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Treatment of CTEV

Dr. Ashish GohiyaMS (Orth), FIAS, FIOS (UK)

Associate Professor Department of Orthopaedics & Traumatology

Gandhi Medical College, Bhopal

Dr. Ashish Gohiya

• C Congenital

• T Tali pes

• E Equinus

• V Varus

• “We are dealing with a condition, the cause of which is unknown, the pathoanatomy of which is uncertain, the behavior of which is unpredictable and the treatment for which remains controversial”

Gartland (1964)

Dr. Ashish Gohiya

When to start the treatment ?

• Before birth

• After birth

Dr. Ashish Gohiya

Manipulation by Mother

• Direction

• Duration

• Frequency

• Force

Dr. Ashish Gohiya

Serial corrective casting

• Kite’s

• Ponseti’s

Dr. Ashish Gohiya

Kite’s

• Manipulation with fulcrum at Calcaneocuboid joint.

• C A V E

• Below Knee Cast

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Rocker bottom foot

Kite’s

• 2 weekly cast change

• Assess at 6 months

• Operate for remaining deformities

• After surgery cast for 3 months

• DB splints (Full time , Night time)

• CTEV Shoes

Dr. Ashish Gohiya

Ponseti’s Technique

• Correction of cavus deformity by supinating the inner part of forefoot

Ponseti’s Technique (contd)

•Thumb pressure over the lateral aspect of Talar head

•Holding the foot in supination, externally rotate the foot

POSETI METHOD

Cast Application

Tenotomy – TA

Post Op

• Plaster for 3 weeks

• Switch to splints

• Assessment by Pirani Score

Dr. Ashish Gohiya

Kite’s

• Sequential (CAVE)

• Calcaneocuboid joint

• Below knee cast

• Cast change 2 wks

• 6 -9 month

• -

• DB Splint

Ponseti’s

• Simultaneous

• Talonavicular joint

• Above knee cast

• Cast change weekly

• 6 -9 wks

• Tenotomy

• ABER brace

Dr. Ashish Gohiya

PMSTR

• Postero Medial Soft Tissue Release

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Club Foot

ऑपरेशन से पहले ऑपरेशन के बाद

Club Foot

ऑपरेशन से पहले ऑपरेशन के बाद

Dr. Ashish Gohiya

Dilwyan Evan’s Procedures

• PMSTR

• Calcaneo- cuboid Fusion

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Wedge Tarsectomy

• Dorsolateral Wedge Resection

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Triple Arthrodesis

Dr. Ashish Gohiya

Tripple Arthrodesis

Dr. Ashish Gohiya

Illizarov Fixator

• Differential Distraction

Dr. Ashish Gohiya

Dr. Ashish Gohiya

Age Treatment

Non Operative T/t

< 3 yr PMSTR

4 – 8 yr Dilwyn Evans

8 – 11 yr Wedge Tarsectomy

>12 yr Tripe Arthrodesis

Recurred Ilizarov

•When to stop treatment ?

•Follow – up till ………….. ?

Dr. Ashish Gohiya

Dr. Ashish Gohiya