• Reference Number: HEY1474/2024
• Departments: Paediatrics, Therapies
• Last Updated: 31 July 2024

What is Congenital Talipes Equino Varus (CTEV)

Congenital Talipes Equino Varus is a fixed position of your baby’s foot.  The foot is turned in and the toes point down. It affects up to 3 in 1000 babies and in 50% of cases can affect both feet. The cause of CTEV is unknown, however there is evidence for a possible gene being responsible, which is active from the 12^th to the 20^th weeks of foetal life and lasts until 5 years of age, hence why the whole treatment continues until about age 5.

This problem may have been diagnosed at your 20 week scan or when your baby was born. The treatment that your child is going to have is called the Ponseti Technique.  It is a technique to correct the foot posture that has been successfully used internationally for decades.

Your baby will be screened for hip problems at a few weeks old by ultrasound, as there is a very small risk of associated hip problems.

Ponseti Treatment

We will begin treatment within the first couple of weeks following birth, as long as your baby is at term and well. The physiotherapist may see yourself and your baby whilst you are still an inpatient and discuss the treatment; otherwise you will be contacted for a discussion and an out-patient appointment will be arranged

On your baby’s first visit for treatment, you will meet the Ponseti team and your baby will be assessed by the physiotherapist. At each appointment the position of your baby’s foot will be noted and scores taken by measuring range of movement and by using the Pirani score. We will also take photographs intermittently to help measure the progress of treatment.

Stages of Treatment

The overall treatment consists of four stages, each of which will be explained in full as it approaches and more detailed leaflets will be provided at each stage, however please ask any of the physiotherapy team if you have any questions about any of the treatment. The stages in brief are as follows:-

Stage 1 – Plaster Casts

Your baby will initially undergo weekly application of plaster of paris to gradually correct the foot position.  This plaster is from the toes to the top of the thigh. The knee is bent, to ensure that plaster remains in place and doesn’t slip off. This stage of treatment takes approximately 4 to 6 weeks.

Stage 2 – Tenotomy

Once a good foot position has been achieved, the tendon at the back of the heel needs to be released to allow the foot to achieve a weight bearing position.  You will meet the Paediatric Orthopaedic Consultant, who will re-assess the foot/feet and carry out the tenotomy in the clinic under local anaesthetic.

Your baby will then have another plaster of paris applied in the newly achieved position, which remains in place for 2 weeks to allow the tendon to heal in a lengthened state.

Stage 3 – Boots and Bars

To maintain the corrected position achieved your child will then need to wear ‘boots connected together with a small bar’ for 23 hours a day.  This will continue for 12 weeks.

Stage 4 – Nights and Naps

The final stage is for your child to wear the boots and bar during the night and any sleeps during the day, this will continue until your child is around 5 years old.

Conclusion

Following the Ponseti method of treatment, your child’s foot/feet should be in a good weight-bearing position and this should enable your child to start walking at a normal developmental age. They will not have any visible scars and will be able to wear normal, well-fitting footwear. The calf and foot may be slightly smaller, which is a common side-effect of having CTEV, but will not usually cause any problems. A small percentage of children require a minor operation when they are older if the foot starts turning in. This is called a Tibialis Anterior Tendon Transfer, which requires an overnight stay in hospital but children recover quickly from this.

This method of treatment has been proved to be extremely successful, if it is followed and adhered to at all stages. It is therefore very important that you follow all the instructions; otherwise the treatment is likely to be unsuccessful.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.