A
t one time, a diagnosis of Congenital
Talipes Equinovarus (CTEV) was a nearly
impossible situation to manage based
on the manifestation. The condition
is commonly known as club foot as the
deformity makes the leg and foot look like a club.
CTEV manifests from mild varus position to a
significant pathology that can result in an inability
to walk or even stand. Since the 1960's, CTEV
for the most part, is a manageable condition, with
the introduction of the Ponseti Method. Serial
casting, tendon releases and other associated
surgical procedures, Denis-Browne splints and foot
orthoses have made poor results of this condition
almost non-existent.
CTEV is one of the most common congenital structural foot deformities
in children. Its presentation is of a plantarflexed, inverted, and adducted
position of the foot. At the nadir of the deformity is the talar neck, which is
positioned in varus and plantargrade. In general there are two recognized
types: those who respond to strapping or casting, and the resistant types
that require surgical correction. To a new parent, this presents a serious
emotional issue. Every parent dreams of a healthy, normal delivery of
their child; to a parent whose child has CTEV, it is a nightmare, even if of
the simple variety.
There is a long history of treating this condition going back to the ancient
Greeks. The condition was first described by Hippocrates and was treated
with manipulation. Plaster was first used by Guerin in 1836. A wrench
invented by Thoma s was introduced for forced manipulation and is only
mentioned in the literature for its historical value as it was regarded as too
brutal for use. In 1930, Kite described a modified wedge plaster modality
that is occasionally used to this day. Surgical procedures were introduced
in 1792. We have come a long way.
This topic will be a series of articles that will appear here and in other
media over the course of the next year, tracking two different patients
with two manifestations of CTEV nearly fifty years apart. Both are of the
resistant variety and there are two very different outcomes.
Our first and original patient Albert was born in 1950 with a rather severe
form of CTEV. We have already met him in a previous article. Without
successful correction, adulthood presents a serious pressure problem on
the plantar surface. Pressures
are maldistributed across the
lateral border of the foot and
presents as serious callosities,
often painful. Such is the case
of Albert.
CEP
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Take Survey to
Earn Continuing
Education Points
The Pedorthic Footcare Association
(PFA) offers Continuing Education Points
(CEPs), approved by the American Board
for Certification in Orthotics, Prosthetics
& Pedorthics (ABC) and the Board of
Certification/Accreditation International
(BOC), via specially designated articles
within Current Pedorthics magazine.
To take advantage of the program,
thoroughly read the adjacent article,
“A Tale of Two Pathologies:A New
Case Study on Congenital Talipes
Equinovarus (CTEV) Part 1” and then visit
www.pedorthics.org and click on the
Continuing Education Opportunities tab to
purchase the 10-question quiz associated
with this article. CEP quizzes cost $15
for members and $25 for non-members.
The quizzes are worth 1.0 Scientific or
Business CEP, depending on the content.
Successful completion of the quiz will
result in 1.0 CEP reported directly to ABC
and BOC at the end of each quarter.
Look for
additional CEP-eligible articles in
future issues of the magazine; previous
articles are available in the magazine
archive at www.pedorthics.org.
If you have any questions, contact
PFA, at (800) 673-8447 or e-mail
[email protected].
Our second and newest
patient, Tommy, was born
Current Pedorthics
January/February 2013
15