A newborn child presents with inveed foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is
CTEV [Ref: Maheshwari Ohopaedics 3/e p195; Ebnezar 3/e p454J In a new born child it is possible to dorsiflex and eve the foot till the dorsum of foot touches anterior surface of tibia.This is not possible in CTEV. This is known as 'clorsillexion test' and can be used as a screening test. Ahrogryposis Multiplex Congenita is a rare congenital disorder that is characterized by multiple joint contractures and muscle atrophy and fibrosis. It is a non-progressive disease. CTEV can be seen as one of the components of AMC. So AMC can also be the answer but since it's much rarer than CTEV and in the question other joints involvement is not mentioned, answer would be `CTEV'. Congenital veical talus is a'rare disease usually affecting both feet, characterized by rigid flatfoot deformity, with the plantar aspect of the foot having a convex contour. The heel is in valgus, and the forefoot is abducted and dorsiflexed. In the newborn having this condition, the dorsal aspect of the foot may be in close approximation to the distal aspect of tibia. Flat foot or Pes planus is a condition characterized by varying degrees of loss of the longitudinal arch of the foot. This condition can be normal which usually disappears as the child grows, or can be pathological as seen in Congenital veical talus, tarsal coalition, inflammatory joint disorder or a neurological disorder. Congenital Talipes Equinovarus (Idiopathic club-food -Talipes is a term for any foot deformity that centres around the talus. - Equinus implies that the foot is flexed in the plantar direction. - Varus implies that the foot is inveed and adducted so that the sole faces inwards. CTEV is a complex deformity of the foot where the foot is both turned and twisted inwards so that the sole faces posteromedially. Deformities noted are: - plantar flexion (equines) - in version - adduction - supination - sometimes cavus (high medial arch) The involved foot is generally smaller than the opposite side with varying amounts of calf atrophy. More common in boys (2:1) Bilateral in 1/3 cases.(Ret Apley's Ohopaedics 11/e 591) Clinical tests in CTEV: 1)Dorsiflexion test: described above. 2)Plumbline test: This test helps to detect the tibial torsion. The child is made to sit on a table with both the lower limbs hanging from the edge. A line drawn from the centre of the patella to the tibial tubercle when extended down, should cut the foot at the first or second intermetatarsal space normally. This is called the pulmline. In CTEV, with medial rotation of the tibia. the plumbline cuts the zith or 5th intermetatarsal space. 3)Scratch test: This test is performed to detect muscle imbalance in an infant who cannot obey commands. - Medial scratch test- In a normal child when the medial sole is scratched, the foot eves. The tests the peroneals. - Lateral scratch test- When the lateral sole is scratched, the child inves the foot. This tests the inveors. X-ray: Radiographs AP and Lateral are obtained in maximally corrected position. The talo-calcaneal angle (Kite's angle) obtained in both AP and lateral views is reduced in CTEV.
Congenital veical talus
Ahrogryposis Multiplex
CTEV
Flat foot