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Condition/Disorder Synonyms

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  • Congenital talipes equinovarus (CTEV)

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ICD-9-CM Code

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  • 754.51 Congenital talipes equinovarus

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ICD-10-CM Code

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  • Q66.0 Congenital talipes equinovarus

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Preferred Practice Pattern1

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  • 4B: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Impaired Posture

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Key Features

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Description

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  • Three malformations of the foot/ankle complex seen at birth

    • Plantarflexion (ankle or hindfoot equinus)

    • Inversion (rearfoot varus)2

    • Adduction (forefoot varus or metatarsus adductus)2

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Essentials of Diagnosis

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  • Idiopathic, though can be hereditary

  • Neurogenic

  • Associated with syndromes such as arthrogryposis and Larsen syndrome3

  • Postural or positional; not a true club foot

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General Considerations

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  • Two categories: flexible or rigid

  • Results from abnormally shaped tarsal bones that cause ligament and joint changes

  • Often associated with myelomeningocele4

  • May result from arthrogryposis

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Demographics

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  • Incidence 1 to 2 per 1000 infants

  • 2:1 male-to-female ratio

  • Hispanics at greater risk

  • Asians at least risk

  • 50% bilateral

  • Occurs most often in first-born infants

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Clinical Findings

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Signs and Symptoms

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  • Either flexible or rigid deformities of the foot including plantarflexion, adduction, and inversion

  • Contracted intrinsic muscles of the foot

  • Vertical talus

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Functional Implications

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  • Unable to stand with flat foot or bear weight on the involved side

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Possible Contributing Causes

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  • Genetic: siblings 30 times more likely to also have club foot

  • Environmental: in-utero complications, such as too little amniotic fluid (oligohydramnios) or abnormal fetal positioning

  • Dwarfism

  • Myelomenigocele

  • Polio

  • Cerebral palsy

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Differential Diagnosis

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  • Metatarsus adductus

  • Postural club foot

  • Tarsal coalitions

  • Skew foot

  • Streeter's dysplasia

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray to assess bone alignment

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Referrals/Admittance

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  • All patients with CTEV should be referred to an orthopedic surgeon for possible

    • Serial casting5

    • Stretching and splinting

    • Surgical repair (15 to 50%)

    • Ponseti method involving manipulation and casting6

    • Night splint after correction

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Impairments

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  • Unable to stand independently

  • Unable to ambulate

  • Decreased passive and active ROM for dorsiflexion, abduction, and eversion

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Tests and Measures

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  • Goniometric measurements

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Intervention

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  • Serial casting

  • Gentle passive ROM to stretch soft tissue and correct alignment

  • Neurodevelopmental treatment to achieve age-appropriate motor milestones in conjunction with serial casting or splinting

    • Facilitate weight-bearing while sitting on bench or chair

    • Facilitate weight-bearing with supported standing or while standing at furniture

  • Pre-gait training activities and gait training

  • Manual therapy; mobilize the talonavicular joint by moving the navicular laterally and the head of ...

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