Makindo Medical Notes.com

The foot points down and in

About

• Clubfoot or CTEV (Congenital Talipes Equinovarus) is a common condition
• present from the early pregnancy, that causes the lower leg, ankle and foot to be twisted inwards from the normal position.

Risks

• Boys > Girls and can be bilateral in 25-50%

Possibly Associated conditions

• Spina bifida, Cerebral palsy, Arthrogryposis

Clinical

• Present at birth - The foot points down and in
• Achilles tendon at the back of the baby's heel are tight
• Tendons on the inside of their leg have become shortened.

Investigations

• Fetal USS in pregnancy may pick it up

Management

• Ponseti method: gentle manipulation to the foot to correct each element of the deformity. Above-knee plaster casts are used with the knee flexed to maintain the corrected foot position. It starts within the first week to ten days from birth; usually, weekly plaster cast changes and manipulations to the baby's foot/feet are required, in order to gradually achieve a corrected foot posture. Most babies need a small procedure to lengthen the normally tight Achilles tendon at the back of the heel. This is normally required to gain full correction of the foot and is performed under a local anaesthetic as an outpatient; the baby will be allowed home after the procedure. A further three-week period in above-knee casts will be required.
• To prevent the foot deformity from relapsing the baby will then be required to wear boots-on-bar. These are open-toed sandals attached to a bar, with boots set in an out-turned position. These need to be worn for three months full-time, and then at nights only until five years of age. This part of the treatment is essential for maintaining a well-corrected clubfoot.
• All babies who have a clubfoot are followed up regularly by the physiotherapy team and reviewed with the doctors every six months to years after treatment when the plaster casts have been completed.