A case of bilateral Congenital Talipes Equinovarus (CTEV)

Stella1, Subadhra Devi2, Maha Lakshmi3

1Nursing Supervisor Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Cantonment, Trichy. Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

This report describes a neonate with bilateral congenital clubfoot (talipes equinovarus), characterized by inward twisting of both feet that prevents the soles from resting flat. The infant, delivered full‑term via LSCS, has a maternal history of consanguineous marriage and a positive family history of clubfoot, suggesting a possible genetic predisposition. The clinical presentation, etiological factors, and management considerations for congenital clubfoot are discussed with emphasis on early intervention and genetic counseling for similar high‑risk families.

Introduction

Congenital Talipes Equinovarus is a musculoskeletal deformity present at birth, involving four major components: Cavus, Adduction, Varus, and Equinus (CAVE). It may occur unilaterally or bilaterally and can be associated with genetic, environmental, or neuromuscular factors. The Ponseti method is the gold‑standard treatment worldwide, emphasizing gentle manipulation, serial casting, and, when required, Achilles tenotomy.

While the exact cause of clubfoot is not always known, several factors may contribute to its development:

Genetics: Clubfoot can run in families, suggesting a genetic component.

Positioning in the Womb: In some cases, the baby’s position in the womb may contribute to the condition.

Neurological Factors: There may be a link between clubfoot and certain neurological conditions.

A 1‑month‑old baby was brought to the Outpatient Department (OPD) with a history of birth defect characterized by inward twisting of both feet, making it difficult to place the soles flat on the ground. The mother had a history of consanguineous marriage, and there was a positive family history of clubfoot. The baby was born full‑term by Lower Segment Caesarean Section (LSCS).

Clinical Examination

  • On examination, bilateral medical creases were present.
  • Detailed foot assessment revealed:
  • Left foot: Dorsiflexion –10°, abduction –50°
  • Right foot: Dorsiflexion – neutral, abduction –45°
  • Toe movements were present. Examination of the spine and hips showed no abnormalities, ruling out associated neuromuscular or spinal defects.

Diagnosis

Based on clinical findings, the infant was diagnosed with Bilateral Congenital Talipes Equinovarus (CTEV).

Management

The patient was treated using the Ponseti method of correction. Serial casting and bilateral Achilles tenotomy were performed to achieve optimal correction of the deformity.

Serial Casting Schedule

1st cast: 07/12/2024 (done at an outside hospital)

2nd cast: 11/12/2024

3rd cast: 17/12/2024

4th cast: 31/12/2024

5th cast: 07/01/2025

6th cast: 13/01/2025

Following serial casting, bilateral Achilles tenotomy was performed on 22/01/2025 to correct residual equinus deformity.

Outcome and follow‑up

Post‑tenotomy, the feet showed satisfactory correction with improved dorsiflexion and alignment. The patient was advised to receive regular follow-up and brace application as per the Ponseti protocol to prevent recurrence.

Discussion

CTEV is one of the most common congenital orthopedic conditions. Risk factors include genetic predisposition and consanguineous marriage, as seen in this case. Early initiation of the Ponseti method yields excellent outcomes, minimizing the need for extensive surgery. Achilles tenotomy is often required to achieve complete correction of equinus deformity.

Skilled Nursing Care

  • Performed thorough initial assessment of foot position, range of motion, skin integrity, and neurovascular status.
  • Identified severity of deformity and document findings accurately for ongoing evaluation.
  • Assist the orthopedic team during Ponseti casting procedures.
  • Ensure proper cast care, including keeping the cast clean, dry, and well-fitted.
  • Monitored for complications such as swelling, discoloration, pressure sores, impaired circulation, or excessive crying.
  • Assessed capillary refill, temperature, color, and movement of toes regularly.
  • Educated the parents on cast care at home, warning signs, and follow-up schedules.
  • Provided guidance on proper positioning and handling of the infant to avoid cast damage.
  • Support the parents emotionally and address concerns related to genetic factors and prognosis.
  • Promoted adherence to bracing protocol after casting to prevent recurrence.

Conclusion

Early identification and timely intervention of congenital clubfoot are crucial for achieving optimal functional outcomes. In this case, the infant presented at an early age, allowing prompt initiation of appropriate management. Skilled nursing care played a vital role in assessment, cast care, monitoring complications, parental education, and ensuring adherence to treatment and follow-up. With coordinated multidisciplinary care and active family involvement, the prognosis for correction of the deformity and attainment of normal foot function is favorable.

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