Congenital talipes equinovarus

Changed by Ian Bickle, 24 Jan 2016

Updates to Article Attributes

Body was changed:

Show markup changes

Congenital talipes equinovarus (CTEV) or club foot (CF) is a common skeletal anomaly affecting the foot. It is the commonest anomaly affecting the feet diagnosed on antenatal ultrasound ⁴.

Epidemiology

It carries an estimated incidence of 0.5-5% of live births ⁴. Some reports suggest a male predilection with a male to female ratio of 2:1. The condition is bilateral in more than half of cases.

Pathology

The deformity involves both ankle and subtalar joints. The malalignment is fixed by joint, ligamentous and tendinous contractures.

There may be a familial predilection in approximately 15% of cases ⁹. If detected antenatally, a careful search for other associated anomalies are recommended.

Associations

There is an immense number (estimated at 200) ⁸ of associations which include:

chromosomal anomalies
other syndromic conditions
renal anomalies
- prune belly syndrome
- renal agenesis
connective tissue disorders
- Marfan syndrome
- Ehlers-Danlos syndrome
spinal anomalies
skeletal dysplasias
- diastrophic dysplasia

Radiographic features

Assessment requires weightbearing DP and lateral radiographs. Where weightbearing is not possible, it should be simulated.

Talipes equinovarus consists of four elements ⁷:

hindfoot equinus: lateral talocalcaneal angle less than 35^o
hindfoot varus: talocalcaneal angle less than 20^o
metatarsus adductus: adduction and varus deformity of the forefoot; talus to first metatarsal angle greater than 15^o
talonavicular subluxation: medial subluxation of the navicular on the talus

Treatment and prognosis

Many (at least 50%) require orthopaedic intervention ⁸.

Therapeutic options range from casting and manipulation, through to surgical release. The most common surgical complication is over-correction resulting in a "rockerbottom" flat foot deformity. Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully ⁸.

-<p><strong>Congenital talipes equinovarus (CTEV)</strong> or <strong>club foot (CF)</strong> is a common skeletal anomaly affecting the foot. It is the commonest anomaly affecting the feet diagnosed on antenatal ultrasound <sup>4</sup>. </p><h4>Epidemiology</h4><p>It carries an estimated incidence of 0.5-5% of live births <sup>4</sup>. Some reports suggest a male predilection with a male to female ratio of 2:1. The condition is bilateral in more than half of cases. </p><h4>Pathology</h4><p>The deformity involves both <a href="/articles/ankle-joint">ankle</a> and <a href="/articles/subtalar-joint">subtalar joints</a>. The malalignment is fixed by joint, ligamentous and tendinous contractures.</p><p>There may be a familial predilection in approximately 15% of cases <sup>9</sup>. If detected antenatally, a careful search for other associated anomalies are recommended. </p><h5>Associations</h5><p>There is an immense number (estimated at 200) <sup>8</sup> of associations which include:</p><ul>
+<p><strong>Congenital talipes equinovarus (CTEV)</strong> or <strong>club foot (CF)</strong> is a common skeletal anomaly affecting the foot. It is the commonest anomaly affecting the feet diagnosed on antenatal ultrasound <sup>4</sup>.</p><h4>Epidemiology</h4><p>It carries an estimated incidence of 0.5-5% of live births <sup>4</sup>. Some reports suggest a male predilection with a male to female ratio of 2:1. The condition is bilateral in more than half of cases.</p><h4>Pathology</h4><p>The deformity involves both <a href="/articles/ankle-joint">ankle</a> and <a href="/articles/subtalar-joint">subtalar joints</a>. The malalignment is fixed by joint, ligamentous and tendinous contractures.</p><p>There may be a familial predilection in approximately 15% of cases <sup>9</sup>. If detected antenatally, a careful search for other associated anomalies are recommended.</p><h5>Associations</h5><p>There is an immense number (estimated at 200) <sup>8</sup> of associations which include:</p><ul>
-</ul><h4>Radiographic features</h4><p>Assessment requires <a href="/articles/weightbearing-dp-foot-radiograph">weightbearing DP</a> and <a href="/articles/weightbearing-lateral-foot-radiograph">lateral radiographs</a>. Where weightbearing is not possible, it should be simulated. </p><p>Talipes equinovarus consists of four elements <sup>7</sup>:</p><ul>
+</ul><h4>Radiographic features</h4><p>Assessment requires <a href="/articles/weightbearing-dp-foot-radiograph">weightbearing DP</a> and <a href="/articles/weightbearing-lateral-foot-radiograph">lateral radiographs</a>. Where weightbearing is not possible, it should be simulated.</p><p>Talipes equinovarus consists of four elements <sup>7</sup>:</p><ul>
-</ul><h4>Treatment and prognosis</h4><p>Many (at least 50%) require orthopaedic intervention <sup>8</sup>. </p><p>Therapeutic options range from casting and manipulation, through to surgical release. The most common surgical complication is over-correction resulting in a "<a href="/articles/rocker-bottom-foot">rockerbottom</a>" flat foot deformity. Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully <sup>8</sup>.</p>
+</ul><h4>Treatment and prognosis</h4><p>Many (at least 50%) require orthopaedic intervention <sup>8</sup>.</p><p>Therapeutic options range from casting and manipulation, through to surgical release. The most common surgical complication is over-correction resulting in a "<a href="/articles/rocker-bottom-foot">rockerbottom</a>" flat foot deformity. Overall prognosis will often depend on other associated condition. Isolated condition may be treated successfully <sup>8</sup>.</p>

Images Changes:

Image 9 Ultrasound (4d reconstruciton) ( create )

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":53188323,"studyId":93860,"caseSlug":"congenital-talipes-equinovarus-3","caption":"Figure 1: clinical photograph","thumbnail":"https://prod-images-static.radiopaedia.org/images/53188323/c4f035e1e0b2387262eb0339903ad3_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":53188319,"studyId":93859,"caseSlug":"congenital-talipes-equinovarus-3","caption":"Case 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/53188319/2b0674da052eaeb03ea137dfe7d9ae_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":239895,"studyId":9201,"caseSlug":"congenital-talipes-equinovarus-4","caption":"Case 2","thumbnail":"https://prod-images-static.radiopaedia.org/images/239895/b9d2920adb10fb04add4958a15f036_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":14543423,"studyId":40415,"caseSlug":"congenital-talipes-equinovarus-1","caption":"Case 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/14543423/b2da1d54e663a27e714529518f4f76_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":2032496,"studyId":45580,"caseSlug":"congenital-talipes-equinus-varus-1","caption":"Case 5: lateral talocalcaneal angle of 14 degrees","thumbnail":"https://prod-images-static.radiopaedia.org/images/2032496/111af65ec5dae098d222dd73450468b2698b781931482446a8451740de9c11be_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":3973024,"studyId":23412,"caseSlug":"bilateral-congenital-talipes-equino-varus-deformity-in-fetus","caption":" Case 6: in fetus","thumbnail":"https://prod-images-static.radiopaedia.org/images/3973024/3ad51bb456766a8b42ad595a533c62_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":5499910,"studyId":26907,"caseSlug":"congenital-talipes-equinovarus","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/5499910/ed6ec6cd4cb6e2e25effb768a52e6f_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":9902454,"studyId":33998,"caseSlug":"club-foot-3","caption":"Case 8","thumbnail":"https://prod-images-static.radiopaedia.org/images/9902454/0976ef1ae942a6df1d0d0d5c88ebe1_big_gallery.JPG","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":19098883,"studyId":45635,"caseSlug":"antenatal-unilateral-talipes-equinovarus-1","caption":"Case 9: antenatal - 4d reconstruciton ","thumbnail":"https://prod-images-static.radiopaedia.org/images/19098883/aeb4ac4678a625ff1c2a69b711fd24_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":22325960,"studyId":49072,"caseSlug":"club-foot-antenatal-ultrasound-1","caption":"Case 10","thumbnail":"https://prod-images-static.radiopaedia.org/images/22325960/552f72f7be98ad55f454e46747a625_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":29116359,"studyId":57704,"caseSlug":"congenital-talipes-equinovarus-ctev","caption":"Case 11","thumbnail":"https://prod-images-static.radiopaedia.org/images/29116359/5f21d14d21c057d64059f90930396d_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":430027,"studyId":10150,"caseSlug":"talipes-equinovarus-clubfoot-1","caption":"Case 12","thumbnail":"https://prod-images-static.radiopaedia.org/images/430027/cf9f2c57fd7c1835aa33d09647f1ce_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":53436106,"studyId":95711,"caseSlug":"idiopathic-congenital-talipes-equinovarus-in-an-adult-with-follow-up","caption":"Case 13: bilateral congenital talipes equinovarus in an adult","thumbnail":"https://prod-images-static.radiopaedia.org/images/53436106/IM-0005-0001_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":53965744,"studyId":99932,"caseSlug":"congenital-talipes-equinovarus-antenatal-1","caption":"Case 14","thumbnail":"https://prod-images-static.radiopaedia.org/images/53965744/3_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"}],"ddx_inclusions":[],"lang":"us"}