Treatment of choice in newborn with club foot:
Ans: C (Both manipulation and splint) Ref: Campbell's Operative Orthopaedics, 11th editionExplanation:Components of CTEV:Ankle equinesHindfoot varusMidfoot cavusForefoot adduction.Aim of Treatment: To produce and maintain a plantigrade, supple foot that will function well.The primary treatment for CTEV is conservative.Conservative Treatment:Treatment starts within a day or two of birth.Treatment includes repeated manipulation and adhesive strapping with regular monitoring of correction by a physical therapist.Alternatively, a light plaster cast is applied with correction of the deformity and is changed every week.Order of correction of deformity:o Midfoot cavuso Forefoot adductiono Hindfoot varuso Lastly ankle equinesMnemonic for the deformities in CTEV and the order of correction of deformities: CAVE - Cavus. Adductus, Varus and Equinus.Overoorrection has to be achieved.Complication arising with incorrect manipulation - rocker- bottom deformity (arises from attempts to overcome equines before the other deformities are corrected causing a break in the foot in the midtarsal region).The universally accepted method used for serial manipulation and casting - Ponseti technique.Technique that was used previously but has fallen out of favor now - Kite technique.Difference between Ponseti and Kite techniques - During correction of deformity, in Kite technique, the center of rotation of malaligned foot (fulcrum) is on the cuboid; whereas in Ponseti technique, the fulcrum is on the head of talus.RESISTANT CASES -- Those feet that are not corrected despite &-12 weeks of serial manipulations and strapping.Operative treatment needed for resistant cases and severe, rigid deformities.Surgeries Performed for CTEV:Persistent Equinus Deformity Alone:Tendoachilles (TA) release in young infants.Tendoachilles lengthening in older children.All Components Remaining: Posteromedial Soft-Tissue Release (PMSTR)TA and tibialis posterior tendons lengthened by Z-tenotomy to correct equines and varus repectivety.Posterior capsules of ankle and subtalar joints divided to correct equines.Flexor digitorum iongus and flexor halluds longus lengthened to correct equines.Calcaneo-fibular ligament released to correct calcaneal mal rotation.Talonavicular and calcaneocuboid joints released to correct forefoot adduction.Origin of intrinsic muscles and plantar fascia from the calcaneum divided to reduce any cavus or plantaris deformity.Foot is placed in a plaster cast in corrected position.LATE OR RELAPSED CLUBFOOTYoung Child (4-7 years):Revision of soft tissue releases.Shortening of the lateral side of the foot by calcaneo-cuboid fusion or cuboid enucleation (Dilwyn-Evans operation) to correct forefoot adduction.Calcaneal lateral closing wedge osteotomy to correct varus deformity.Older Child (4-11 years):Ilizarov fixator.In Above 12 Years:Triple arthrodesis (Fusion of subtalar, talonavicular and calcaneocuboid joints after correction of deformity).
Observation and follow up
Manipulation only
Both manipulation and splint
Splint application alone
Congenital Talips Eqino Varvs (C.T.E.V.)