Amsir Ryadi S

Congenital talipes equinovarus

(CTEV)
Talipes, literally
"ankle-foot",
refers to the talus
Equinovarus refers
to the position of
the clubfoot,
in equinus and
varus or adductus

Congenital deformity
1 of 1000 babies
One or both feet
boy : girl = 2 : 1
1st trimester of
pregnancy
The foot pointing
downwards and twisted
inwards
Club, "kidney shaped",
with a prominent medial
crease along the plantar
aspect of the foot
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Etiologi
1.Mekanik(Hippocrates)
2.EnvironmentalBrowne (1936)
3.HerediterWynne-Davies (1964)
4.IdiopatikBhm

An uncorrected clubfoot in the older child or

adult is very unsightly, and worse, very
crippling
The patient walks on the outside of his foot
which is not meant for weight-bearing
The skin breaks down, and develops chronic
ulceration and infection
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Two variations:
1) positional deformities
caused by the position of
the foot in the womb
2) structural malformations
where bones, joints,
muscles, and blood vessels
are malformed

Whether positional or structural, there are

four common types of clubfoot

Gambaran Klinis:
Inversi pada kaki depan
Adduksi atau deviasi interna
dari kaki depan terhadap kaki
belakang
Ekuinus atau plantar fleksi
Pengecilan dari otot-otot betis
Kaki tidak dapat digerakkan
secara pasif pada batas eversi
dan dorsofleksi normal.

Treatment
very important to treat
clubfoot as early as
possible
(i.e. shortly after birth)
to prevent disability and
problems with walking
when the child gets older

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CASTING
ManipulasidanPemasangangips(dimulaisegerasetelahlahir)
Menentukanletakkaputtalusdengantepat
Manipulasiabduksidarikakidibawahcaputtalusyangtelahdistabilkan.
Mengoreksi(memperbaiki)cavusmemposisikankakidepan(forefoot)
dalamalignmentyangtepatdengankakibelakang(hindfoot).Alignment
(kesegarisan)forefootdanhindfootuntukmencapaiarcusplantarisyang
normalsangatpentingagarabduksiyangdilakukanuntukmengoreksi
adduksidanvarusdapatefektif.
PemasanganGips

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child will be seen

frequently by
the pediatric
orthopedic
surgeon:
every one to two
weeks
Initial treatment is
provided by
a series of casts to
the affected foot
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a circumferential long leg cast is applied in

the over-corrected position of heel
dorsiflexion,
pronation of the foot and external rotation of
the ankle
The knee is placed at 90 degrees of flexion
13

After multiple serial castings are

completed (2-3 months),
special shoes with or without a bar may
be needed

14

SURGERY
If cast treatment fails,
surgery is necessary
This is not performed
until the child is
between four and eight
months of age
The Pediatric Orthopaedic Surgeon lengthens
several of the tendons
(structures which connect muscle to bone)
which allows to foot to adopt a normal position
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Koreksi jaringan lunak

dilakukan pada bayi dan anak dibawah 5 tahun
Tenotomi Indikasi : untuk mengoreksi equinus setelah cavus
adduksi, dan varus sudah terkoreksi baik akan tetapi
dorsofleksi ankle masih kurang dari 10 derajat.Pastikan
abduksi sudah adekuat sebelum melakukan tenotomi.
Tenotomi merupakan operasi minor, dengan anestesi lokal,
dan dilakukan di klinik rawat jalan.
Gips paskatenotomi dipertahankan selama 3 minggu
setelah koreksi komplet.
Koreksi jaringan keras
Operasi pada tulang atau osteotomi dilakukan setelah usia
anak 5-10 tahun. Tindakan berupa :
1.Osteotomi calcaneus untuk koreksi inversi
2.Wedge reseksisendi calcaneocuboid
3.Osteotomicuboid
4.Osteotomi cuneiformisuntuk koreksiadduksiyang
berlebihan

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Three week after surgery

the splint is removed
the foot is examined
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Sometimes orthotic
fitting is done at this
time for a kneeankle-foot orthotic
(KAFO)
OR an ankle-foot
orthotic (AFO)
The device will be
worn for months

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If a KAFO is used,
it will eventually
be replaced by an
AFO to allow the
baby to walk.
These are worn
inside shoes

Bilateral AFO orthotics

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Prognosis
50%CTEVpadaneonatesdapatdiperbaiki
secaranonoperatif.
Ponesti89%terkoreksidenganmenggunakan
tekniknya(termasuktenotomiAchilles).

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KESIMPULAN
Congenital talipes equinovarus (CTEV)
kelainan kongenital bentuk kaki dan
pergelangan kaki yang berupa equines
(plantar fleksi), varus (inversi) dan adduksi
Diagnosa CTEV anamnesa, pemeriksaan
fisik, serta pemeriksaan penunjang.
Prognosis baik bila diberikan terapi sedini
mungkin

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