ctev

CTEV – Why Clubfoot Should Be Treated Early

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At Raghav’s birth, our pediatrician noticed his feet were abnormally bent, which caused the parents – Jyoti and Akash – to worry about their son’s health.

“This is where we heard about CTEV or clubfoot for the first time,” recalled Jyoti.

CTEV (Congenital Talipes Equinovarus), more commonly known as clubfoot, is a birth defect where an infant’s foot is twisted inward. The deformity, usually present at birth, worsens over time if left untreated.

Upon further investigation by our pediatrician, Raghav was immediately referred to Dr. Manish Dalwani, Senior Consultant, Orthopedics at Sitaram Bhartia Hospital, Delhi.

CTEV does not need to be a cause of panic if treated early,” reassured Dr. Manish.

Jyoti posed some questions at the consultation before they decided to go ahead with the treatment –

How does clubfoot affect a child?

CTEV or clubfoot isn’t painful for the babies. As your child grows, however, they can have difficulties in walking if treatment is delayed.”

“If left untreated the foot can also become painful in an adult with CTEV.”

CTEV affects the ankle and foot and is diagnosed at birth. The leg looks deformed, visibly shorter than normal and the calf muscles look chubbier.

Keep in mind that, in most cases, clubfoot can be detected during a prenatal ultrasound.

What causes clubfoot in a fetus?

“For most cases of CTEV, the causes are not known (idiopathic in nature). There are some situations, however, where it tends to be seen more commonly.”

“In these cases, the defect may occur if spinal disorders such as meningomyelocele are present in the infant during birth.”

The anomaly is more likely to occur in male children than females, by the ratio of 2:1.

“Could Raghav’s condition have happened due to anything I did during or after pregnancy?” asked Jyoti, worried that she had caused her son harm.

Dr. Manish was quick to quell her worries – “Though clubfoot causes are as of yet unknown, it is not related to how you have handled your pregnancy or the infant after birth.”

Can you treat CTEV?

Treatment for CTEV should be started as early as the 1st week.

If diagnosed early and treated under expert guidance, children with clubfoot can grow up to have as close to normal feet as possible, to run and play like their peers.

Raghav’s CTEV treatment was begun with nonsurgical methods like stretching, exercises, and serial plaster casting called the Ponseti method.

Sometimes, a minor surgical procedure of a tenotomy is required after 6-8 weeks following the exercises.

A minor surgery such as a tenotomy loosens the muscle at the back of the ankle and corrects the foot’s position.

“In certain severe cases of clubfoot, there is a possibility of serial casting method failing. In that case, a corrective surgery is required to be done at around 6 months of age.”

After the possibility of surgery was mentioned, Jyoti and Akash seemed unsure.

“Is clubfoot surgery required for my child’s state?” asked the anxious couple.

“As the child is still young and growing, the tissues are more flexible,” answered Dr. Manish.

“This means the shape of their feet can be corrected to near normal easily at this stage.”

Jyoti and Akash decided to go ahead with the treatment as they realized further delay could make Raghav’s condition worse.

Dr. Manish continued careful stretching and manipulation of the foot using a cast to treat Raghav. This was repeated every week over 20 weeks.

Conclusion

Most of the patients can be treated fully before 1-2 years of age using the procedures mentioned above.

“Do keep in mind that once the foot is corrected, it may need to be maintained in certain shoes and splints to reduce the risk of recurrence.”

A lot of parents tend to leave the treatment in the middle as clubfoot treatment takes a long time.

This ends up making the condition more resistant to treatment and would then require surgery at the earliest. Even then, CTEV may not get fully corrected.

Raghav’s parents vowed to stay consistent with his treatment and met with Dr. Manish every 3-6 months for a follow-up consultation.

Slowly, Raghav’s feet showed signs of improvement, and over the years he was able to walk and run normally.

“For proper CTEV management, regular follow-ups and a lot of patience is a must. Don’t lose hope and consult your doctor as early as possible for the best treatment,” emphasized Dr. Manish.

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