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At least 181 records · Page 10Linked to original sources
PubMed2006

[Conservative treatment of clubfoot: the Functional Method and its long-term follow-up].

Despite the presence of a considerable number of papers published in the international literature, talipes equinovarus keeps its secrets. Conservative methods of treatment are currently accepted as advantageous over surgery. Prediction of the future of a clubfoot after treatment is not possible, for this reason, a long-term follow-up is needful. A true Functional Method based solely on gentle manipulations has been used for more than thirty years. Its aim is to correct the deformity and to allow the child to walk without delay. The principle of this method is to distract joint contractures prior to progressive correction of the deformity. No selection is made regarding the severity of the deformity and its etiology. Family plays an important role in performing routine manipulations at home. Concerning this Functional Method, three main series have been published by our team, with excellent-good results accounting for up to 77%. We believe that our Functional Method of conservative treatment of clubfoot is an appropriate way for correction of the deformity and its stabilization.

Child↗
PubMed1991

A method of assessment of the clubfoot deformity.

The literature on clubfeet is inadequate because a common method language for assessing the deformity is lacking. Different severities of clubfoot deformity will give different results for a standard procedure: a less severe deformity can be corrected by limited releases, whereas a severe deformity requires radical procedures. This paper presents a language of assessment that has been used for a number of years. The importance of developing a language of assessment to be able to identify the various types of clubfoot deformity is important if the treatment of this condition is to develop within the field of pediatric orthopedics.

Clubfoot↗
PubMed1987

The technique of dynamic adhesive strapping for congenital clubfoot.

The use of dynamic adhesive strapping to correct congenital clubfoot in the immediate neonatal period is an effective method of treatment. The technique is described in detail, the steps are illustrated, and precautions and limitations are given. This type of treatment should shorten the amount of time required to correct congenital clubfoot. If the holding phase is sufficiently prolonged, a reduction in the number and complexity of operative procedures needed for recurrent and recalcitrant cases can be expected.

Bandages↗
PubMedDate not supplied

Experience in the conservative treatment of congenital clubfoot in newborns and infants.

We studied 323 children with congenital clubfoot from 1970 to 1987. The principles of conservative treatment of congenital clubfoot in newborns have completely changed since 1973. The present principles we follow are to begin treatment immediately after birth; and adduction and varus removal by manipulation. In each case, we use a plaster cast, which is changed after a few days as long as the foot is limp and well corrigible. The knee is immobilized at 60 to 70 degrees in a plaster cast. During the manipulations, the surgeon's hand presses only the plantar side of the foot. The results can be described as good, since in each child we have removed adduction and varus as operation by posterior release and Achilles lengthening was necessary in only 50% of the children.

Casts, Surgical↗
PubMed1987

The four quadrant approach to clubfoot surgery.

In the last 20 years, the approach to clubfoot surgery has changed. When surgery is performed, a comprehensive posterior, medial, and lateral release is indicated. The concept of derotation of the os calcis has proved beneficial in resolving the residual pigeon-toed gait. This constitutes the fourth quadrant of correction in clubfoot surgery. The ultimate goal is to achieve a supple functioning, plantargrade foot in one sitting.

Child, Preschool↗
PubMed1981

The surgical anatomy of the interosseous ligament of the subtalar joint as it relates to clubfoot surgery.

Confusion exists as to the exact anatomical description of the interosseous ligament of the subtalar joint. An effort was made through anatomical dissections to elucidate the exact boundaries of this tiny ligament. It is the authors' belief that in some resistant clubfeet, unless this ligament is transected completely, a full correction of the clubfoot deformity will not be obtained and a less than satisfying result, or a recurrent clubfoot deformity, may be the sequela.

Ankle Joint↗
PubMed1978

The pathoanatomy of congenital clubfoot.

Patients with resistant clubfeet were reviewed in their second and third decades. For comparison, normal embryological and fetal feet, untreated clubfeet, a recurrent clubfoot, and an amputated foot were dissected. In no child with a resistant clubfoot was the bone architecture normal. In untreated and recurrent clubfeet we found the lateral malleolus to be directed posteriorly, the head of the talus pointed laterally, and the navicular subluxated medially toward the medial malleolus. An operative technique to restore normal alignment of the talus in the ankle mortice, of the navicular and talus, and of the talus and os calcis is described.

Adult↗
PubMed1978

External rotation tibial osteotomy in clubfoot: adverse late effects.

In a review of 16 feet in clubfoot patients who had external rotation osteotomies to correct internal tibial torsion, 13 had the undesired effect of aggravating and increasing the varus deformity of the foot. External rotation osteotomy to correct internal tibial torsion seems contraindicated in the presence of clubfoot. If an indication does exist, the chances of late adverse effects can be decreased by deferring surgery until the child is over the age of 8, or by combining the procedure with lengthening of the long flexor tendons.

Braces↗
PubMed1980

Some new aspects in the pathology of clubfoot.

As part of a research project that is still in progress, 12 human embryos, fetuses, and one stillborn infant with clubfeet, were given injections of barium sulfate solution with China ink for correlated-contrast radiography and anatomic dissections of cleared specimens including histologic sections. The following observations suggested a vascular factor in the etiology of congenital idiopathic clubfoot: (1) the muscular, tendinous, fascial and other soft elements were not conspicuously abnormal; (2) radiologically and anatomically, all deformed feet had vascular abnormalities consisting of an ischemic area at the level of the sinus tarsi; (3) a wedge form, with its acute angle pointed towards the head of the talus, showed the disarrangement of the vascular network at the ischemic sinus tarsi area; (4) the vascular alteration was always more conspicuous in the early period of fetal life, being reduced to a simple knot of fatty infiltration and fibrous tissue in the older specimens and in the stillborn; (5) the vascular nucleus of the talus "Anlage" also was not in the normal location in the neck, but on the deformed side of the body; (6) the established deformity was well vascularized and characterized by a small area of necrotic fatty degeneration covering the infarction area (secondary to helicoidal movement pressures of the forefoot on the hindfoot). Five stages in the fetal development of clubfoot can be defined beginning with adduction of the forefoot and ending in complete equinovarus deformity.

Clubfoot↗
PubMed1994

Correction of the neglected clubfoot by the Ilizarov method.

Untreated clubfoot deformity remains a significant problem for the orthopaedist practicing in Third World countries. Using gradual distraction applied through the Ilizarov external fixator, 12 cases of neglected clubfoot deformity in seven adult patients were successfully treated at the General Hospital for the Mexican Institute of Social Security. The two men and five women ranged in age from 19 to 42 years (mean, 27 years). These minimally constrained frames required five to eight months of fixation time to achieve the correction. When a plantar-grade position was achieved, the fixator was removed and a below-knee walking cast applied. The follow-up time ranged from two to five years. Complete correction was obtained in all patients, and adductus deformity recurred in three. Feet were stiff before and after treatment, especially the forefoot. Postoperative ambulation seemed to restore some motion.

Adult↗
PubMedDate not supplied

Long-term follow-up of clubfoot surgery: analysis of 44 patients.

The purpose of this study was to evaluate the long term results of clubfoot surgery. Forty-four patients were evaluated for periods from one to 41 years. The evaluation was based upon clinical, radiological and functional criteria. Results revealed that in spite of anatomically and radiologically imperfect feet, most patients demonstrated excellent levels of function. The results of other follow-up clubfoot studies were analyzed and compared to the present study.

Adolescent↗
PubMedDate not supplied

Congenital clubfoot.

1. Clubfoot is more common in males and 50% of cases are bilateral. 2. Contact and reassurance with the parents is important during a lengthy procedure, such as bilateral club foot releases. 3. Edema is the most common complication of clubfoot repair, so it is important to monitor the infant closely postoperatively for circulatory problems.

Clubfoot↗
PubMed1996

[Evaluation of pathogenesis of encephalocele, high spina bifida and congenital clubfoot not forming part of any known syndrome: a case report].

The authors report the case, non forming part of any known syndrome, of a newborn with encephalocele, high cranial schisis, ocular anomalies, cleft palate and congenital clubfoot. The photographic documentation of the malformations is not possible due to a technical error in taking the photographs (lack of light in the room). Alterations to cerebral nervous tissue were histologically and cytologically characterised by immaturity and block of normal development during the early stages. For this reason the alteration of primary neuro-ectodermal tissue appears to be the initial factor with secondary involvement of anatomically and functionally contiguous fields and tissues, such as cranial bones and the eyes. The alteration of the nervous system resulted in the incapacity of the fetus to make fetal movements, making it vulnerable to extrinsic compression, above all uterine pressure. This led to the adoption of fixed postures with articular blockage most evident in the lower limbs (congenital clubfoot). The pathogenic noxa was not identified.

Anencephaly↗
PubMedDate not supplied

A comparison of the long-term results of posterior and comprehensive release in the treatment of clubfoot.

This study compared the long-term results of posterior and comprehensive release in the treatment of clubfoot. Patients were eligible for this study if the clubfoot was idiopathic and treatment was performed before 2 years of age. Medical records were reviewed to obtain the age, sex, bilaterality, and details of surgical treatment. Posterior release (performed before 1971) consisted of Achilles tendon lengthening and posterior ankle and subtalar releases. The comprehensive release, as described by Carroll, was performed after 1972. At the time of final review, patients completed Ponsetti's functional 100-point grading system, were examined, and had foot radiographs performed. Of 81 eligible patients, 59 (72%) were reviewed. Children in the two groups were not significantly different at the time of surgery for age, sex, and bilaterality. The patients were evaluated an average of 28 years (range, 25-30) after surgery in the posterior-release group and 16 years (range, 13-20) after surgery in the comprehensive-release group. Ponsetti scores were higher in the comprehensive-release group (mean, 86 vs. 81) but were not significantly different (p = 0.13). The comprehensive-release group required fewer procedures per patient compared with the posterior-release group (1.5 procedures vs. 2.0; p = 0.04). The ankle range of motion was similar in the two groups (p = 0.12), but the percentage of patients with subtalar stiffness was higher in the posterior-release group (50 vs. 18%; p = 0.01). Although the two groups were not statistically different based on the function-weighted Ponsetti scale, the comprehensive group had fewer operations, more complete correction of heel varus, and improved subtalar motion.

Achilles Tendon↗
PubMed1997

[Outcome of surgical treatment for infant clubfoot with complete subtalar release according to McKay].

Between 1992 and 1996 81 clubfeet in 69 children younger than 1 year of age were operated on with Mc Kay procedure at Pediatric Orthopedic Department in Lublin. Results of treatment after follow-up ranging from 6 months to 2.5 years are presented. Mc Kay procedure proved to give access to clubfoot morphology and allowed for complete correction of the deformity. The author recommend it for treatment of severe clubfoot, especially arthrogrypotic one.

Clubfoot↗
PubMedDate not supplied

Muscle and tendon size relationships in a paralyzed chick embryo model of clubfoot.

Clubfoot is a birth defect that may be related to muscle weakness or imbalance. The purpose of this study was to examine the relationships among muscle and tendon size and embryonic motility in a paralyzed chick embryo model of clubfoot and arthrogryposis. Decamethonium bromide, a neuromuscular blocking agent, was administered to a series of embryos in five dosage groups, producing a cohort of embryos with various degrees of paralysis and atrophy of tendons and muscle. Embryonic movement frequency was monitored, and after death in late gestation, the cross-sectional areas of the calf musculature and the gastrocnemius tendon proximal to the ankle were measured histologically. Significant correlations were found between embryonic motility and both muscle (r2 = 0.52) and tendon (r2 = 0.77) areas. In addition, a significant correlation (r2 = 0.74) was found between muscle and tendon areas, suggesting that a measurement of one may be used to predict the other.

Animals↗
PubMedDate not supplied

Rotation fasciocutaneous flap for neglected clubfoot: a new technique.

Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily the result of excessive tension on the skin edges and a poor understanding of the abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure by using a local-rotation fasciocutaneous flap. Posteromedial skin incision is taken. Posterior tibial artery perforators supplying the medial flap and saphenous vein are preserved. After soft-tissue release and correction of deformity, a defect appears in the posteromedial part of wound. Horizontal backcut is taken at proximal part of the incision and entire medial fasciocutaneous flap is rotated inferiorly to cover the defect. Triangular defect appearing proximally is sutured primarily or covered with skin graft. Primary uncomplicated wound healing was achieved within 2 weeks in all 20 rigid and neglected clubfeet (1-7 years) operated on with this technique. This flap is scientifically logical, technically easy, and ensures primary wound healing.

Child↗
PubMed1976

Early posterior ankle release in the treatment of congenital clubfoot.

Eighty-one patients (116 clubfeet) underwent posterior ankle release before the age of two years, following unsatisfactory responses to serial corrective casts applied according to the technique of Kite. Seventy-three per cent of these feet showed no or only mild talar flattening at an average follow-up of 7.5 years. Four years, following posterior ankle release there was a none-mild talar flattening rate of 69 per cent in this group compared to a 40 per cent none-mild rate in ankle release reduces the incidence of recurrent equinus deformity and the necessity for subsequent surgery in comparison to the results obtained with serial plaster casts or with tendo Achillis lengthening alone. Recent trends in clubfoot management have favored increasingly early operative intervention. Denham stated that "In the infant hard tissues (bone and cartilage) should be regarded as soft, and the soft tissues (tendon and ligament) as hard." Our operative experience with posterior ankle release supports this philosophy and indicates that early aggressive surgical management is the treatment of choice for the resistant clubfoot.

Age Factors↗