I'm afraid at the age your patient is at there is no real permanent solution or fix for CTEV. Ideally CTEV needs to be treated within the first 2-4 years of birth with treatment needing to be started within the 1st(preferrably the first 2 weeks) month via the Ponseti regime and dennis browne splinting afterwards. (there are other methods of treatment however the above mentioned treatment is the most effective in 75% of the cases resulting in a good functional and cosmetic foot with absolutely no pain)
saying that I am unsure what the ramifications of surgery at this very late stage would be although i have never heard of anyone having a successfully treated CTEV at the age you are considering without prior treatment.
However there are things you can do to stretch out and hold the foot in a good functional alignment. Taping as you have tried is the most simple and often helps. Obviously physiotherapy to loosen out the ligaments and stretch the influencing muscles is also advised.
In my own field of expertise (orthotics) you could refer your patient to an orthotist for use of a night splint which preferrably should hold the foot in plantigrade and subtalar neutral if thats possible and if not then as close to this as possible. For during the daytime when the patient is up and about i would definitely reccomend the use of custom made AFO's (ankle foot orthoses). Referral to a quallified orthotist should be all you need as they would make their own assessment and make an appropriate device...by the sounds of things with your patient i would say they needed a solid plastic AFO set as close to plantigrade and subtalar neutral as possible with a solid ankle (NO JOINTS) and a full sole plate. the typical type of material is a lightweight thermal moulded pastic such as homopolymer polypropylene. the material is very strong and hard wearing and can be made thin enough that patients in my experience should have no bother at all in fitting shoes although they may have to go up one shoe size once fitted with the AFO. if the degree of equinous is such that plantigrade is not possible then wedging and other techniques can be employed during manufacture process to accomodate for this.
As i say i cannot make an accurate prescription guide as i do not personally know the patient but by the sounds of it an AFO would be the ideal device to allow the maximum mobillity and comfort. Also it should be noted that the AFO will give a constant active stretch on the muscles and ligaments if it is manufactured correctly so it will continue with a long term stretch between physio to maintain any correction thats achieved and i would be surprised if the foot did not correct further with time.
I hope this sheds a little bit of light on the subject for you. I would definitely reccomend seeing about referring your patient to an orthotist.
EDIT:
Global-HELP : "Clubfoot - Ponseti Management" <<< that link is to a website that offers a full featured book on the ponseti regime for treating clubfoot and I have found it to be extremely helpfull. all publications are free and that particular book was co-written by Ponseti himself!
02-12-2006, 02:50 PM
Congenital Talipes Equinovarus
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