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Talipes Equinovarus

Talipes Equinovarus. Hazem Wafa Lecturer of Orthopaedic Surgery. The Latin word talipes was compounded from talus ( ankle ) + pes ( foot ). Incidence: 1 in 1000 births. ♂ : ♀ = 2 : 1. Most common in blacks (3.5/1000) and Polynesians (6.8/1000) but rare in Chinese and Japanese (0.5/1000).

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Talipes Equinovarus

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  1. Talipes Equinovarus Hazem Wafa Lecturer of Orthopaedic Surgery

  2. The Latin word talipes was compounded from talus (ankle) + pes (foot). • Incidence: 1 in 1000 births. • ♂ : ♀ = 2 : 1. • Most common in blacks (3.5/1000) and Polynesians (6.8/1000) but rare in Chinese and Japanese (0.5/1000). • Equal incidence as unilateral and bilateral. • Isolated cases / autosomal dominant cases.

  3. Etiology: • Idiopathic in more than 90% of cases. • Muscular type: arthrogryposis multiplex congenita. • Paralytic type: meningomyelocele. • Bony type.

  4. Elements of the deformity: • Equinus: Plantar flexion at the ankle joint. • Varus = adduction + inversion. • Adduction of the forefoot at the midtarsal joint. • Inversion of the heel at the subtalar joint.

  5. Elements of the deformity: • Supination:Best observed by bringing the heel to the neutral position in relation to the tibia and assessing the first and fifth metatarsals. • Cavus: high-arched foot. • Internal tibial torsion: the lateral malleolus lies in a plane more anterior to that of the medial malleolus.

  6. Treatment: • Conservative (non-operative treatment): • Correction of the deformity. • Maintenance of the correction obtained. • Correction of the deformity: • The Kite technique. • The Ponseti technique.

  7. Treatment: • Maintenance of the correction: • Adhesive Strapping: in the first two weeks of life. • Plaster-of-Paris Cast. • Denis Browne Splints: keeps the calcaneus in valgus, the forefoot in abduction and the ankle dorsiflexed - all in an attempt to straighten out the child with club foot.

  8. Treatment: • Operative Treatment: • If conservative treatment fails. • Persistent hindfoot equinus and varus. • Timing of surgery: age 9-12 months & size of the foot > 8 cm in length. • Technique: posteromedial release (Turco’s incision) or combined posteromedial and posterolateral release (Cincinnati incision).

  9. Treatment: • Operative Treatment: • Structures divided or lengthened: • Muscles – Tendons: • Achilles tendon. • Tibialis posterior. • FHL and FDL. • Capsules – Ligaments: • Capsules of the talonavicular, calcaneocuboid, ankle, and subtalar joints. • Ligaments: calcaneofibular, posterior talofibular, and interosseous talocalcaneal ligaments.

  10. Thank You

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