Wednesday, April 8, 2020

Club foot: Age-wise Management Flowchart

Club foot is one that resembles a golf club. It is also called Congenital Talipes Equino Varus or CTEV.
Figure 1. Dennis-Brown Splint

Deformity:
- Increased plantar arch (Cavus)
- Adduction of midfoot and forefoot
- Plantar flexion of the ankle (Equinus)
- Inversion of forefoot, midfoot and hindfoot (Varus)

Pathology:
The main problem in CTEV is that the foot's Lateral border is Longer and the Medial border is Shorter. So, our goal is to Equalise both the borders to prevent any future deformity.

2 prominent orthopedic surgeons entered the race for correction of CTEV:
- Kite - followed earlier
- Ponsetti - now preferred
Each surgeon proposed varying models of management protocols. Let's compare them both:


Kite's method
Ponsetti's method
Screening at birth 
Manipulation by Mother during initial weeks
Manipulation and cast by Orthopedic surgeon
Changing the cast
Every 2 weeks 
Each week
Fulcrum of manipulation
Calcaneo-cuboid joint 
Head of Talus
Total duration of treatment
6-8 months

6-8 weeks 

Age-wise management flowchart of CTEV:

<1 year: Ponsetti's treatment: Above-knee POP cast
- Dennis Brown Splint: encourages abduction and dorsiflexion
- Thomas CTEV shoes.

In the absence of early screening and intervention (within 1 year of age) the order of correction of each deformity is given by mnemonic: *C-A-V-E
C - Cavus
A - Adduction
V - Varus
E - Equinus

See the following illustration to get a lucid picture of the methods of deformity correction as the child grows.

That's all!
Cheers :)

Content and Illustration by Anagha

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