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  • Congenital talipes equinovarus (CTEV)

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  • 754.51 Congenital talipes equinovarus

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  • Q66.0 Congenital talipes equinovarus

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

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Description

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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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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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Imaging

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  • X-ray to assess bone alignment

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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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  • Goniometric measurements

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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 the talus medially

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  • Patient will be able to:
    • Demonstrate full passive and active ankle and foot ROM to maximize function
    • Stand at furniture for 5 to 10 minutes while playing
    • Cruise at furniture to increase mobility
    • Ambulate with 2 hands held for household mobility
    • Ambulate with 1 hand held as primary method of mobility
    • Ambulate independently with normal gait pattern for independence with ...

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