Treatment of CTEV - Gohiya Ortho Clinicgohiyaorthoclinic.com/.../07/treatment-of-ctev.pdf ·...
Transcript of Treatment of CTEV - Gohiya Ortho Clinicgohiyaorthoclinic.com/.../07/treatment-of-ctev.pdf ·...
Treatment of CTEV
Dr. Ashish GohiyaMS (Orth), FIAS, FIOS (UK)
Associate Professor Department of Orthopaedics & Traumatology
Gandhi Medical College, Bhopal
Dr. Ashish Gohiya
• C Congenital
• T Tali pes
• E Equinus
• V Varus
• “We are dealing with a condition, the cause of which is unknown, the pathoanatomy of which is uncertain, the behavior of which is unpredictable and the treatment for which remains controversial”
Gartland (1964)
Dr. Ashish Gohiya
When to start the treatment ?
• Before birth
• After birth
Dr. Ashish Gohiya
Manipulation by Mother
• Direction
• Duration
• Frequency
• Force
Dr. Ashish Gohiya
Serial corrective casting
• Kite’s
• Ponseti’s
Dr. Ashish Gohiya
Kite’s
• Manipulation with fulcrum at Calcaneocuboid joint.
• C A V E
• Below Knee Cast
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Rocker bottom foot
Kite’s
• 2 weekly cast change
• Assess at 6 months
• Operate for remaining deformities
• After surgery cast for 3 months
• DB splints (Full time , Night time)
• CTEV Shoes
Dr. Ashish Gohiya
Ponseti’s Technique
• Correction of cavus deformity by supinating the inner part of forefoot
Ponseti’s Technique (contd)
•Thumb pressure over the lateral aspect of Talar head
•Holding the foot in supination, externally rotate the foot
POSETI METHOD
Cast Application
Tenotomy – TA
Post Op
• Plaster for 3 weeks
• Switch to splints
• Assessment by Pirani Score
Dr. Ashish Gohiya
Kite’s
• Sequential (CAVE)
• Calcaneocuboid joint
• Below knee cast
• Cast change 2 wks
• 6 -9 month
• -
• DB Splint
Ponseti’s
• Simultaneous
• Talonavicular joint
• Above knee cast
• Cast change weekly
• 6 -9 wks
• Tenotomy
• ABER brace
Dr. Ashish Gohiya
PMSTR
• Postero Medial Soft Tissue Release
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Club Foot
ऑपरेशन से पहले ऑपरेशन के बाद
Club Foot
ऑपरेशन से पहले ऑपरेशन के बाद
Dr. Ashish Gohiya
Dilwyan Evan’s Procedures
• PMSTR
• Calcaneo- cuboid Fusion
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Wedge Tarsectomy
• Dorsolateral Wedge Resection
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Triple Arthrodesis
Dr. Ashish Gohiya
Tripple Arthrodesis
Dr. Ashish Gohiya
Illizarov Fixator
• Differential Distraction
Dr. Ashish Gohiya
Dr. Ashish Gohiya
Age Treatment
Non Operative T/t
< 3 yr PMSTR
4 – 8 yr Dilwyn Evans
8 – 11 yr Wedge Tarsectomy
>12 yr Tripe Arthrodesis
Recurred Ilizarov
•When to stop treatment ?
•Follow – up till ………….. ?
Dr. Ashish Gohiya
Dr. Ashish Gohiya