- Clubfoot or CTEV (Congenital Talipes Equino Varus) is the most common congenital deformity of the foot and ankle.
- In this deformity there is a bending of the foot and ankle inwards and the sole of the foot faces the leg. The foot looks like ‘bean shape’.
- The cause of the deformity is not well known, though linked with several genetic factors which effects the growth and development.
- Overcrowding in the uterus during the intra-partum period is also suggested to be a contributing factor.
Diagnosis-
Intrapartum diagnosis is possible around 20 weeks with USG scan. But most of the cases it is diagnosed postpartum.
Treatment of club foot-
Club foot has to be distinguished from a ‘Postural Clubfoot’. Postural club foot corrects by itself and does not requires any treatment other than manipulation by mother.
CTEV treatment starts as early as second day of life, with weekly casting and slowly correcting the deformity over a period of six weeks. The method of CTEV casting is known as ‘Ponseti Method’ and is followed worldwide. This method have significantly reduced the need for surgery in CTEV. At the end of plastering many a times a small surgery, known as Tendo-Achilles tenotomy is performed to get the tight heel cord released and the foot straight. The preferred method is a ‘needle tenotomy’ of the heel cord which has a benefit of cosmetic scar.
After the plastering and tenotomy, a special shoe known as ‘Foot Abduction Brace’ is given for maintenance of the correction. The regimen is started with 23 hours per day for first 3 months and then weaned off to night and nap time over a period of time. This shoe need to be worn for four-five years of age. It has been proved without a doubt that most common cause of recurrence of the deformity is not wearing the ‘Foot abduction brace’ properly.
Prognosis of CTEV is excellent and recovery is near normal.
Surgery has been proposed in difficult and resistant cases which fails plaster casting especially in club foot associated with syndromes and recurrent cases. There are a constellation of surgeries from soft tissue to bony. Illizarov external fixator also has been tried with mixed result for correction of the CTEV.
Caution- Hip USG screening should be done around 6 weeks of life to rule out Hip dysplasia which might be associated with CTEV.
