## Pathoanatomical Deformity of CTEV **Key Point:** Congenital talipes equinovarus is a complex deformity comprising four main components that occur simultaneously. ### The Four Components (CAVE Deformity) | Component | Description | |-----------|-------------| | **C**avus | High medial arch (supination) | | **A**dductus | Adduction of the forefoot | | **V**arus | Inversion of the hindfoot | | **E**quinus | Plantarflexion of the ankle | **High-Yield:** The deformity is best remembered as **supination** (not pronation) of the entire foot combined with plantarflexion and inversion. The foot assumes a position of "turning inward and downward." ### Anatomical Basis 1. The talus is plantarflexed and inverted 2. The calcaneus is inverted and adducted beneath the talus 3. The navicular is medially displaced 4. The forefoot is adducted and supinated 5. The medial arch is exaggerated (cavus) **Clinical Pearl:** On inspection, the sole of the foot faces medially (inversion), and the foot cannot be passively dorsiflexed beyond neutral in untreated cases. The medial border of the foot is convex ("C-shaped" appearance). **Mnemonic:** **CAVE** — Cavus, Adductus, Varus, Equinus — captures all four deformities in one word. 
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