CTEV that is commonly termed as club foot in lay man language is a congenital deformity of the foot. It basically involves the soft tissues and the bony structures in different parts of the foot. The abbreviation CTEV derives the term Congenital Talipes Equinovarus. Making it easy to understand lets understand the term by splitting the words apart. I.e., 

This orientation of the foot in children makes it difficult for the child to walk and restricts the mobility. Anatomically, The subtalar joint will be seen in equinus position and the midfoot and hindfoot causing the cavus and the varus. 

Because of the malalignment the foot is bit shorter than the unaffected one and leads to some amount of muscle wasting in calf muscles resulting out of non-use. 

It is recommended to all the parents to look for any kind of abnormality in child’s foot from the very beginning as if left untreated can cause severe pain and deformity causing restriction in activity because of inappropriate weight bearing resulting from the congenital malalignment. Even in few cases a large thickened callus of skin forms on the surface where the weight is getting distributed and makes it more prone to injury and infections.

Globally it is accepted that more than 75% of cases occurs among people belonging to lower or middle income groups. It has also been observed that many of the cases being left untreated because of lack or medical facilities or awareness among the population.

Neglecting the deformity causes the child to bear weight on lateral and dorsal side of the foot while walking , where a large callous forms and as the child continues to walk the deformity worsens leaving the child in pain and restricted mobility overtime. 

In Indian Scenario even when the government as well as the private sectors are very active to spread awareness about the prevention and correction of such deformities. A large no. of population is still in black shadow. The consequences of CTEV can greatly impact a individual’s life. Even in this advanced environment the deformity is seen as a curse and In such a disabling environment with such poor transport infrastructure, it becomes very difficult for a child to grow with disability. Lack of awareness and belief that CTEV deformity is due to fate and can’t be treated also results in parents not willing to seek appropriate treatment for the child.

More than 80% of the cases are idiopathic whereas rest 20% represents in association with other congenital diseases like Spina Bifida, Cerebral palsy or Arthrogryposis. 

Till now the exact cause of the deformity are poorly understood. It is estimated that the deformity is occurring because of genetic predisposition, environmental factors, In utero positioning or the seasonal variation.

In few countries still the mothers are being blamed for the deformity because of spiritual beliefs, spells or curses. These belief causes exclusion of the affected child from the society. So it is very important to exclude this misconception from the society.

Researchers estimate that there are both genetic & environmental factors that causes clubfoot. This belief considers both intrinsic and extrinsic causes which basically includes – Position of foetus in intrauterine life, mechanical compression, muscle disease, genetic defects, interruption in developmental milestones or congenital bony structural defects.  

The foot is comprised of 26 bones. Three bones are most involved in CTEV i.e., Talus, Calcaneus and the Navicular. The word CAVE – Cavus, Adductus, Varus & equinus represents the underlying deformity of the clubfoot. The first two CA – Cavus and the adductus deformity occurs in the midfoot and the VE – Varus and equinus in the hind foot. 

There will be remarkable muscular imbalance between the invertor-plantar flexors and the everter-dorsiflexors. Atrophy of calf and the peroneal muscle & persistent contraction of the triceps surae, tibialis posterior, flexor digitorum longus and the flexor halluces muscles leaving the foot in adducted and inverted position. On the contrary the posterior and medical ligaments of the ankle are thick and taut. 

Most of the CTEV don’t resemble. It is classified as per the type or the occurrence depending on the specified characteristics. The appropriate assessment and diagnosis of the type of clubfoot is very important to prescribe the best treatment to the child. Few terms that are used to classify club foot are - 

Early diagnosis is always considered the best.  CTEV can be detected in antenatal period in Ultrasound scan or even at birth. After birth the foot is gently manipulated and observed to come in normal position. If not, then it reflects the diagnosis of club foot. 

Prognosis

Early diagnosis and treatment leads to the good prognosis.  It is always recommended to treat the child before the child starts weight bearing. Prolong use of Foot abduction brace is also suggestive of good prognosis. Depending on the amount of disability, Ponseti maneuver solely or in association with serial casting and corrective surgery is performed. 

Throughout the treatment of Clubfoot there are few Key Messages to keep in consideration -

Many different treatment techniques for CTEV has been administered since many years and we at Makino Healthcare expertise in treating the deformity conservatively. In few cases it is necessary for the child to underwent corrective surgery and then maintenance phase is followed by us.

Basically there are two phases of treatment – Corrective and the Maintenance. 

In corrective phase mostly the approach is to treat conservatively or in association with minor surgeries like tenotomy for Achilles tendon which usually takes 6-8 weeks. 

On the other hand once the correction is done, The maintenance phase is to prevent the foot to go back to the deformed position. This involves the continuous monitoring and maintenance of the foot for 4-5 years till that child start full weight bearing in the corrected position. In initial period of 12 weeks the patient is recommended to wear brace for 23 hours a day and later on suggested to wear night splint for 4-5 years. 

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