Ans: C (Increased dorsiflexion) Ref: Nelson's Textbook of Pediatrics, 19th ed.Explanation:Plantar flexion (cavus) is seen in CTEV, not increased dorsiflexionCongenital Talipes Equinovarus (Clubfoot) CTEVDeformity involving malalignment of the calcaneotalar-navicular complex.Components of this deformity - mnemonic CAVE (cavus, adductus, varus, equinus).Plantar flexion (cavus) of the 1st ray and adduction of the forefoot/midfoot on the hindfoot. The hindfoot is in varus and equinus)Clubfoot is extremely common in patients with myelodysplasia and arthrogryposis.Congenital clubfoot is seen in approximately 1/1,000 births.Etiology is niultifactorial environmental factors in a genetically susceptible host.The risk is approximately 1 in 4 when both a parent and one sibling have clubfeet.It occurs more commonly in males (2:1)Bilateral in 50% of cases.The pathoanatomy involves both ah normal tarsal morphology (plantar and medial deviation of (he head and neck of the talus) and abnormal relationships between the tarsal bones in all three planes.Clinical ManifestationsThe spine should be inspected for signs of occult dysraphism.Examination of the infant clubfoot demonstrates forefoot cavus and adductus and hindfoot varus and equinus.All patients exhibit calf atrophy.Both internal tibial torsion and leg-length discrepancy (shortening of the ipsilateral extremity) may he present.Radiographic EvaluationAnteroposterior and lateral radiographs are recommended, often with the foot held in the maximally corrected position.The navicular hone does not ossify until 3-6 yr of ageA common radiographic finding is ' parallelism" between lines drawn through the axis of the talus and the calcaneus on the lateral radiograph, indicating hindfoot varus.Many clinicians believe that radiographs arc not required in the evaluation and treatmentTreatmentNonoperative treatment is initiated in all infants and should be started as soon as possible following birth.Techniques have included taping and strapping, manipulation and serial casting, and functional treatment.Historically, a significant percentage of patients treated by manipulation and casting required a surgical release, which was usually performed between 3 and 12 mo of age. Although many feet remain well aligned after surgical releases, a significant percentage of patients have required additional surgery for recurrent or residual deformities.Stiffness remains a concern at long-term follow up.The Ponseti method of clubfoot treatment involves a specific technique for manipulation and serial casting and may be best described as minimally invasive rather than nonoperative.The order of correction follows the mnemonic CAVE. Weekly cast changes are performed, and 3 to 10 casts are typically required.The most difficult deformity to correct is the hindfoot cquinus. for which ~909f of patients require an outpatient percutaneous tenotomy of the heel cord.Following the tenotomy, a long leg cast with the foot in maximal abduction (70 degrees) and dorsiflexion is worn for 3 vk; the patient then begins a bracing program.An abduction brace is worn full time for 3 mo and then at nighttime for 3-5 yr.A subset of patients require transfer of the tibialis anterior tendon to the middle cuneiform for recurrence. Although most patients require some form of surgery, the procedures are minimal in comparison with a surgical release, w hich requires capsulotomy of the major joints (and lengthening of the muscles) to reposition the joints in space.Functional treatment, or the French method. involves daily manipulations (supervised by a physical therapist) and splinting with elastic tape, as well as continuous passive motion (machine required) while the baby sleeps.Surgical realignment has a definite role in the management of clubfeet, especially in the minority of congenital clubfeet that have failed nonoperative or minimally invasive methods, and for the neuromuscular and syndromic clubfeet that are characteristically rigid.Common surgical approaches include a release of the involved joints (realign the tarsal bones ), a lengthening of the shortened posteromedial musculotendinous units, and usually pinning of the foot in the corrected position.Triple arthrodesis is reserved as salvage for painful, deformed feet in adolescents and adults.