CONGENITAL TALIPES EQUINO-VARUS (C.T. E. V.)

 CONGENITAL TALIPES EQUINO-VARUS (C.T. E. V)

Congenital:- Since Birth.

Talipes:-  Foot.

Equino:- Plantarflexion deformity-At tibiotalar joint(Ankle Joint).

Varus:- Inversion at Talocalcaneal Joint(Subtalar Joint) + Adduction of the foot at the mid-tarsal joint.

Cavus:- Increase medial arch of foot.

Plantar Flexion Deformities:-  

• means an increase in the plantarflexion of the foot. The entire foot points downwards in relation to the tibia. 
• Plantar flexion deformity is due To:-

1. Contracted posterior capsule of the ligament.

2. Contracted Achilles tendon 

3. Contracted plantaris muscles. 

• Due to plantar flexion, the patient will start to walk on toes instead of heels.

 

Inversion at the subtalar joint:-

• The foot moves towards the midline.
  The heel is in varus in relation to the tibia.

• It is due to:-

1. Tendons on the medial side of the foot are contracted.

2. Tight or Contracted foot inverters.

• The structure on the medial side:- 

T- Tibialis Posterior

D- Flexor Digitorum Longus

A- Posterior Tibial Artery

N- Posterior Tibial Nerve

H- Flexor Hallucis Longus

Adduction Of Forefoot:-

• The foot moves towards the midline.

• The navicular moves medially and starts to dislocate off the talus. 

• The calcaneum also rotates medially under the talus as part of the adductus deformity.

Cavus:-

• The arch of the foot is higher than normal.

CAUSES-

Congenital:-

• Raised intra-uterine pressure

• Ischemia of muscle of foot 

• Genetic

• Presentation:-

• Present since birth

• Bilaterally

• Passively not correctable 

Acquired:-

Due to contracted Inverters and plantar flexors; and they are stronger than evertors and dorsiflexors.

• UMN- Cerebral Palsy

Cause-Friedrich’s ataxia & Syringomyelia

• LMN- Spina Bifida

Cause-Myelodysplasia 

• Neve- Neuropathy(common peroneal nerve dysfunction)

• NMJ- Myasthenia gravis 

• Muscle- Muscular dystrophy

Cause-Peroneal MD, Charcot Marie tooth DS, Arthrogryposis Multiplex Congenita(AMC), Defective development of muscle