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CONGENITAL TALIPES

EQUINO VARUS

By Mohd Amirnizam Ahmad

Nazari

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INTRODUCTION

Children i!h "hy#i$aldi#a%ili!ie# are o&!en#o$ially ande$onomi$allydi#ad'an!a(ed

Im"or!an$e o&

Cl)%&oo! * ea#ilydia(no#ed* ea#ily

!rea!ed

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INTRODUCTION

CTEV + $on(eni!al$on(eni!al

!ali"e# e,)ino*'ar)#!ali"e# e,)ino*'ar)#

Tali"e# * The !erm!ali"e# i# deri'ed &roma $on!ra$!ion o& !heLa!in ord# &or an-lean-le.

talus,talus,and &oo!.&oo!. pespes/The !erm re&er# !o !he

(ai! o& #e'erelya0e$!ed "a!ien!#. hoal-ed on !heir an-le#

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DE1INITION

$on(eni!al de&ormi!yo& !he &oo! and an-le$hara$!erized %y e,)in)# de&ormi!y a!

!he an-le in'er#ion a! !he

#)%!alar

add)$!ion a! !hemid!ar#al 2oin!

$a')# and in!ernal !i%ial!or#ion

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INCIDENCE

Commone#! $on(eni!al or!ho"edi$ a%normali!y

3/453666 li'e %ir!h#

Male#71emale# + 853

46*96: %ila!eral

In )nila!eral $a#e# ri(h! #ide i# more o&!en in'ol'ed

M)$h more $ommon in Polyne#ian ; Maori ; loer inA#ian#

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T

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3/ IDIOPAT?IC CAUSE

Dia(no#ed hen $hild ha# normal )""er andloer e@!remi!ie# #"ine and ne)rolo(i$al #!a!)#a"ar! &rom $l)% &oo!

Can %e de!e$!ed %y USG %y 3 -# (e#!a!ion

Com%ina!ion o& (ene!i$ and en'ironmen!al &a$!or#are in'ol'ed

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3/ IDIOPAT?IC CAUSE

Theorie# re(ardin($a)#e

Primary (erm "la#mde&e$! o& !al)#

Con!ra$!ilemyo%ro%la#!i$ !i##)e in!he m)#$)lo!endino)#)ni!#

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8/ SECONDAR< CLUB1OOT

Dia(no#ed hen de&ormi!y &orm# "ar! o& ano!herheal!h $ondi!ion

Ne)ro"a!hi$ 5Ne)ro"a!hi$ 5 de&ormi!y in a##o$ia!ion i!hne)rolo(i$al a%normali!ie# or #"ina %ida

Syndromi$Syndromi$ 5 $l)%&oo! in a##o$ia!ion i!h o!her#yndrome#

S!ree!er# dy#"la#ia

Ar!hro(ry"o#i#

Edard# #yndrome

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8/ SECONDAR< CLUB1OOT

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4/ POSTURAL

D)e !o a%normal in!ra)!erine "o#i!ion

Ea#ily $orre$!ed i!h ma##a(e %ymo!her or %y $a#!#

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T

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PAT?OLOGICAL C?ANGES

1o)r %a#i$$om"onen!# are

3/ Mid&oo! Ca')#

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1ore&oo! Add)$!)#

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?ind&oo! Var)#

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A##o$ia!ed ndin(#

hy"o!ro"hi$ an!erior !i%ial ar!ery

a!ro"hy o& m)#$le# aro)nd !he $al&

a%normal &oo! i# #maller

I& !he de&ormi!y i# le&! )n!rea!ed la!e ada"!i'e$han(e# o$$)r in !he %one#/

The#e de"end on !he #e'eri!y o& #o&! !i##)e$on!ra$!)re and e0e$! o& al-in(

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Congenital Talipes Equino-Varus

CTEV

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BONE C?ANGES IN CTEV

Ti%io*!alar "lan!are@ion

Medially di#"la$ed

na'i$)lar

Add)$!ed and in'er!ed$al$ane)#

Medially di#"la$ed$)%oid

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The an-le. #)%!alar and mid!ar#al 2oin!# arein'ol'ed

The #e'eri!y o& de&ormi!y 'arie# and i# (raded %y!he "irani #$ore

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Mid &oo! #$ore

C)r'ed la!eral%order FA

Medial $rea#e FB

Talar head$o'era(e FC

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?ind &oo! #$ore

Po#!erior $rea#e FD

Ri(id e,)in)# FE

Em"!y heel F1

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USES O1 PIRANIS SCORE

A##e##men! o& "ro(re## %y #erial "lo!!in( o& !he#$ore

Predi$!in( need &or !eno!omy Hh#73; m#3=

E#!ima!ion o& "ro%a%le no/ o& $a#!# re,d

Very (ood in!ero%#er'er relia%ili!y and

re"rod)$i%ili!y

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RADIOLOGICAL EVALUATION

Talo$al$aneal an(leTalo$al$aneal an(le

An!ero"o#!erior'ie5 46*99 de(ree#

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Talo$al$aneal an(leTalo$al$aneal an(le

Dor#ie@ion la!eral'ie5 89*96

de(ree#

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Tal)# + r#!me!a!ar#al an(le

An!ero"o#!erior

'ie5 9*39 de(ree#

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TREATMENT

Non o"era!i'e + Pon#e!i !e$hni,)e

Ki!e !e$hni,)e

1ren$h !e$hni,)e

S)r(i$al+

Po#!eromedial #o&! !i##)e relea#e

O#!eo!omie#

Tri"le ar!hrode#i#

A$hille# !endon len(!henin(

Ilizaro' > ESS

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TREATMENT

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AIMS O1 TREATMENT

A&!er #)$e##&)l !rea!men! &oo! #ho)ld

Loo- (ood

1eel (ood

Mo'e (ood

Mea#)re (ood

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NON SURGICAL

TREATMENT

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3/ PONSETI TEC?NIQUE

ee-ly Serial mani")la!ion and $a#!in( Hlon( le($a#!=

Goal i# !o ro!a!e &oo! la!erally aro)nd a @ed !al)#

Order o& $orre$!ion Hcavecave=

mid&oo! $$a')#

&ore&oo! aadd)$!)#

hind&oo! ''ar)#

hind&oo! ee,)in)# HTAL=

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3/ PONSETI TEC?NIQUE

A&!er !he la#! $a#!. TA len(!henin( $an %e$on#idered

1oo! A%d)$!ion Bra$e H1AB= &or orn &)ll !ime &or38 ee-#. and !hen a! ni(h!# and na"#. )" !o a(e

o& &o)r

Chan$e o& re$)rren$e )" !o or 9 yr# o& a(e

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8/ KITES TEC?NIQUE

1oo! mani")la!ed i!h $al$aneo $)%oid 2oin! a#&)l$r)m

Ca#!in( done a&!er mani")la!ion

A&!er $orre$!ion. Deni# Brone #"lin! a""lied

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4/ 1RENC? TEC?NIQUE

Daily mani")la!ion %y "hy#i$al !hera"i#! &or 46m!#/ Ele$!ri$al #!im)la!ion o& "eroneal m)#$le#done

The ")r"o#e o& m)#$le #!im)la!ion i# !o main!ain

!he $orre$!ion o%!ained %y mani")la!ion/

A&!er mani")la!ion and m)#$le #!im)la!ion. !a"in(i# a""lied/

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POSTEROMEDIAL SO1T TISSUERELEASE HPMR=

Done a! a(e 3 year#old

Ti(h! #!r)$!)re# in"o#!erior and medial

a#"e$! o& !he &oo! i#relea#ed orlen(!hened

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POSTEROLATERAL SO1T TISSUE RELEASE

HPMR= len(!henin( o& !he

TA

Po#!erior $a"#)lo!omy

o& An-le 2oin!;S)%!alar 2oin!

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PERCUTANEOUS TENOTOM

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