Common Pediatric Foot Deformities

Common Orthopedic Problems

in Children
 Angular deformities of LL:
 Bow legs.
 Knock knees.
 Rotational deformities of LL:
 In-toeing.
 Ex-toeing.
 Leg aches.
 CDH.
 Feet problems.
 Irritable hip.
Angular LL Deformities of LL
Angular Deformities
Nomenclature
Bow legs Knock knees

Genu Varus Genu Valgus

 Angular Deformities
Range of Normal Varies With Age

 During first year : Lateral bowing of Tibiae

 During second year : Bow legs (knees & tibiae)

 Between 3 – 4 years : Knock knees

Angular Deformities
Evaluation

Should differentiate between

“physiologic” and
“pathologic”
deformities
Angular Deformities
Evaluation

Physiologic Pathologic

• Symmetrical • Asymmetrical
• Mild – moderate • Severe
• Regressive • Progressive
• Generalized • Localized
• Expected for age •Not expected for age
Angular Deformities
Causes

Physiologic Pathologic

• Normal – for age • Rickets

• Exaggerated : • Endocrine disturbance
- Overweight • Metabolic disease
- Early wt. bearing • Injury to Epiphys. Plate
Infection / Trauma
- Use of walker?
• Idiopathic
Angular Deformities
Evaluation

Symmetrical deformity
Angular Deformities
Evaluation

Asymmetrical Deformity
Angular Deformities
Evaluation

Generalized deformity
Angular Deformities
Evaluation

Localized deformity

Blount’s
Angular Deformities
Evaluation
Localized deformity

Rickets
 Angular Deformities
Evaluation
Measure Angulation
( standing / supine )

in bow legs / genu varum

Inter-condylar distance
 Angular Deformities
Evaluation
Measure Angulation
( standing / supine )

in knock knees /genu

valgum
Inter- malleolar distance
 Angular Deformities
Evaluation
Measure Angulation

Use goneometer
measures angles directly
 Angular Deformities
Evaluation
Investigations / Laboratory

 Serum Calcium / Phosphorous ?

 Serum Alkaline Phosphatase
 Serum Creatinine / Urea – Renal function
 Angular Deformities
Evaluation
Investigations / Radiological

X-ray when severe or possibly pathologic

 Standing AP film
 longfilm ( hips to ankles ) with patellae directed
forwards
 Look for diseases :
 Rickets/ Tibia vara (Blount’s) / Epiphyseal injury..
 Measure angles.
 Angular Deformities
Evaluation
Investigations / Radiological

Medial Physeal Slope Femoral-Tibial Axis

Angular Deformities
When To Refer ?
 Pathologic deformities:
Asymmetrical.
Localized.
Progressive.
Not expected for age.

 Exaggerated physiologic
deformities:
Definition ?
Angular Deformities
Surgery
Rotational LL Deformities

In-toeing / Ex-toeing

 Frequently seen.
 Concerns parents.
 Frequently prompts varieties of treatment.
( often un-necessary / incorrect )
Rotational Deformities

Level of affection :
Femur
Tibia
Foot
Rotational Deformities
Femur
Ante-version = more medial rotation
Retro-version = more lateral rotation
Rotational Deformities
Normal Development

 Femur : Ante-version :
 30 degrees at birth.
 10 degrees at maturity.
 Tibia : Lateral rotation :
 5 degrees at birth.
 15 degrees at maturity.
Rotational Deformities
Normal Development

Both Femur and Tibia laterally rotate with growth in children

 Medial Tibial torsion and Femoral ante-

version improve ( reduce ) with time.

 Lateral Tibial torsion usually worsens with

growth.
Rotational Deformities
Clinical Examination
Rotational Profile

 Atwhich level is the rotational deformity?

 How severe is the rotational deformity?
 Four components:

1- Foot propagation angle.

2- Assess femoral rotational arc.
3- Assess tibial rotational arc.
4- Foot assessment.
Rotational Deformities
Clinical Examination
Rotational Profile

1- Foot propagation angle – Walking

Normal Range:
+10o _10o
? In Eastern Societies
+25o _10o
Rotational Deformities
Clinical Examination
Rotational Profile
2- Assess Femoral Rotational Arc

Supine
Extended
Rotational Deformities
Clinical Examination
Rotational Profile
2- Assess Femoral Rotational Arc
Supine
flexed
Rotational Deformities
Clinical Examination
Rotational Profile
3- Tibial Rotational Arc
Thigh-foot angle in prone

foot position is critical

leave to fall into natural
position
Rotational Deformities
Clinical Examination
Rotational Profile
4- Foot assessment

 Metatarsus adductus
 Searching big toe
 Everted foot
 Flat foot
 Rotational Deformities
Common Presentations
Infants
 Out-toeing : Normal
• seen when infant positioned upright
( usually hips laterally rotate in-utero )

• Metatarsus adductus :
• medial deviation of forefoot
• 90 % resolve spontaneously
• casting if rigid or persists late in 1st year
Rotational Deformities
Common Presentations

Toddlers

 In-toeing most common during second year.

( at beginning of walking )
 Causes :
 medial tibial torsion.
 metatarsus adductus.
 abducted great toe.
Rotational Deformities
Common Presentations

Toddlers - Medial Tibial Torsion

 The commonest cause of in-toeing

 Observational management is best
 Avoid special shoes / splints / braces
 unnecessary, ineffective, interferes with activity
and cause psychological and behavioral problems.
Rotational Deformities
Common Presentations

Toddler - Metatarsus Adductus

 Serial casting is effective in this age-group

 Usually correctable by casting up to 4 years
Rotational Deformities
Common Presentations

Toddlers - Abducted Great Toe

 Dynamic deformity
 Over-pull of Abductor
Hallucis Muscle during
stance phase

• Spontaneously resolve - no treatment

Rotational Deformities
Common Presentations

Child

 In-toeing : due to medial femoral torsion

 Out-toeing : in late childhood

lateral femoral / tibial torsion
Rotational Deformities
Common Presentations

Child
Medial Femoral Torsion
 Usually: - starts at 3 - 5 years,
- peaks at 4 – 6 years,
- then resolves spontaneously.
 Girls > boys.
 Look at relatives - family history – normal.
 Treatment usually not recommended.
 If persists > 8 years and severe, may need
surgery.
Rotational Deformities
Common Presentation
Medial Femoral Torsion (Ante-version)

 Stands with knees medially rotated (kissing

patellae).
 Sits in W position.
 Runs awkwardly (egg-beater).

Family History
 Rotational Deformities
Common Presentations

Child
Lateral Tibial Torsion
 Usually worsens.
 May be associated with knee pain (patellar)
specially if LTT is associated with MFT.
( knee medially rotated and ankle laterally rotated )
 Rotational Deformities
Common Presentations

Child
Medial Tibial Torsion

 Less common than LTT in older

child
 May need surgery if :
 persists > 8 year,
 and causes functional disability
Rotational Deformities
Management

 Challenge : dealing effectively with family

 In-toeing : spontaneously corrects in vast majority of children as LL

externally rotates with growth - Best Wait !
Rotational Deformities
Management

Convince family that only observation is appropriate

 < 1 % of femoral & tibial torsional deformities fail to

resolve and may require surgery in late childhood.
Rotational Deformities
Management

 Attempts to control child’s walking, sitting and

sleeping positions is impossible and ineffective
cause frustration and conflicts.

 She wedges and inserts : ineffective.

 Bracing with twisters :ineffective - and limits
activity.
 Night splints : better tolerated - ? Benefit.
Rotational Deformities
Management

Shoe wedges Ineffective Twister cables

Ineffective
Rotational Deformities
When To Refer ?

 Severe & persistent deformity.

 Age > 8-10y.
 Causing a functional dysability.
 Progressive.
Rotational Deformities
Management

When Is Surgery Indicated ?

•In older child ( > 8 – 10 years ).

•Significant functional disability.

•Not prophylactic !
Leg Aches / Growing Pains
Leg Aches / Growing Pains

 Incidence : 15-30 % of children.

 More In girls / At night / In LL.
 Diagnosis is made by exclusion.
Leg Aches / Growing Pains
History

 Vague pain.
 Poorly localised.
 Bilateral.
 Nocturnal.
 Seldom alters activity.
 Long duration.
Leg Aches / Growing Pains
Examination

 General health is normal.

 No deformities.
 No joint stiffness.
 No tenderness.
 Normal gait.
 No limping.
Leg Aches / Growing Pains
Management

 When atypical history or signs present on examination:

 Imaging and lab. Studies.
 If all negative :
 Symptomatic treatment :
 Heat / Analgesics.
 Reassure family :
 Benign.
 Self-limiting.
 Advise to re-evaluate if clinical features change.
Leg Aches / Growing Pains

Feature Growing Pain Serious Problem

History :
Long duration Often Usually not
Pain localised No Often
Pain bilateral Often Unusual
Ulters activity No Often
Cause limping No Sometimes
General health Good May be ill

From Stahili : Practice of Pediatric Orthopedics 2001

Leg Aches / Growing Pains

Feature Growing Pain Serious Problem

Physical examination :
Tenderness No May show
Guarding No May show
Reduced rang of motion No May show
Laboratory :
CBC Normal ? Abnormal
ESR Normal ? Abnormal

From Stahili : Practice of Pediatric Orthopedics 2001

CDH / DDH

Congenital Dislocation of Hip.

Developmental Dysplasia of Hip.
 CDH Spectrum

 Teratologic Hip : Fixed dislocation

Often with other anomalies
 Dislocated Hip : Completely out
May or may not be reducible
 Subluxated Hip : Only partially in
 Unstable Hip : Femoral head can be dislocated
 Acetabular Dysplasia : Shallow Acetabulum
Head Subluxated or in
place
CDH
Etiology & Risk Factors
 Prenatal :
 Positive family history (increases risk 10X)
 Primi-gravida
 Female (4-6 X > Males)
 Oligo-hydramnious
 Breech position (increases risk 5-10 X)
 Postnatal :
 Swaddling / Strapping ( ? Knees extended)
 Ligament Laxity
 Torticollis (CDH in 10-20 % cases)
 Cong. Knee recurvatum / dislocation
 Metatarsus adductus / calcaneo-valgus
CDH
Risk Factors

When Risk Factors Are Present

 The infant should be examined repeatedly
 The hip should be imaged by
 U/S
 or X-ray
CDH
Clinical Examination
CDH
Neonatal Examination

LOOK :
 Asymmetric thigh
folds
 Posterior

 anterior
CDH
Clinical Examination
Look :
 Shortening ( not in neonates )

- in supine
- Galeazzy sign
CDH
Neonatal Examination
MOVE :
 Hip instability
in early infancy
 Limited hip abduction
in flexion - later
 (careful in bilateral)
if <600 on both
sides:
request
imaging
CDH
Neonatal Examination
CDH
Neonatal Examination
Hip Flexion Deformity
Thomas Test
SPECIAL :
 Loss of fixed flexion
Normal
deformity of hips in FFD
early infancy.
 Normally FFD:
 newborn 28o
 at 6 weeks 19o CDH
No FFD
 at 6 months 7o
CDH
Neonatal Examination
Ortolani Barlow

Feel Clunk
Not hear click !
CDH
Neonatal Examination
Ortolani / Barlow

clunk

Ortolani Barlow
CDH
Neonatal Examination

Ortolani Test Barlow Test

CDH
Clinical Examination
 Hip clicks :
- fine, short duration, high pitched sounds
- common and benign – from soft tissues
 Hip clunks :
- sensation of the hip displacing over the
acetabular margin
 If in doubt : U/S in young infants
single radiograph if > 2-3 months
CDH
Clinical Examination
 Neonate (up to 2-3 months) :
 Instability/ Ortolani-Barlow
 Infant ( > 2-3 months) :
 Limited abduction
 Shortening ( Galeazzi )
 Toddler :
 Limited abduction
 Shortening ( Galeazzi )
 Walker :
 Trendelenburgh limpimg
CDH
Ultrasound Screening

 Early U/S screening not recommended

 Delayed U/S screening :
 Older than 3 weeks
 Those at risk or suspicious by:
 History
 Clinical exam
CDH
Treatment
 Birth to 6 months :
 Pavlik harness or hip spica cast
6 months – 12 months :
 closed reduction UGA and hip spica casts
 12 months – 18 months :
 possible closed / possible open reduction
 Above 18 months :
 open reduction and ? Acetabuloplasty
 Above 2 years :
 open reduction,acetabulplasty, and femoral
osteotomy
CDH
Treatment

 Method depends on Age

 The earlier started, the easier the treatment & the
better the results
 Should be detected EARLY
 UREGENT referral once an abnormality is detected.
Anatomy/Terminology
•3 main sections
1.Hindfoot – talus,
calcaneus
2.Midfoot – navicular,
cuboid, cuneiforms
3.Forefoot –

metatarsals and
phalanges
Anatomy/Terminology

• Important joints
1. tibiotalar (ankle) – plantar/dorsiflexion
2. talocalcaneal (subtalar) – inversion/eversion

• Important tendons
1. achilles (post calcaneus) – plantar flexion
2. post fibular (navicular/cuneiform) – inversion
3. ant fibular (med cuneiform/1st met) – dorsiflexion
4. peroneus brevis (5th met) - eversion
Anatomy/Terminology

• Varus/Valgus
Calcaneovalgus foot
Calcaneovalgus foot

• ankle joint dorsiflexed, subtalar joint everted

• classic positional deformity
• more common in 1st born, LGA, twins
• 2-10% assoc b/w foot deformity and DDH
• treatment requires stretching: plantarflex
and invert foot
• excellent prognosis
Congenital Vertical Talus

• true congenital deformity

• 60% assoc w/ some neuro impairment
• plantarflexed ankle, everted subtalar joint, stiff
• requires surgical correction (casting is
generally ineffective)
Talipes Equinovarus (congenital clubfoot)

A. General
- complicated, multifactorial deformity of
primarily genetic origin

- 3 basic components
(i) ankle joint plantarflexed/equines
(ii) subtalar joint inverted/varus
(iii) forefoot adducted
Talipes Equinovarus (congenital clubfoot)
Talipes Equinovarus (congenital clubfoot)

B. Incidence
- approx 1/1,000 live births
- usually sporadic
- bilateral deformities occur 50%

C. Etiology
- unknown
- ?defect in development of talus leads to
soft tissue changes in joints, or vice
versa
Talipes Equinovarus (congenital clubfoot)

D. Diagnosis/Evaluation
- distinguish mild/severe forms from other disease
- AP/Lat standing or AP/stress dorsiflex lat films

E. Treatment
• Non-surgical
- weekly serial manipulation and casting
- must follow certain order of correction
- success rate 15-80%
• Surgical
- majority do well; calf and foot is smaller
Talipes Equinovarus (congenital clubfoot)
Pes Planus (flatfoot)

A. General
- refers to loss of normal medial long. arch
- usually caused by subtalar joint assuming an
everted position while weight bearing
- generally common in neonates/toddlers

B. Evaluation
- painful?
- flexible? (hindfoot should invert/dorsiflex
approx 10 degrees above neutral
- arch develop with non-weight bearing pos?
Pes Planus (flatfoot)
Pes Planus (flatfoot)

C. Treatment
(i) Flexible/Asymptomatic
- no further work up/treatment is necessary!
- no studies show flex flatfoot has increased
risk for pain as an adult

(ii) rigid/painful
- must r/o tarsal coalition – congenital fusion or
failure of seg. b/w 2 or more tarsal bones
- usually assoc with peroneal muscle spasm
- need AP/lat weight bearing films of foot
In-Toeing

A. General
- common finding in newborns and children
- little evidence to show benefit from treatment
In-Toeing

B. Evaluation
- family hx of rotational deformity?
- pain?
- height/weight normal?
- limited hip abduct or leg length discrepancy?
- neuro exam

C. 3 main causes
(i) metatarsus adductus
(ii) internal tibial torsion
(iii) excessive femoral anteversion
In-Toeing

(i) metatarsus adductus

- General
• normal hindfoot,
medially deviated
midfoot

• diagnosis made if
lateral aspect of foot
has “C” shape, rather
than straight
In-Toeing

(i) metatarsus adductus

- Evaluation
• should have normal

ankle motion

• assess flexibility by
holding heel in
neutral position,
abducting forefoot
In-Toeing

(i) metatarsus adductus

• treatment
- if flexible, stretching; Q diaper change, 10 sec
- if rigid, or if no resolution by 4-8 months,
refer to ortho
- prognosis is good: 85-90% resolve by 1yr
In-Toeing

(ii) Internal Tibial Torsion

• usually presents by
walking age

• knee points forward,

while feet point
inward
In-Toeing

(ii) Internal Tibial Torsion

• Treatment
- reassurance! spontaneous resolution in 95%
children, usually by 7-8yrs
- controversy with splints, casts, surgery
In-Toeing

(iii) Excessive Femoral Anteversion

• both knees and feet

point inward

• presents during early

childhood (3-7yrs)

• most common cause

of in-toeing
In-Toeing

(iii) Excessive Femoral Anteversion

• int rotation 70-80 deg

ext rotation 10-30 deg

• “W” position
In-Toeing

(iii) Excessive Femoral Anteversion

• increase in internal
rotation early with
gradual decrease
In-Toeing

(iii) Excessive Femoral Anteversion

• Treatment
- no effective non-surgical treatment
- surgical intervention usually indicated if
persists after 8-10 yrs and is cosmetically
unacceptable or functional gait problems
- derotational osteotomy
References

• Hoffinger SA. Evaluation and Management of Pediatric

Foot Deformities. Pediatric Clinics of North America. 1996.
43(5):1091-1111
• Yamamoto H. Nonsurgical treatment of congenital clubfoot
with manipulation, cast, and modified Denis Browne splint.
J Pediatric Ortho. 1998. 18(4): 538-42
• Sullivan JA. Pediatric flatfoot: evaluation and management.
J Am Acad Orthop Surg 1999. 7(1): 44-53
• Dietz FR. Intoeing-Fact, Fiction and Opinion. American
Family Physician. 1994. 50(6): 1249-1259
• Canale. Campbell’s Operative Orthopedics, 9th ed. 1998
1713-1735; 938-940
CLUB FOOT
Gross deformity of the foot that is giving it the stunted lumpy appearance
 CLUB FOOT
Definitions

Talipes: Talus = ankle

Pes = foot
Equinus: (Latin = horse)
Foot that is in a position of
planter flexion at the ankle,
looks like that of the horse.
Calcaneus: Full dorsiflexion at the ankle
 CLUB FOOT
Planus: flatfoot

Cavus: highly arched foot

Varus: heal going towards

the midline
Valgus: heel going away
from the midline
Adduction: forefoot going Forefoot Hind foot

towards the midline

Abduction: forefoot going away
From the midline
CLUB FOOT

Types
Postural :
Calcaneo-Valgus Equino-
Varus
Look for CDH Minor and
correctable
CLUB FOOT
Types
Idiopathic (Unknown Etiology) :
 Congenital Talipes Equino-Varus CTEV
Acquired, Secondary to :
 CNS Disease : Spina bifida, Poliomyelitis
 Arthrogryposis
 Absent Bone : fibula / tibia
 Congenital Talipes Equino-Varus
CTEV
Congenital clubfoot or CTEV occurs
typically in an otherwise normal child.
Congenital Talipes Equino-Varus
CTEV
Etiology
 Polygenic
 Multifactorial

although many of these factors are speculative

 Congenital Talipes Equino-Varus
CTEV
Etiology
Some of these factors are :
 Abnormal intrauterine forces
 Arrested fetal development
 Abnormal muscle and tendon insertions
 Abnormal rotation of the talus in the mortise
 Germ plasm defects
Congenital Talipes Equino-Varus
CTEV
Incidence
 Occurs approximately in one of every 1000
live birth
 In affected families, clubfeet are about 30
times more frequent in offspring
 Male are affected in about 65% of cases
 Bilateral cases are as high as 30 – 40 %
Congenital Talipes Equino-Varus
CTEV
Geographic Distribution
 Middle East , KSA common
 Mediterranean Coast & North Africa
 White race
Congenital Talipes Equino-Varus
CTEV
Basic Pathology
 Abnormal Tarsal Relation
Congenital Dislocation / Subluxation
Talo Calcaneo Navicular Joint
 Soft Tissue Contracture
Congenital Atresia

EGG & CHICKEN

Congenital Talipes Equino-Varus
CTEV
Congenital Talipes Equino-Varus
CTEV
Adaptive Changes
Wolff’s Law
“ Every change in the use of static function of bone
caused a change in the internal form or architecture
as well as alteration in its external formation and
function according to mechanical law ”

Davis Law
“ When ligaments and soft tissue are in loose or lax
state; they gradually shorten ”
Congenital Talipes Equino-Varus
CTEV
Adaptive Changes
 Bony :
Change in the shape of tarsal and metatarsal
bones especially after walking

 Soft Tissue :
Shortening ? Contracture in the Concave Side
1- Muscles 2- Tendons
3- Ligaments 4- Joints Capsule
5- Skin 6- Nerves & Vessels
Congenital Talipes Equino-Varus
CTEV
 Congenital Talipes Equino-Varus
CTEV
Diagnosis
General Examination :
Exclude
 Neurological lesion that can cause the deformity
“Spina Bifida”
 Other abnormalities that can explain the deformity
“Arthrogryposis, Myelodysplasia”
 Presence of concomitant congenital anomalies
“Proximal femoral focal deficiency”
 Syndromatic clubfoot
“Larsen’s syndrome, Amniotic band Syndrome”
Congenital Talipes Equino-Varus
CTEV
Diagnosis

Spina Bifida = Paralytic TEV

 Congenital Talipes Equino-Varus
CTEV
Diagnosis
Characteristic Deformity :

Hind foot
 Equinus (Ankle joint)
 Varus (Subtalar joint)
Fore foot
 Adduction (Med tarsal joint)
 Supination fore foot
 Cavus
Congenital Talipes Equino-Varus
CTEV
Diagnosis
Congenital Talipes Equino-Varus
CTEV
Diagnosis

“ Hind foot “ “ Fore foot “

Equinus, Varus Adduction, Supination, Cavus
Congenital Talipes Equino-Varus
CTEV
Diagnosis
Congenital Talipes Equino-Varus
CTEV
Diagnosis
 Short Achilles tendon
 High and small heel
 No creases behind Heel
 Abnormal crease in middle of the foot
 Foot is smaller in unilateral affection
 Callosities at abnormal pressure areas
 Internal torsion of the leg
 Calf muscles wasting
 Deformities don’t prevent walking
Congenital Talipes Equino-Varus
CTEV
Diagnosis
 Congenital Talipes Equino-Varus
CTEV
Diagnosis
X-Ray needed to assess progress of treatment
Congenital Talipes Equino-Varus
CTEV
Treatment
The goal of treatment for clubfoot is to obtain a plantigrade foot that is
functional, painless, and stable over time
A cosmetically pleasing appearance
is also an important goal sought by
the surgeon and the family
 Congenital Talipes Equino-Varus
CTEV
Treatment
Non surgical treatment should begin shortly after
birth
1. Gentle manipulation

2. Immobilization
- Strapping ????
- POP or synthetic cast
 Congenital Talipes Equino-Varus
CTEV
Treatment
Non surgical treatment should begin shortly after
birth
3. Splints to maintain correction
- Ankle-foot orthosis ????
- Dennis Brown splint
Congenital Talipes Equino-Varus
CTEV
Treatment
Manipulation and serial casts
 Validity, up to 6 months !
 Technique “Ponseti”

 Avoid false correction

 When to stop ?
 Maintaining the correction
 Follow up to watch and avoid recurrence
 Congenital Talipes Equino-Varus
CTEV
Treatment
Ponseti technique
1. Always use long leg casts, change weekly.
2. First manipulation raises the 1st metatarsal
to decrease the cavus
3. All subsequent manipulations include pure
abduction of forefoot with counter-pressure
on neck of talus.
4. Never pronate !
5. Never put counter pressure on calcaneus or
cuboid.
 Congenital Talipes Equino-Varus
CTEV
Treatment
Ponseti technique (cont.)
6. Cast until there is about 60 degrees of external
rotation (about 4-6 casts)
7. Percutaneous tendo Achilles tenotomy in cast room
under local anesthesia, followed by final cast (3
weeks)
8. After final cast removal, apply Normal last shoes with
Denis Browne bar set at 70 degrees external rotation
(40 degrees on normal side)
9. Denis Browne splint full time for two months, then
night time only for two-four years.
10. 35% need Anterior Tibialis tendon transfer at age 2-3
 Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Indications
 Late presentation, after 6 months of age !
 Complementary to conservative treatment
 Failure of conservative treatment
 Residual deformities after conservative
treatment
 Recurrence after conservative treatment
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
 Types (soft tissue and bony operations)
 Time of surgery
 Selection of the procedure and the incision
 Post operative care
 Follow up
 Complications
 Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Soft tissue operations

1. Release of contractures
2. Tenotomy
3. Tendon elongation
4. Tendon transfer
5. Restoration of normal bony relationship
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
 Congenital Talipes Equino-Varus
CTEV Surgical Treatment
Bony operations
 Indications
 Usually accompanied with soft tissue operation
 Types:
- Osteotomy, to correct foot deformity or int. tibial
torsion
- Wedge excision
- Arthrodesis (usually after bone maturity)
one or several joints
- Salvage operation to restore shape
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment
Congenital Talipes Equino-Varus
CTEV
Surgical Treatment