CTEV (Congenital Talipes Equinovarus) and CDH

Congenital Talipes Equinovarus (CTEV)

It is also known as Club Foot. It is most commonly seen in males. It is bilateral in 50% of the cases. It involves both feet. It has a Polygenic pattern of inheritance. It behaves exactly opposite to CDH (Congenital dislocation of the hip). It is more common in firstborns.

The Suggested etiology/Hypothesis:  

1. Abnormal intrauterine position of the fetus in the uterus.  The uterine wall is very tight, compressing the child's foot. This hypothesis fails as not all the firstborns have CTEV.
2. The most accepted theory is that the talus has a primary germplasm defect. The talus is the lone bone, and its formation is Faulty. The talus is smaller in shape and size, which leads to congenital talonavicular dislocation in the foetus.

Structural changes are more evident in the talus and calcaneus.

Structurally, it is visible during the autopsy.

There are four main Classical deformities:

• Cavus at medial arch (excess arch)
• Adduction at the tarsometatarsal joint (forefoot Adduction)
• Varus at the subtalar joint
• Equinus at ankle(Equine means horse)

CTEV is called the club foot as it resembles the shape of a club (golf bat). CTEV is Associated with Meningomyelocele (most commonly), Spina Bifida (Open neural tube defect), Lateral popliteal nerve palsy, Poliomyelitis (residual polio is still present in India), Cerebral palsy.

CTEV is diagnosed by inspection. Normally, in X-ray, a line along the axis of the talus passes anteriorly through the navicular and shaft of 1st metatarsal bone. In club foot, this deviates to 3rd or 4th metatarsal.

Treatment should begin as soon as possible after birth. To ensure that the baby is able to walk correctly and that there is no visual deformity, a specific order of correction is followed. This is known as Ponseti's method of correction. In this method, the Forefoot is adducted first, then Inverted, and lastly, Equinus. A below-knee POP cast is also given to the patient. When CTEV is corrected serially, it is called the Kites correction method.

It is said that using minimum force in correction results in a better functioning foot.

Also Read: Osteoarthritis: Types, Causes, Symptoms and Treatment

Congenital Dysplasia of the Hip (CDH)

It is also known as the Developmental Dysplasia of Hip (DDH). It is Uncommon in India, and it is very common in Europe. Because the way the Indians carry a baby reduces the risk of CDH.

It is important to know how to differentiate between congenital dysplasia of the hip and CTEV, as they can both have different management steps.

CDH is caused by a delay in the ossification of the capital femoral epiphysis, which leads to a small-sized head of the femur and shallow acetabulum. The defect of the acetabulum is seen more commonly compared to the defect in the femur. In CDH, there is a Shortening of the leg on the affected side or an additional crease in the posterior and medial aspect of the upper thigh on the affected side—usually, only one side creases. 

Multiple tests can be done for the detection of CDH:

1. Ortoloni test/ Test of entry: When a mother delivers a baby with a dislocated hip and dislocation is suspected due to DDH.
   • In a calm environment, Put the baby in a supine Position.
   • Slowly abduct the affected hip and internally rotate.
   • The hip gets reduced with a click sound.
   • This sound ensures Ortolani is positive and a case of DDH.
2. Barlow's test/ Test of exit: When the mother delivers a baby, and the baby does not have a dislocated hip, but a dislocated hip is suspected due to DDH, this test is used to locate a dislocated hip. As it is provocative, it is not practiced much.
3. Telescopic test: When the head of the femur is out of the socket, the knee is flexed to 90 degrees and pushed down and pushed up. If the head goes up and down, the Telescopic test is said to be +ve.
4. Galeazzi's sign/ Allis test: The baby is made to lie down in a supine position, then the hips and knees are flexed to 90 degrees.

Normally, the knee is at the same level, but in the case of Developmental Dysplasia of the Hip, the knee level will be lower than normal.

Also Read: Rib Fracture: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

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