Congenital Talipes Equinovarus: Definition and Orientation
Congenital talipes equinovarus (CTEV), or congenital clubfoot, is a three-dimensional congenital deformity of the foot characterised clinically by cavus, adductus, varus and equinus (CAVE). It is usually idiopathic, although it may occur as part of a neuromuscular, syndromic, or chromosomal disorder. The deformity is not simply an abnormal position of the foot at birth; it is a complex structural disorder involving the bones, joints, capsules, ligaments, tendons, muscles, and neurovascular soft tissues of the hindfoot and midfoot.
The examiner should distinguish idiopathic clubfoot from non-idiopathic clubfoot associated with arthrogryposis, spina bifida, cerebral palsy, myelomeningocele, congenital muscular disorders, or recognised syndromes. Non-idiopathic feet are generally stiffer, more resistant to correction, and more prone to recurrence. The present question asks specifically for pathoanatomy and then management of a 12-year-old with a severe, untreated deformity; therefore, the structural basis of the deformity is essential for planning treatment.
Pathoanatomy of CTEV
Three-dimensional deformity
The deformity is best understood as a coupled sequence rather than four unrelated components. The hindfoot is in varus and equinus, the forefoot is adducted and supinated, and the medial border is shortened and curved. The components are:
- Cavus: increased longitudinal arch, principally due to…