Manipulation and orthosis in the management of congenital talipes equinovarus

Abstract

Background: There have been controversies regarding the ideal treatment method for congenital talipes equinovarus (CTEV). It is now accepted that conservative management is the first line of management. Aims: To find out if manipulation and maintenance of the correction achieved with a dynamic CTEV orthosis can correct CTEV deformities. Study Settings: Department of Physical Medicine and Rehabilitation in a tertiary care teaching institute, Imphal. Study Design: Intervention study without comparison group. Materials and Methods: Fifteen patients (twenty-one CTEV feet) were enrolled in the study. Manipulation with the head of talus as fulcrum was performed without any attempt to separately correct cavus and other deformities from the beginning. This procedure was repeated ten times for a minimum of three sittings daily. Correction so achieved was maintained with a dynamic CTEV orthosis manufactured with polypropylene plastic. The CTEV orthosis was worn throughout the day except during manipulations and bathing. Roentgenography was performed before the start and at the end of the treatment to assess improvement. Statistical Analysis: Wilcoxon signed-rank test was used to assess the improvement in the radiological angles from baseline to the last follow-up. Results: The differences in the paired X-ray angles [talocalcaneal angle-lateral (TCA-LAT), tibiocalcaneal angle-lateral (TibCA), talocalcaneal angle-anteroposterior (TCA-AP), talo-first metatarsal angle-anteroposterior (TMT)] between the baseline and the sixth follow-up were statistically significant (P < 0.001). Conclusion: Proper daily manipulation by a caregiver and maintenance of correction with appropriately designed dynamic ankle-foot orthosis is a practical and effective means of correcting CTEV deformity.