ANSWER: (A) Talus is only bone involvedREF: Textbook of Orthopedics by John Ebnezar 4th ed page 510 table 35-11, 5-Minute Orthopaedic Consult, 2nd Ed by Frassica, Frank J. Sponseller, Paul D. Wilckens, John H. page 80-81"Tibialis Posterior tendon acts as a "guy rope" to hold up the arch of the foot"CTEV:Congenital talipes equinovarus is a fixed deformity of the foot characterized by1. Plantar flexion of ankle (equinus)2. Inversion of hind foot, axial internal rotation of subtalar joint (varus)3. Medial subluxation of talonavicular and calcaneocuboid joints (adductus)4. Cavus midfootIncidence:* Occurs 1 in 1000 births*Male:Female ratio: ~2:1* Polygenic inheritance pattern* Bilateral in 50% of casesRisk Factors:* A parent with the disorder* A sibling with the disorder* Drugs, such as aminopterin, taken during pregnancy* Presence of other disorders associated with clubfoot, including:PATHOLOGIC CHA-NG6S iN COMGENITftl CLUBFOOTAmniotic band syndromeArthrogryposisMyelodysplasiaMobius syndromeFreeman-Sheldon syndromeLarsen syndromeDiastrophic dwarfismImaging:I. The AP view: The forefoot is noted to be in adduction.AP VIEW NORMAL Vs CTEVNormal footCTEV Foot[?] The talus aligns roughly with the first metatarsal, and the calcaneus aligns roughly with the 5 th metatarsal.[?] The angle thus formed between the axes of these 2 bones is the anterior talocalcaneal angle, or Kite angle.[?] Normal range for this angle is 20 to 40deg[?] The axes of the calcaneus and talus are nearly parallel, and thus the angle is much smaller.II. Lateral view: The position of the foot is in equines.LATERAL VIEW NORMAL Vs CTEVNormal footCTEV Foot[?] In a normal foot, the talocalcaneal angle is 35-50deg[?] In a clubfoot, that angle is considerably smaller because the 2 bones are nearly parallel in all planes.Pathological Findings:The essential bony change is medial deviation of the talar neck with subluxation of the talonavicular joint.Histologic study also has revealed smaller muscle fibers than normal on cross-section.Increased thickness of fascia and joint capsules is present on the medial side of the foot.