CTEV (Congenital Talipes Equinovarus)

Khoirunnisa Humairoh
712016075
Anamnesys
Alloanamnesys with the patients father on 4th July 2017.
Identification

Name : Risna Elvani Putri

Age : 1 year 6 month old
Sex : Female
Addres : Plaju
Anamnesys: Chief Complain

A girl, 1 year 6 month old comes with bent left leg since birth.
Anamnesys: Clinical History

The patient has bent left leg since birth. When she was 3
month old, her foot got massage treatments for 3 times but
chief complaint unchanged. After that, the patient fathers
attempt for order iron shoes from site online but chief
complaint unchanged too.
 The patient fathers recieved information from his friend that
he come to hospital with his children and got chief complaint
is similar, after given treatment his children healthy now.
Antenatal History

During pregnancy mothers patient who have checked

regularly to obstetrician and during pregnancy was never sick,
never taking drugs expect vitamin obtained from obstetrician.
When mothers patient pregnancy examination used USG
seems like gemeli fetus and breech location.
Postnatal History

The patient was born spontaneous crying, the young girl one
was gave birth one hour after her older sister.
Child growth history

4 month old : she can crawling

7 month old: she can sitting
Immunisation history

Hepatitis B (since birth, 1 and 6 month old)

Polio (2, 4, 6 month old)
BCG (2 month old)
DPT (2, 4, 6 month old)
Campak ( 9 month old)
Food history

Since birth until 6 month old breastfeeding

6 month until 10 month old spoon food
10 month until now food like adult
History of family illness

No one in family got disease like her

History of past illness
Other disease (-)
General State

General condition : good

Sensory : compos mentis
Vital sign
- Pulse rate: 140x/minnute
- Respiratory rate: 30x/minnute
- Temperature: 36,7C
Local State

Regio pedis sinistra

Local Examination

Regio pedis sinisitra

Look: club foot (+), bean shaped deformity (+), forefoot and
midfoot inversion and adduction (+)
Feel: pain (-)
Move: forefoot can be positioned on the abduction and
hindfoot can be positioned on the eversion, legs can be made
neutral position
Assignment

CTEV (Congenital Talipes Equinovarus)

Plan

Gips installation