CONGENITAL TALIPES EQUINO VARUS
Short Questions and Answers
Q1. What is the hind-foot?
Calcaneum and talus forms the hind foot along with subtalar and calcaneocuboid joint .
Q. What is mid-foot?
Navicular , cuboid and cuneiform bones for the mid foot along with talonavicular and naviculo cuneiform joint .
Q. What is fore-foot?
Metatarsal and phalanges from the fore-foot along with tarsometatarsal joints and all distal joints.
Q.4 What are the ligaments of the ankle?
Primary ligaments of the ankle include :
Deltoid ligament
Calcaneonavicular ligament (spring ligament)
Syndesmosis
Anterior talofibular ligament (ATFL)
Posterior talofibular ligament (PTFL)
Calcaneal fibular ligament (CFL)
Lateral talocalcaneal ligament (LTCL).
Q. Commonest congenital foot deformity?
Congenital talipes equino varus (CTEV).
Q. What are the other congenital foot deformity?
Talipes calcaneo valgus
Metatarsus adductus
Metatarsus varus
Q. What are the etiology of CTEV?
Multifactorial:
Increases intrauterine pressure -Oligohydramnios, multiple pregnancies
Ischemia of calf muscles in intrauterine life
Genetic.
Q. What is the primary and secondary club foot?
Primary is idiopathic from birth.
Secondary where the cause is found and acquired like poliomyelitis, myelodysplasia, Friedreich's ataxia.
Q. How will you manage the case?
Investigation:
X-ray of the foot: AP view (Talo calcaneal angle > 35 degree normal decreased in CTEV).
Manipulation
Corrective plaster cast preceeding manipulation.
Dennis brown splint (used before the child starts walking)
CTEV shoes (Used up to 5 years of age).
Q. Which deformity is corrected first?
(Mneumonic: CAVE)
Cavus followed by Adduction and Varus then Equinus
Q. What is Dennis Brown splint?
The brace consists of open toe high-top straight last shoes attached to a bar.
For unilateral cases, the brace is set at 60-70 degrees of external rotation on the clubfoot side and 30-40 degrees of external rotation on the normal side.
In bilateral cases, it is set at 70 degrees of external rotation on each side
The bar should be of sufficient length so that the heels of the shoes are at shoulder width
The bar should be bent 5-10 degrees with the convexity away from the child, to hold the feet in dorsiflexion.
Q. What is the protocol for wearing a DB splint?
The brace should be worn full time (day and night) for the first 3 months after the last cast is removed then the child should wear the brace for 12 hours at night and 2-4 hours in the middle of the day for a total of 14 to 16 hours during each 24-hour period. This protocol continues until the child is 3-4 years of age.
Q.What is the rationale for splinting?
At the end of casting, the foot is abducted to 60 to70 degrees. This degree of foot abduction is required to maintain the abduction of the calcaneus and forefoot and prevent relapse
The foot will gradually turn back inward, to a point typically of 10 degrees of external rotation
The medial soft tissues remain stretched out only if the brace is used after the casting
In the brace, the knees are left free, so the child can kick them "straight" to stretch the gastro-soleus tendon
The abduction of the feet in the brace, combined with the slight bend, causes the feet to dorsiflex. This helps maintain the stretch on the gastrocnemius muscle and Achilles tendon.
Q. What are the surgeries done?
Soft-tissue release
Postero medial soft tissue release
Dwyer's osteotomy
Evan's operation
Wedge tarsectomy
Triple arthrodesis.
0 Comments