CTEV

CTEV, or congenital talipes equinovarus, is a congenital deformity of the foot and ankle in which the foot is twisted inward and downward. The typical deformity includes hindfoot varus, equinus (plantarflexed ankle), midfoot cavus, and forefoot adduction. It is usually present at birth and may affect one or both feet. Most cases are idiopathic, but CTEV can also be associated with neuromuscular disorders, syndromes, or other congenital anomalies.

Etiology and epidemiology: The condition has a multifactorial origin with genetic susceptibility and environmental influences. It affects about 1 in 1,000 live births and occurs more often in males. Approximately half of cases are bilateral. Non-idiopathic CTEV is linked to other medical conditions such as spina bifida or arthrogryposis.

Diagnosis and classification: Diagnosis is primarily clinical, based on physical examination. Imaging is not routinely required in newborns but may be used later to assess bone alignment or plan surgery. CTEV is commonly classified as idiopathic or non-idiopathic (associated with neuromuscular or syndromic conditions).

Treatment and prognosis: The standard treatment is the Ponseti method, a non-surgical approach involving gentle manipulation and serial casting to gradually correct all components of the deformity, typically followed by a percutaneous Achilles tenotomy to address equinus in many infants. After correction, a rigid foot abduction brace is worn for several years to prevent relapse. Some cases with relapse or residual deformity may require surgical procedures, such as posterior release. With early treatment and good bracing adherence, most children achieve a functional, plantigrade foot; relapse rates are higher with poor brace compliance.