Congenital talipes equinovarus deformity includes all of the following except: March 2010
Ans. A: Eversion The ankle is in equinus, and the foot is supinated (varus) and adducted (a normal infant foot usually can be dorsiflexed and eveed, so that the foot touches the anterior tibia). Forefoot cavus deformity is the result of excessive arching of the foot at the mid-tarsal joints. Dorsiflexion beyond 90deg is not possible. The navicular is displaced medially, as is the cuboid. Contractures of the medial plantar soft tissues are present. Not only is the calcaneus in a position of equinus but also the anterior aspect is rotated medially and the posterior aspect laterally. The heel is small and empty. The heel feels soft to the touch (akin to the feel of the cheeks). As the treatment progresses, it fills in and develops a firmer feel (akin to the feel of the nose or of the chin). The talar neck is easily palpable in the sinus tarsi as it is uncovered laterally. Normally, this is covered by the navicular, and the talar body is in the moise. The medial malleolus is difficult to palpate and is often in contact with the navicular. The normal navicular-malleolar interval is diminished. The hindfoot is supinated, but the foot is often in a position of pronation relative to the hindfoot. The first ray often drops to create a position of cavus. The Ponseti method of closed management of clubfeet through manipulations and casting describes the elevation of the first metatarsal as a first step, even if it means seemingly exacerbating the supination of the foot. Similar deformities are seen with myelomeningocele and ahrogryposis. Therefore, always examine for these associated conditions.
Eversion
Forefoot adduction
Forefoot cavus
Equinus