A TALE OF TWO PATHOLOGIES : A NEW CASE STUDY ON CONGENITAL TALIPES EQUINOVARUS ( CTEV ) ( PART 1 )
to removal with a plaster knife . The preferred method is to use the oscillating plaster saw for cast removal . The cast is bivalved and removed and then reconstituted by coating the 2 halves . This allows for monitoring of the progress of the forefoot abduction and , in the later stages , the amount of dorsiflexion or equinus correction .
Step 5 :
Forcible correction of the equinus ( and cavus ) by dorsiflexion against a tight Achilles tendon results in a spurious correction through a break in the midfoot , resulting in a rockerbottom foot . The cavus should be separately treated as outlined in step 2 , and the equinus should be corrected without causing a midfoot break . It generally takes up to 4 – 7 casts to achieve maximum foot abduction . The casts are changed weekly . The foot abduction ( correction ) can be considered adequate when the thigh-foot axis is 60 ° After maximal foot abduction is obtained , most cases require a percutaneous Achilles tenotomy . This is performed in the cast room under aseptic conditions . The local area is anesthetized with a combination of a topical lignocaine preparation ( e . g . EMLA cream ) and minimal local infiltration of lidocaine . The tenotomy is performed through a stab incision with a round tip (# 6400 ) Beaver blade . The wound is closed with a single absorbable suture or with adhesive strips . The final cast is applied with the foot in maximum dorsiflexion , and the foot is held in the cast for 2 – 3 weeks .
Step 6 :
Following the manipulation and casting phase , the feet are fitted with open-toed straight-laced shoes attached to a Dennis-Brown bar . The affected foot is abducted ( externally rotated ) to 70 ° with the unaffected foot set at 45 ° of abduction . The shoes also have a heel counter bumper to prevent the heel from slipping out of the shoe . The shoes are worn for 23 hours a day for 3 months and are worn at night and during naps for up to 3 years .
Step 7 :
In 10 – 30 % of cases , a tibialis anterior tendon transfer to the lateral cuneiform is performed when the child is approximately 3 years of age . This gives lasting correction of the forefoot , preventing metatarsus adductus and foot inversion . This procedure is indicated in a child aged 2 – 2.5 years with dynamic supination of the foot . Prior to surgery , cast the foot in a long leg cast for a few weeks to regain the correction .
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