Congenital Talipes Equinovarus : management and outcome
Congenital Talipes Equinovarus is the commonest congenital musculoskeletal disorder with an incidence of 1 in 1000 live births. Although there has been much research into various aspects of the condition, there are still many unanswered questions. CTEV shows a spectrum of severity. In practice, a small percentage of cases resolve completely shortly after birth, but the remainder require further management with surgery in up to 80% of patients in some series. In children under the age of 6, soft tissue operations are often all that is required. After that age however, bony procedures are often necessary as the growing bones adapt to their abnormal environments. A number of factors have been investigated to assess the results of initial management and predict which patients will require further treatment, but there is little agreement between authors as to what variables should be studied. Outcome and the assessment of different management strategies is also contentious. This study describes the assessment of 204 families identified as having at least one child with congenital talipes. Outcome was initially assessed using a subjective scoring system. This was then used to evaluate a number of proposed objective and clinical outcome measures. On the basis of this, an objective system of assessment is proposed using measurement of foot length discrepancy, calf circumference, and range of movement at the ankle. Management was then evaluated objectively showing that in the medium term, a prolonged period of conservative management with Denis Browne splints and boots produced the best outcome. Despite a number of family studies looking at inheritance patterns in CTEV, the mode of genetic transmission remains unclear, and, while a number of environmental factors have been linked to CTEV, scientific methodology, in particular lack of a control group, limits the conclusions which can be drawn. Analysis of 176 family pedigrees demonstrates that CTEV may have an autosomal dominant mode of inheritance in a subgroup of cases. This study also presents the results of a case control study of epidemiological factors in CTEV, demonstrating a link between smoking and CTEV.