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Congenital Talipes Equinovarus (CTEV), commonly known as clubfoot, is a complex congenital deformity of the foot characterized by four fixed (CAVE) deformities:
CLUB FOOT Pathoanatomy Made Easy - The Young Orthopod
https://www.youtube.com/watch?v=BUxpO1BrhB0
https://www.youtube.com/watch?v=PabItKvmk-E
| Cause | Notes |
|---|---|
| Idiopathic (most common) | Unknown exact mechanism; likely multifactorial with genetic influence |
| Secondary (non-idiopathic) | Due to neurological or syndromic causes |
| Pathological basis | Abnormal development of muscles, tendons, ligaments, and bones around the ankle and foot joints during fetal life |
| Finding | Description |
|---|---|
| Foot deformity | Inwardly rotated, plantar-flexed foot at birth |
| Calf muscle atrophy | Affected leg may be slightly smaller |
| Rigidity | Varies; more rigid in syndromic or neurogenic types |
| No pain | Typically painless in neonates |
CAVE deformities:
Forefoot cavus, midfoot adductus, hindfoot varus and ankle equinus
Illustration of the four components of CTEV that are easily remembered using the acronym CAVE. (A) Pronation of the forefoot (cavus). (B) Adduction of the midfoot (adductus). (C) Inversion of the subtalar joint or hindfoot (varus). (D) Plantar flexion of the talus in the ankle (equinus).
Adham, Peixoto JB, Miyahara LK, et al. Clubfoot: Congenital Talipes Equinovarus. Radiographics. 2024;44(7). doi:https://doi.org/10.1148/rg.230178
Clinical photograph of CTEV child showing cavus (a), adductus (b), inversion (c) & equinus (d)
Drawn from Pirani S. Naddumba E. In: Staheli’s Ponseti club foot management. Teaching manual for healthcare providers. 2008;1:1-48
Diagnosis is primarily clinical. Important to differentiate: