EXAMINATION OF A CASE OF CTEV

Name XXXX

Age DOB

Sex Birth weight,

CHIEF COMPLAINTS :- 1) Deformity of the foot/feet -? Since birth

2) Unable to walk plantigrade since? When (older children)

H/PI;- elaborate on deformity – type (club foot),onset(since birth)Duration(since

birth)Progressive(neurogenic)( or not), any correction attempted (neglected-virgin, recurrent or
resistant<treated> find out why? non compliance with brace, shoes or follow up , scarring due to
surgery )

Unable to walk plantigrade since when?,Any Associated with callosities,

Any associated anomalies of the face(plagiocephaly),upperlimbs, lowerlimbs ,trunk and spine(scoliosis ),

hips(DDH) and knees(Dislocations)(arthrogryposis).

NEGATIVE HISTORY ;-breech presentation, first born, spina bifida , maternal drugs intake- thalidoamide,
epilepsy drugs, twins ,packaging problems ( bicornuate uterus, short stature of mother ,tall father –short
mother), syndromic- mobius, Larsen syndrome ,weidmann beckwith , pierie robin syndr

FAMILY HISTORY- any other sibling suffering same anomalies

Developmental history- any delay ?

GPE; - Screen for spina bifida, hips for DDH, arthrogryposis(tubular hands and legs)

GAIT; - if the child is walking look if he is walking on the lateral border of foot , with equinus at ankle at
foot in Supination , painless, or painful(callosities),assisted or unaided, short limb gait.

ATTITUDE AND DEFORMITY;-

Child in supine or sitting posture with hips in flexion, knee in flexion, ankle in equinus ,fore foot in
adduction ,heel in varus, and deformity resembles a club hence club foot deformity .

INSPECTION ;-

Anteriorly ;-Asis is at same level and patella at same level ,ankle in equinus,talar head
prominent,dorsally, forefoot in adduction and Supination , great toe is short,foot is short,
chubby,rigid(in atypical club foot ) skin is stretched over the ankle.
Medially;-foot is adducted and supinated deep medial crease, short medial border of foot,medial
malleolus is less prominent .

Laterally ;-ankle in equinus ,lateral borderof foot is long , any presence of callosities,

Posteriorly;-ankle in equinus , tendoachilis is taut, calf appears small, deep posterior crease,small size of
heel .

PALPATION; - confirm inspectory findings particularly feel for the talus Antrly ,deep creases medially
and Posteriorly and empty heel

MOVEMENTS ;-

ACTIVE AND PASSIVE ;–

PASSIVE ANKLE MOVEMENTS –DF limited, foot -Pronation and eversion limited , heel valgus limited

ACTIVE MOVEMENTS – scratch the lateral border of foot to check if eversion possible – to check
peroneus brevis is working or not. For future Tib Antr transfers.

MEASUREMENTS; – SCORING OF FOOT – PIRANI AND BENSAHEL-DIMEGLO SCORING

DIMEGLO SCORING AND CLASSIFICATION

EXAMINATION OF DISTAL NEUROVASCULAR STRUCTURES;-

DIAGNOSIS; – ANATOMICAL; – FOOT AND ANKLE INVOLVED

PATHOLOGICAL; - CTEV – IDIOPATHIC/ SYNDROMIC/ NEUROGENIC /

INVESTIGATION ;-

LABORATORY ;- HB,WBC, TCDC,

RADIOLOGICAL ;- X-RAYS

SPECIAL INVESTIGATIONS ;- CT SCAN IN OLDER FEET