1.  Congenital Talipes EquinoVarus
 Club foot
 Talipes(Latin) – Talus + Pes (Foot)

2.  Heel - Equinus
 Hind foot – Varus
 Fore foot – Adduction & supination
Cavus foot
Internal tibial torsion

3.  Associted problems
Constricted Annular rings
(Streetere’s syndrome)
Tibial deficiency
Inguinal hernia
CDH
Spina bifida

4.  1-2 per 1000 live births
 Boys : Girls – 2:1
 Common in left
 Bilateral in 50%

5.  Unknown cause
 Germ plasm defect
 Development defect
 Neurologic/Neural tube defects
 Abnormal position in utero
 Arthrogryposis

6.  Pathoanatomy
 Joints
Equinus ankle & subtalar
 Bone
Posterior displacement Lat. Malleolus
Medial rotation & inversion talus
Medial angulation of neck of talus
Medial rotation, equinus Calcaneus
Medial rotation, equinus of navicular

7.  Ligaments
Contracture of Spring lig.
Bifurcarcated Y lig
Deltoid lig.
Calcaneo-fibular lig
Talo fibular lig.

8.  Tendons
Tibialis posterior
FHL
FDL
FDB
Tendo Achillis
Abductor hallucis
Plantar aponeurosis
Tibialis anterior
EHL

9.  Master knot of Henry’s
Fibrous sheath envelops FHL&FDL
Bind the medial & plantar side of
naviculum

10.  Present at birth
 Small, bean shaped foot
 Ankle in equinus
 Fore foot adducted & supinated
 Heel inverted, small & high
 Cavus foot
 Deep posterior & medial creases
 Prominent talar head dorso laterally
 Tight Tendo achillis

11.  Antero-posterior View
Kite’s angle
Talo-calcaneal angle
normal 20-40 degrees
 Lateral view
in forced dorsiflextion
Line thru longitudinal axis of
talus
and that of calcaneum
Normal 30 –40 degrees

12.  AIM
To produce & maintain plantigrade, supple
& functionally near normal foot

13.  Conservative Mx
1.Manipulation by parents- 1-2 days
post birth
2.Manipulation and strapping
3.Serial corrective casting
Forefoot adduction
Heel varus
Equinus

14.  Surgical Mx
Indications
Resistant CTEV (after 8-12 wks
cons mx)
Late presentation
Rigid CTEV
Arthrogryposis
 Time of surgery
6-9 months

15.  Soft tissue procedures
Postero medial release
Turco’s release
TA lengthening

16.  Post Operative management
Dennis brown splint/shoes x 3
months

17.  Ilizarov
 Jess fixator
 Tripple arthrodesis
 Dilwyn Evans
osteotomy
 Dwyers osteotomy

18.  Rocker bottom deformity
 Recurrence
 Residual deformity
 Flat top talus