day for 3 months, then just at night time for 5 years. 

                                                            Avoids need of surgical release

                                                            25 % require TA transfer laterally for inversion in swing after age                                                             of 4-5 years.

                                                            

     

                                    

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