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CTEV Club Foot for Orthopaedic Exams
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CTEV Club Foot for Orthopaedic Exams
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https://cadmoreoriginalmedia.blob.core.windows.net/a868ca58-d64a-49d3-b2c5-87b767d28af4/CTEV Club foot for orthoapedic Exams.mp4?sv=2019-02-02&sr=c&sig=KUf9tXzpCTfES0m6RcGcazKBNs93zmAt1MsS4deTG5Y%3D&st=2024-11-22T16%3A49%3A09Z&se=2024-11-22T18%3A54%3A09Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
The before I start the presentation, I would like to thank the mentor in this group because I passed the exam in April 19 and the group make a difference for me when I was preparing for the exam. I did a couple of sessions over here. David was doing a couple of them for me and that made a difference for me, so I have to thank the senior mentor in this group today I be presenting the TV for the Fox and as David mentioned, I. That topic is really a common one.
And I had the same topic twice. I had to exam twice and I had that topic twice and I really went through the presentation. I will explain the difference in that 2 times and how using. And specific words will make a huge difference when you are talking, as fast as you can. So what I'm covering on is what is it, CTV epidemiology, the anatomy of the food, the biomechanics, the clinical picture classification and the management.
What's congenital typekit to find, where's the CTV is television is made of a Latin name, which is the tolerance with uncle, and the food and equines indicates that he is elevated like a horse. And it's fast because it's indicated turned inward. Look to that image on the right hand side. That's what you're going to see on the exam and you're going to start saying, is this the clinical picture of 180 food minus the full food and abductions, the highest food and virus?
From that presentation you need from that slide, you need to 3 points. Incidence is 1 to two per thousand, so it's very common. So that's why it's important and that's why it's getting asked a lot. And for example, there is some kinds of first degree relative percentage, two percent, it's bilateral and 50% of the cases.
And when it's unilateral, it's more affecting the right side. I'm today talking mainly about the issue perspective, which is always coming to be asked, and there is thousands of theories about why the dramatically. But the only important message from this slide, it's not a packaging disorder. So no matter what you're going to quote, it's not important. It's just important to know it's not a packaging disorder.
The anatomy and the biomechanics of the foot and ankle is very important to understand that management concept of ponseti, so we're going to go through them and we're going to go first about the movement of the foot and ankle, which is very important to analyze in your head. So you understand how is the management going? So is a foot and ankle.
There is three plants which the movement happen on them. The first is the sagittal movement, which is the planter and reflection. And that's happened on the ankle joint. So one, it's a flexion into its plantar flexion. The second movement has happened in the four foot, and it's in the transverse plane and it's abduction, abduction, and it's only for food. So when you describe for food and abduction or abduction, you describe the forefoot.
The third movement is a virus and vulgaris, and that's happened on the coronal plane and that's happened on the hind food to describe the virus and Bulger's. The more complicated movement is happening in two planes together, which is the inversion and eversion and when like for inversion, the high end route will be.
Invite us and for food introduction. So by Mason and pronation has happened in the three planes. So the three toys was described before on the previous table will be sharing the movement. So, for example, insubordination, the ankle has to go into plantar flexion, the forefoot. We're going to go into adduction, the highest foods we're going to go into where you'll find that.
Explanation in the foot and ankle chapter is the concise note that the book offers are not. The kinematics of the foot and ankle is an important point, which is on safety has discovered, and he felt the management on top of the next couple of slides that the old bones of the first move as a unit around the tail. So a food move around the two functional entities of the subtalar joint and the tale of continuous articulation of cold as acetabulum feeding.
So remember that slide, because you're going to use that passports and in describing ponseti, which is the kind of magic couplings. So remember, when we were talking about the four-foot going into Britain as the highest food is going into grass and burgers. So that to movement together I call kinematic complex. So this MeToo movement is always linked together.
So if we look to the pathological anatomy, there is too many pathology happen in the foot and ankle and the CTV. But this is not completely irrelevant to the FRC exam. So you don't need to be that in particular shifted immediately or it's 2.8 or take whatever direction you need to know that the forefoot is subordinated and the hind foot going in Equinix. But you don't need to go all through this pathological anatomy.
The second important message from the biomechanics is the importance of the tendon and ligaments are very elastic properties. So we have that ability to creep, which is a slow, progressive, permanent deformation of a material under a constant stress. So when Ponseti putting the cast for a week, he put a constant stress to reach a progressive permanent deformation and correct that with the cream property of the elastic material.
So I was going to stop here about the presentation, and I will show the difference. When you when you are in exam and you start talking about the consejo technique, which always the people start talking about concepts that he will be correcting the cave, which is I found it's. Not tonight, but you didn't show the examiner that, you know, any basic science.
But however, if you said, are you going to manage this kid with a foam safety technique who was dependent and to biomechanical theory to get his correction first, that basically elastic property of the tendon and ligament using the crepe. And second, the kind of magic coupling in the movement of the foot and ankle that will show the examiners that you already know about the technique and details, and you are going to move to a higher level of talking rather than stay talking about every single step and porosity.
So classification was there is hundreds of classification in the literature that the common six of them, but for the FRC s exam, you need that they're only scoring systems. And you know, to know about the training and telling the examiners that, you know, that six components out of it. He described it into six components its components take 0 or half or one.
And so the lowest is zero and the high six. And it's easy to remember, because it's the three of them in the forefoot and three of them in the hind foot. So the first one is the latter curvature, which is if it's straight, it's zero, if there is a mild curve, it's 0.5. If it's completely curve, it's one. And second is how the medial crease, how deep is the medial crease and palpation of the tail had not palpable or partially culpable or easily palpable.
And the hind foot, how far is the equinix? It can go fully, fully those reflections at 0. It doesn't go those reflections at one and palpation of the calcaneus and the posterior crease. How deep is the posterior crease? The only score is very important to assess the progress. Redact need for tenotomy estimation of how many number of costs you will be requiring.
It's very good as an answer observer reliability and reproducibility. I was that to slide, because you will find it in every single book as a matter of completion that you will find there is a role of a plain X ray, but that's not for the exam. You don't mention X-ray for CTV, except if it's an existing case or a relapsed case after a second Ponseti.
So it's not common to get an ab View or lateral view of a kid for a PPV. So don't mention a plain X ray, but to know it's what always you need to get in relapsed cases or resistance case is that they look at Kenya's angle either an AP or lateral. And both of them has to be between 20 to 40 degrees. As a matter of completion. But remember, you are not going to mention anything about the plane X-ray.
It's a clinical assessment and management without need for any investigation. What's the aim of the treatment? I like this sentence to mention to the examiner I want to reach a strong, painless plant grade and supple food using a conservative management. Yes, there is a rule for a surgical management, but mainly we using conservative to reach this four important points.
Strong, painless plant grade and substitute. Well, safety is godfather of the conservative management of the CTV. And we're going to outline his regime for treatment of the clubfoot. First, it's a serial costing second is a percutaneous tenotomy of the tender Achilles. Third is that abduction, food or so third force is the transfer of step and four dynamics of nations.
That's how he described his conservative management. So remember, when you start talking about one safety technique. It's not the cave as a first description, it's a four, it's a different for the cave is a part of number one, which is the serial casting, but you have to mention that it's a serial casting, percutaneous tenotomy or Sosa's. And if we need a tape and transfer because I know a couple of colleagues who've been through the exam and you're kind of stuck to cave and you don't move to a second percutaneous tenotomy, which 90% of kids will need it.
So you have to outline this first to the examiner. So he knows that, you know, how is the management of the cpb? So no one is a serious casting, which is cave, as I mentioned before, which is to correct cave with number one abduction and various, which is connected together as cinematic coupling or sending kids movement. We talked in the movement of the foot and force is the awareness.
So as a first move in the first cast, you trying to correct the caves by increasing the subordination of the four food companies comparing to the highest food. So I put here another. Term, which is that pronation West of the four-foot, so it's the forefoot is more pronounced compared to the high fruit. So you're trying to correct it more to be in line with the highest food before you start correcting the abduction and the virus so that.
Buzzword using and as a cave, as correction that you're going to be reassuring the parents, the first cast will increase the deformity, but you will explain to them that the next period of casting will be correcting it. But the first task is make the deformity worse. So the idea of that is to find where is the toilet? So it's the first point underneath the lateral malleolus and you'll be push underneath that first metatarsal to increase the cavers.
So that's how we'll be looking on the first cast. So it's more increasing deformity rather than correcting the deformity. It's I had a couple of guys have been asking how you recognize, whereas the. So it's the first pony. But I'm not at 1 centimeter anterior to the lateromedially. And remember, you have to mention that you don't touch the calcaneus while you do the manipulation you always hold, hold the tails, but you don't touch the campiness, and I will mention later what the difference.
Next, serial of casting, which will be the second, third and fourth cast will be to correct the production, which is automatically will be correcting the virus. So you remember the cave, it's Cav to adoption and various together in the next cast, so we'll be starting moving forward.
Segment:0 .
The before I start the presentation, I would like to thank the mentor in this group because I passed the exam in April 19 and the group make a difference for me when I was preparing for the exam. I did a couple of sessions over here. David was doing a couple of them for me and that made a difference for me, so I have to thank the senior mentor in this group today I be presenting the TV for the Fox and as David mentioned, I. That topic is really a common one.
And I had the same topic twice. I had to exam twice and I had that topic twice and I really went through the presentation. I will explain the difference in that 2 times and how using. And specific words will make a huge difference when you are talking, as fast as you can. So what I'm covering on is what is it, CTV epidemiology, the anatomy of the food, the biomechanics, the clinical picture classification and the management.
What's congenital typekit to find, where's the CTV is television is made of a Latin name, which is the tolerance with uncle, and the food and equines indicates that he is elevated like a horse. And it's fast because it's indicated turned inward. Look to that image on the right hand side. That's what you're going to see on the exam and you're going to start saying, is this the clinical picture of 180 food minus the full food and abductions, the highest food and virus?
From that presentation you need from that slide, you need to 3 points. Incidence is 1 to two per thousand, so it's very common. So that's why it's important and that's why it's getting asked a lot. And for example, there is some kinds of first degree relative percentage, two percent, it's bilateral and 50% of the cases.
And when it's unilateral, it's more affecting the right side. I'm today talking mainly about the issue perspective, which is always coming to be asked, and there is thousands of theories about why the dramatically. But the only important message from this slide, it's not a packaging disorder. So no matter what you're going to quote, it's not important. It's just important to know it's not a packaging disorder.
The anatomy and the biomechanics of the foot and ankle is very important to understand that management concept of ponseti, so we're going to go through them and we're going to go first about the movement of the foot and ankle, which is very important to analyze in your head. So you understand how is the management going? So is a foot and ankle.
There is three plants which the movement happen on them. The first is the sagittal movement, which is the planter and reflection. And that's happened on the ankle joint. So one, it's a flexion into its plantar flexion. The second movement has happened in the four foot, and it's in the transverse plane and it's abduction, abduction, and it's only for food. So when you describe for food and abduction or abduction, you describe the forefoot.
The third movement is a virus and vulgaris, and that's happened on the coronal plane and that's happened on the hind food to describe the virus and Bulger's. The more complicated movement is happening in two planes together, which is the inversion and eversion and when like for inversion, the high end route will be.
Invite us and for food introduction. So by Mason and pronation has happened in the three planes. So the three toys was described before on the previous table will be sharing the movement. So, for example, insubordination, the ankle has to go into plantar flexion, the forefoot. We're going to go into adduction, the highest foods we're going to go into where you'll find that.
Explanation in the foot and ankle chapter is the concise note that the book offers are not. The kinematics of the foot and ankle is an important point, which is on safety has discovered, and he felt the management on top of the next couple of slides that the old bones of the first move as a unit around the tail. So a food move around the two functional entities of the subtalar joint and the tale of continuous articulation of cold as acetabulum feeding.
So remember that slide, because you're going to use that passports and in describing ponseti, which is the kind of magic couplings. So remember, when we were talking about the four-foot going into Britain as the highest food is going into grass and burgers. So that to movement together I call kinematic complex. So this MeToo movement is always linked together.
So if we look to the pathological anatomy, there is too many pathology happen in the foot and ankle and the CTV. But this is not completely irrelevant to the FRC exam. So you don't need to be that in particular shifted immediately or it's 2.8 or take whatever direction you need to know that the forefoot is subordinated and the hind foot going in Equinix. But you don't need to go all through this pathological anatomy.
The second important message from the biomechanics is the importance of the tendon and ligaments are very elastic properties. So we have that ability to creep, which is a slow, progressive, permanent deformation of a material under a constant stress. So when Ponseti putting the cast for a week, he put a constant stress to reach a progressive permanent deformation and correct that with the cream property of the elastic material.
So I was going to stop here about the presentation, and I will show the difference. When you when you are in exam and you start talking about the consejo technique, which always the people start talking about concepts that he will be correcting the cave, which is I found it's. Not tonight, but you didn't show the examiner that, you know, any basic science.
But however, if you said, are you going to manage this kid with a foam safety technique who was dependent and to biomechanical theory to get his correction first, that basically elastic property of the tendon and ligament using the crepe. And second, the kind of magic coupling in the movement of the foot and ankle that will show the examiners that you already know about the technique and details, and you are going to move to a higher level of talking rather than stay talking about every single step and porosity.
So classification was there is hundreds of classification in the literature that the common six of them, but for the FRC s exam, you need that they're only scoring systems. And you know, to know about the training and telling the examiners that, you know, that six components out of it. He described it into six components its components take 0 or half or one.
And so the lowest is zero and the high six. And it's easy to remember, because it's the three of them in the forefoot and three of them in the hind foot. So the first one is the latter curvature, which is if it's straight, it's zero, if there is a mild curve, it's 0.5. If it's completely curve, it's one. And second is how the medial crease, how deep is the medial crease and palpation of the tail had not palpable or partially culpable or easily palpable.
And the hind foot, how far is the equinix? It can go fully, fully those reflections at 0. It doesn't go those reflections at one and palpation of the calcaneus and the posterior crease. How deep is the posterior crease? The only score is very important to assess the progress. Redact need for tenotomy estimation of how many number of costs you will be requiring.
It's very good as an answer observer reliability and reproducibility. I was that to slide, because you will find it in every single book as a matter of completion that you will find there is a role of a plain X ray, but that's not for the exam. You don't mention X-ray for CTV, except if it's an existing case or a relapsed case after a second Ponseti.
So it's not common to get an ab View or lateral view of a kid for a PPV. So don't mention a plain X ray, but to know it's what always you need to get in relapsed cases or resistance case is that they look at Kenya's angle either an AP or lateral. And both of them has to be between 20 to 40 degrees. As a matter of completion. But remember, you are not going to mention anything about the plane X-ray.
It's a clinical assessment and management without need for any investigation. What's the aim of the treatment? I like this sentence to mention to the examiner I want to reach a strong, painless plant grade and supple food using a conservative management. Yes, there is a rule for a surgical management, but mainly we using conservative to reach this four important points.
Strong, painless plant grade and substitute. Well, safety is godfather of the conservative management of the CTV. And we're going to outline his regime for treatment of the clubfoot. First, it's a serial costing second is a percutaneous tenotomy of the tender Achilles. Third is that abduction, food or so third force is the transfer of step and four dynamics of nations.
That's how he described his conservative management. So remember, when you start talking about one safety technique. It's not the cave as a first description, it's a four, it's a different for the cave is a part of number one, which is the serial casting, but you have to mention that it's a serial casting, percutaneous tenotomy or Sosa's. And if we need a tape and transfer because I know a couple of colleagues who've been through the exam and you're kind of stuck to cave and you don't move to a second percutaneous tenotomy, which 90% of kids will need it.
So you have to outline this first to the examiner. So he knows that, you know, how is the management of the cpb? So no one is a serious casting, which is cave, as I mentioned before, which is to correct cave with number one abduction and various, which is connected together as cinematic coupling or sending kids movement. We talked in the movement of the foot and force is the awareness.
So as a first move in the first cast, you trying to correct the caves by increasing the subordination of the four food companies comparing to the highest food. So I put here another. Term, which is that pronation West of the four-foot, so it's the forefoot is more pronounced compared to the high fruit. So you're trying to correct it more to be in line with the highest food before you start correcting the abduction and the virus so that.
Buzzword using and as a cave, as correction that you're going to be reassuring the parents, the first cast will increase the deformity, but you will explain to them that the next period of casting will be correcting it. But the first task is make the deformity worse. So the idea of that is to find where is the toilet? So it's the first point underneath the lateral malleolus and you'll be push underneath that first metatarsal to increase the cavers.
So that's how we'll be looking on the first cast. So it's more increasing deformity rather than correcting the deformity. It's I had a couple of guys have been asking how you recognize, whereas the. So it's the first pony. But I'm not at 1 centimeter anterior to the lateromedially. And remember, you have to mention that you don't touch the calcaneus while you do the manipulation you always hold, hold the tails, but you don't touch the campiness, and I will mention later what the difference.
Next, serial of casting, which will be the second, third and fourth cast will be to correct the production, which is automatically will be correcting the virus. So you remember the cave, it's Cav to adoption and various together in the next cast, so we'll be starting moving forward.
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