CTEV
Congenital Talipes Equinovarus (CTEV), commonly known as clubfoot, is a congenital deformity of the foot that occurs in approximately 1 in every 1,000 live births. It is characterized by a foot that is twisted inward and downward, making it appear as if the foot is turned inwards and the toes point down. CTEV can affect one or both feet and varies in severity.
Causes and Risk Factors
Genetic Factors:
- A family history of CTEV increases the risk, indicating a genetic predisposition. However, the exact genes involved are not well understood.
Environmental Factors:
- In some cases, environmental factors during pregnancy, such as uterine constraints or amniotic band syndrome, may contribute to the development of CTEV.
Treatment Approaches
Early treatment of CTEV is crucial for achieving the best outcomes. The goal of treatment is to correct the deformity and ensure the foot functions normally, allowing the child to walk without difficulty.
Ponseti Method (Non-Surgical Treatment):
- The Ponseti method is the most widely used and effective treatment for CTEV. It involves a series of gentle manipulations and castings to gradually correct the deformity.
- Steps:
Manipulation and Casting: The foot is gently stretched and repositioned, then placed in a cast to maintain the corrected position. This process is repeated weekly, typically for 5-8 weeks.
Achilles Tenotomy: In most cases, a minor surgical procedure called an Achilles tenotomy is performed to release the tight Achilles tendon. This allows the foot to move into the correct position. The procedure is usually done under local anesthesia.
Bracing: After the casting phase, a brace (abduction orthosis) is used to maintain the corrected position and prevent recurrence. The brace is typically worn full-time for several months and then during naps and nighttime for several years.
French Functional Method (Physical Therapy):
- This method involves daily physical therapy, including stretching, manipulation, and taping, to gradually correct the deformity. It's an alternative to the Ponseti method but requires a more intensive commitment from parents.
- Outcome: While effective, it may be less successful than the Ponseti method in severe cases.
Surgical Treatment:
- Surgery may be required if non-surgical methods fail or in cases of recurrent or severe CTEV. Surgical intervention aims to release tight tissues, lengthen tendons, and realign bones.
- Posterior Medial Release: A common procedure where tight tendons and ligaments at the back and inside of the foot are released to allow proper alignment.
- Tendon Transfers and Osteotomies: More complex surgeries that may be necessary for older children or in cases where other treatments have not been successful.
Rehabilitation:
- Physical Therapy: Post-treatment physical therapy is essential for strengthening the muscles, improving flexibility, and maintaining proper foot alignment.
- Follow-Up: Regular follow-up visits are crucial to monitor progress and ensure that the deformity does not recur.
If you would like to have additional information contact Dr. Vipul Shet, serving communities and people from all walks of live.
