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Congenital Talipes Equinovarus (CTEV) - clubfoot

CTEV (Congenital Talipes Equinovarus), commonly called clubfoot, is a congenital deformity in which the foot is turned downward and inward. It is characterized by four components: Cavus, Adduction, Varus, and Equinus (CAVE). It may be unilateral or bilateral and is usually idiopathic. Early treatment with the Ponseti method, involving serial manipulation and casting followed by bracing, gives excellent results in most children.

Congenital Talipes Equinovarus (CTEV), or clubfoot, is one of the most common congenital deformities of the foot. It is characterized by a complex three-dimensional deformity involving the ankle, hindfoot, midfoot, and forefoot. The classical components are remembered by the acronym CAVE: Cavus of the midfoot, Adduction of the forefoot, Varus of the hindfoot, and Equinus at the ankle. CTEV may occur as an isolated idiopathic condition or may be associated with neuromuscular and syndromic disorders such as arthrogryposis and spina bifida. It can affect one or both feet and is more common in boys. On examination, the affected foot appears smaller, inverted, and plantar-flexed, with medial and posterior skin creases and varying degrees of stiffness. The calf on the affected side may also be smaller because of muscle hypoplasia. Diagnosis is usually clinical at birth, although the deformity may also be detected on antenatal ultrasonography. The severity of the deformity can be assessed using scoring systems such as the Pirani score. The mainstay of treatment is the Ponseti method, which consists of gentle weekly manipulation and serial casting to progressively correct the deformity. Correction is performed in sequence, with cavus corrected first, followed by adduction and varus, and equinus corrected last. Many children require a percutaneous Achilles tenotomy to achieve adequate dorsiflexion. After correction, a foot-abduction brace is essential to maintain the result and reduce the risk of recurrence. With early and appropriate treatment, most children with idiopathic CTEV can achieve a plantigrade, flexible, painless, and functionally normal foot.

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