Physical Therapy: Congenital Talepes Equinovarus (CTEV)/Clubfoot

Congenital Talepes Equinovarus

What is it?: Congenital Talepes Equinovarus or more commonly known as Clubfoot is a congenital disorder that affects normal structural positioning of the ankle or both ankles in infants. Infants with the disability will demonstrate an inversion at the talus and calcaneus joint, adduction of the talus and navicular bone, and equinus (or an upward bend) at the ankle joint. It occurs in males more so than females by a 2:1 ratio and if it occurs there's a 50% chance that it will be unilateral vs bilateral.

How does it occur?: There are several theories on the development of the disorder. Structural TEV can be attributed to a trisomy 18. Another common theory is that the deformity is caused by mechanical factors in the womb (mid trimester). There is also a theory that a primary plasma germ defect results in the talus bone being shortened and the anterior portion being rotated medially and plantarly.

How is it treated?: The Ponsetti method is the most popular method of correcting the deformity. Essentially a doctor or therapist will manipulate the feet towards the correct positioning and cast the feet in that new fixed position over the course of four weeks until the limb is properly aligned. Afterward, an achilles tenotomy, or division of the achilles tendon is performed to help lengthen the tendon and increase range of motion and flexibility of dorsi flexion and plantar flexion of the foot. A brace must then be worn for the next four years by the child to prevent possible relapses. This treatment claims an absurd success rate (95%). Invasive surgery is rarely necessary in the treatment of the deformity.