Amsir Ryadi S*

*Congenital talipes equinovarus (CTEV)Talipes, literally "ankle-foot", refers to the talusEquinovarus refers to the position of the clubfoot, in equinus and varus or adductus

*Congenital deformity1 of 1000 babiesOne or both feetboy : girl = 2 : 11st trimester of pregnancyThe foot pointing downwards and twisted inwardsClub, "kidney shaped", with a prominent medial crease along the plantar aspect of the foot

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*EtiologiMekanik(Hippocrates) Environmental Browne (1936)Herediter Wynne-Davies (1964)Idiopatik Bhm

*An uncorrected clubfoot in the older child or adult is very unsightly, and worse, very cripplingThe patient walks on the outside of his foot which is not meant for weight-bearingThe skin breaks down, and develops chronic ulceration and infection

*Two variations: positional deformities caused by the position of the foot in the womb2) structural malformations where bones, joints, muscles, and blood vessels are malformed

*Whether positional or structural, there are four common types of clubfoot

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Gambaran Klinis:Inversi pada kaki depan Adduksi atau deviasi interna dari kaki depan terhadap kaki belakang Ekuinus atau plantar fleksi Pengecilan dari otot-otot betis Kaki tidak dapat digerakkan secara pasif pada batas eversi dan dorsofleksi normal.

*Treatmentvery important to treat clubfoot as early as possible (i.e. shortly after birth) to prevent disability and problems with walking when the child gets older

*Manipulasi dan Pemasangan gips (dimulai segera setelah lahir)Menentukan letak kaput talus dengan tepat Manipulasi abduksi dari kaki dibawah caput talus yang telah distabilkan.Mengoreksi (memperbaiki) cavus memposisikan kaki depan (forefoot) dalam alignment yang tepat dengan kaki belakang (hindfoot). Alignment (kesegarisan) forefoot dan hindfoot untuk mencapai arcus plantaris yang normal sangat penting agar abduksi yang dilakukan untuk mengoreksi adduksi dan varus dapat efektif.Pemasangan Gips

CASTING

*child will be seen frequently by the pediatric orthopedic surgeon: every one to two weeksInitial treatment is provided by a series of casts to the affected foot

* a circumferential long leg cast is applied in the over-corrected position of heel dorsiflexion,pronation of the foot and external rotation of the ankleThe knee is placed at 90 degrees of flexion

*After multiple serial castings are completed (2-3 months), special shoes with or without a bar may be needed

*The Pediatric Orthopaedic Surgeon lengthens several of the tendons (structures which connect muscle to bone) which allows to foot to adopt a normal position SURGERYIf cast treatment fails, surgery is necessaryThis is not performed until the child is between four and eight months of age

Koreksi jaringan lunakdilakukan pada bayi dan anak dibawah 5 tahunTenotomi Indikasi : untuk mengoreksi equinus setelah cavus adduksi, dan varus sudah terkoreksi baik akan tetapi dorsofleksi ankle masih kurang dari 10 derajat.Pastikan abduksi sudah adekuat sebelum melakukan tenotomi. Tenotomi merupakan operasi minor, dengan anestesi lokal, dan dilakukan di klinik rawat jalan.Gips paskatenotomi dipertahankan selama 3 minggu setelah koreksi komplet.

Koreksi jaringan keras Operasi pada tulang atau osteotomi dilakukan setelah usia anak 5-10 tahun. Tindakan berupa :1.Osteotomi calcaneus untuk koreksi inversi 2.Wedge reseksisendi calcaneocuboid 3.Osteotomicuboid 4.Osteotomi cuneiformisuntuk koreksiadduksiyang berlebihan*

*Three week after surgerythe splint is removedthe foot is examined

*Sometimes orthotic fitting is done at this time for a knee-ankle-foot orthotic (KAFO) OR an ankle-foot orthotic (AFO)The device will be worn for months

*If a KAFO is used, it will eventually be replaced by an AFO to allow the baby to walk. These are worn inside shoesBilateral AFO orthotics

*Prognosis 50% CTEV pada neonates dapat diperbaiki secara non operatif. Ponesti 89% terkoreksi dengan menggunakan tekniknya (termasuk tenotomi Achilles).

KESIMPULANCongenital talipes equinovarus (CTEV) kelainan kongenital bentuk kaki dan pergelangan kaki yang berupa equines (plantar fleksi), varus (inversi) dan adduksiDiagnosa CTEV anamnesa, pemeriksaan fisik, serta pemeriksaan penunjang.Prognosis baik bila diberikan terapi sedini mungkin*

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