- 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 12th to the 20th 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.
