Congenital Foot Deformities
Congential talipes equino varus (CTEV)
Definition
Born with foot like horse bent inwards – standing on talus, calcaneus bent inwards
Epidemiology
- 1/1000
- ↑ 20x in 1deg relatives
- polygenetic inheritance
- M>F; 2-3:1
- B/l 30%
- 30% if 1 parent had CTEV
- Associations: spina bifida
Aetiology
Unknown
Clinical Features
Signs
- Fixed equinus (like horse), turned inwards, midfoot adductus, midfoot supinated
- Internal rotation of foot relative to tibia
- Rigidity of deformity
- Tight soft tissues (including skin) medially
- Callus laterally if wt bearing
- Poorly developed calf mm
- Shorter leg (predominantly tibial)
- Smaller foot (1-2 shoe sizes)
Investigations
Imaging:
- XR (long talar neck (talus not deformed), calcaneum tilted downward, navicular lies medially to talus neck, ankle joint in max plantar flexion)
Management
- Achieve a mobile, plantergrade, shoeable foot by walking age
Primary = conservative
- Gentle manipulation to move calcaneum/ naviculum back around talus
- Hold corrected position until stable (cast/ splints)
Non-conservative
- For more resistant (rigid) or recurrent cases/ no infrastructure for conservative rx
- Anaesthesia is dangerous (habitual nose breathers)
- Cutting tendons
- lengthening of all deforming musculo-tendon units
- Reduce/ align to normal
Prognosis
- Not good for sports/ labour
- Residual banana (metatarsus adductus) deformity
Born with foot like horse bent inwards – standing on talus, calcaneus bent inwards
Epidemiology
- 1/1000
- ↑ 20x in 1deg relatives
- polygenetic inheritance
- M>F; 2-3:1
- B/l 30%
- 30% if 1 parent had CTEV
- Associations: spina bifida
Aetiology
Unknown
Clinical Features
Signs
- Fixed equinus (like horse), turned inwards, midfoot adductus, midfoot supinated
- Internal rotation of foot relative to tibia
- Rigidity of deformity
- Tight soft tissues (including skin) medially
- Callus laterally if wt bearing
- Poorly developed calf mm
- Shorter leg (predominantly tibial)
- Smaller foot (1-2 shoe sizes)
Investigations
Imaging:
- XR (long talar neck (talus not deformed), calcaneum tilted downward, navicular lies medially to talus neck, ankle joint in max plantar flexion)
Management
- Achieve a mobile, plantergrade, shoeable foot by walking age
Primary = conservative
- Gentle manipulation to move calcaneum/ naviculum back around talus
- Hold corrected position until stable (cast/ splints)
Non-conservative
- For more resistant (rigid) or recurrent cases/ no infrastructure for conservative rx
- Anaesthesia is dangerous (habitual nose breathers)
- Cutting tendons
- lengthening of all deforming musculo-tendon units
- Reduce/ align to normal
Prognosis
- Not good for sports/ labour
- Residual banana (metatarsus adductus) deformity
Metatarsus Adductus
Definition
Banana foot. Severe – metatarsus adductus
Epidemiology
Common ½ of <3y
Management
- Use wrong side of shoe on feet (Splint)
Banana foot. Severe – metatarsus adductus
Epidemiology
Common ½ of <3y
Management
- Use wrong side of shoe on feet (Splint)
Calcaneovalgus feet/ Pes Plano-valgus feet
Definition
Calcaneovalgus foot: Foot up against shin
Pes Plano-valgus foot: Flat foot (Arch develops @ 4y)
Management
Stand on tiptoe, keep mobile
Use orthotics after 4y
Source
Dr John Batten 2014
Calcaneovalgus foot: Foot up against shin
Pes Plano-valgus foot: Flat foot (Arch develops @ 4y)
Management
Stand on tiptoe, keep mobile
Use orthotics after 4y
Source
Dr John Batten 2014