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PubMedDate not supplied

The contribution of prenatal sonographic diagnosis of clubfoot to preventive medicine.

From 1995 through 1997, clubfoot was detected by transabdominal sonography in 13 fetuses of 12 women, in nine bilaterally and in four unilaterally (total, 22 clubfeet). The average menstrual age at diagnosis was 23.6 weeks (range, 17-36). Three fetuses had associated malformations: two were therapeutically aborted and one died 2 weeks after birth. Proper understanding of the significance of prenatal ultrasound findings of clubfoot will assist both the orthopaedist and the parents in reaching a decision concerning future management of their pregnancy.

Clubfoot↗
PubMedDate not supplied

Ossification of the calcaneus in the normal fetal foot and in clubfoot.

The ossification of the fetal calcaneus was studied in a series of plastinated sections of 44 normal feet and three clubfeet. The results documented a precise sequence of perichondral and endochondral ossification in the normal calcaneus characterized by ossification grooves and associated cartilage canals. Within the clubfoot calcaneus, the coordination of perichondral and endochondral ossification is disturbed, ossification grooves and associated cartilage canals are not found in regular positions, and the process of endochondral ossification obviously is disturbed. The findings in the clubfoot specimens point to grave irregularities of the extracellular matrix within or outside the calcaneus.

Calcaneus↗
PubMed1997

Subtalar realignment in congenital clubfoot using the Cincinnati approach.

GOAL OF SURGERY: Surgical correction of clubfoot through an extensive and meticulous posterior, lateral, medial, subtalar, and plantar release. INDICATIONS: Failed conservative treatment of clubfoot at 6 months of age. CONTRAINDICATIONS: Previous failed surgery with a different incision. PREOPERATIVE WORK UP: Radiographs of both foot and ankle in the anterior-posterior and lateral projections. POSITIONING AND ANAESTHESIA: Supine. Tourniquet. General anaesthesia. Free draping above the knee. SURGICAL TECHNIQUE: Through a Cincinnati incision the Achilles tendon is exposed and lengthened and the posterior capsule excised. The talofibular and the calcaneofibular ligaments are incised and released. The plantar aponeurosis is divided and the small plantar muscles are detached. Finally a medial release is achieved having excised the abductor hallucis muscles. Release of the dorsal talonavicular joint capsule. In severe cases the calcaneoucuboid joint must also be released. The corrected position is maintained with Kirschner wires. POSTOPERATIVE MANAGEMENT: Long leg cast with the knee bent at 90 degrees . Cast changed after 10 to 14 days. Eight weeks postoperatively removal of cast and Kirschner wires and prescription of a Dennis-Brown boot to be worn for 12 to 18 months. POSSIBLE COMPLICATIONS: Injury to neurovascular structures. Pin tract infection. Tightness, loosening or slipping of cast. Inadequate correction and damage to articular surfaces. RESULTS: From 1985 to 1992 60 infants (70 feet) were operated. Average follow-up was 5 years (1 to 7). Assessment of clinical and functional results was based on the Magone rating system: 60% excellent, 18.6% good, 11% fair results were obtained; 2 infants had a minor skin breakdown, 7 were undercorrected and 2 were overcorrected.

Journal Article↗
PubMed1992

Short stature, Robin sequence, cleft mandible, pre/postaxial hand anomalies, and clubfoot: a new autosomal recessive syndrome.

We report on 5 unrelated Brazilian children with short stature, Robin sequence, cleft mandible, pre/postaxial hand anomalies, and clubfoot. Genetic aspects and phenotypic manifestations are compared with those of previous reports of acrofacial dysostoses and with other Robin sequence syndromes. We suspect that these patients present a previously undescribed autosomal recessive syndrome.

Abnormalities, Multiple↗
PubMed1984

The anatomy of a congenitally short limb with clubfoot and ectrodactyly.

Previous studies have shown an association between an abnormal arterial pattern and bony malformations of the human lower limb. We have dissected and performed arteriography on a congenitally short limb with ectrodactyly in order to examine the relationship between arterial pattern and bony anomalies in another type of deformity. The bony anomalies were a combination of short femur, tibia and fibula, clubfoot with tarsal synostoses, metatarsal absence, ectrodactyly, and a bifid hallux. The arterial pattern was characterized by deficiency of the anterior tibial artery and absence of the plantar arch. Major muscular anomalies were noted in the foot only; the muscles of the missing toe were absent and any muscles that normally cross the midventral line were either missing or failed to cross the midline. The superficial peroneal nerve failed to enter the dorsum of the foot and its sensory distribution was assumed by an extra branch of the sural nerve. The most severe abnormalities of the bones, muscles, arteries, and nerves occurred near the midventral line of the foot. We hypothesize that the abnormal arterial pattern put the limb at risk of teratogenic damage by reducing the number of collateral blood supply routes. We suggest that some event, such as extravasation of blood or embolization, compromised the blood flow in the remaining blood vessels and that this event resulted in both a general shortening of the limb and the specific defects observed in the foot. We interpret the anatomy to be consistent with the vascular teratogenic event occurring near the midline of the foot during the fifth week of embryonic development.

Abnormalities, Multiple↗
PubMed1995

Atypical aortic coarctation and innominate artery stenosis associated with clubfoot and lower leg ischemia in an infant.

We report findings in a male infant born with talipes equinovarus and ischemic necrosis of the left lower leg and foot associated with atypical coarctation of the ascending aorta and stenosis and hypoplasia of the proximal innominate artery. We hypothesize that a vasculopathy of unknown etiology occurred in utero that resulted in ascending aortic arch coarctation and innominate artery stenosis. The presence of a thrombus in the coarcted segment suggests that one or more emboli could have been responsible for vascular compromise and subsequent clubfoot deformity and lower leg ischemia. Alternatively, a vasculopathy similar to that hypothesized as occurring in the aorta might also have occurred in the left anterior tibial artery, causing structural deformity and soft tissue ischemia of the left lower leg and foot. We believe that this is the first report of this association of findings.

Abnormalities, Multiple↗
PubMed1977

[The importance of the radiological angle between talus and calcaneus in patients with congenital clubfoot (author's transl)].

A reduction of the angle between the longitudinal axes of talus and calcaneus in the lateral X-ray view of a clubfoot is a sign of persistent supination of the subtalar joint and not due to anatomical changes of the bone. Correction of this deformity by closed manipulation produces a normal angle between talus and calcaneus. The angle between talus and calcaneus can thus be used as a guide for adequate correction of the subtalar deformity.

Anthropometry↗
PubMed1990

Correction of clubfoot relapse using Ilizarov's apparatus in children 8-15 years old.

Treatment of relapsed or neglected clubfeet between the age of 8-15 years is at present unsatisfactory. Correction by triple arthrodesis with wedge osteotomies is not possible before the end of skeletal maturation. This caused us to use Ilizarov's external fixator, which made it possible to correct all components of clubfoot simultaneously by continuous guided distraction. Thirteen feet in 12 children were treated. A plantigrade foot was achieved in all cases. All patients were able to wear ready-made shoes. Complications were some slight and two severe pin track infections, temporary edema, and two relapses successfully treated by means of second procedures.

Adolescent↗
PubMed1984

Clubfoot therapy according to Bösch: conservative and operative aspects.

To Bösch goes the honor of having revealed the contradictions of the classical redressment treatment as early as 1950. Bösch's method was new insofar as he exerted pressure on the calcaneus from laterally and thus intuitively corrected the most important deformity, the subtalar horizontal internal rotation. Theoretical confirmation of this subtalar rotation was only made possible by computer tomography investigations, as described herein. On the grounds of these findings, the current operative concept has to be questioned and adapted to the latest scientific findings on the pathomorphology of the clubfoot. Also reported is an operation technique which permits correction of subtalar internal rotation and simultaneous complete reduction of the navicular on the talus, including the calcaneocuboid joint.

Adolescent↗
PubMed2003

[Conservative and functionally oriented treatment of idiopathic clubfoot].

The article describes current conservative treatment of idiopathic clubfoot, especially plaster cast manipulation, functional mobilization, and orthosis. New procedures such as mobilization of the foot on a continuous passive motion machine and the use of botulinum toxin are presented and discussed.

Casts, Surgical↗
PubMed2004

Correction of severe residual clubfoot deformity in adolescents with the Ilizarov technique.

Correction of severe residual clubfoot deformities in adolescents is a difficult undertaking and historically has had mediocre success without an accompanying arthrodesis procedure. Soft tissue release alone has yielded extremely high recurrence rates. Additional osteotomies have been used for correction of single deformities in one plane. The use of Ilizarov external fixation techniques has allowed for improvement of correction, stabilization, and decrease in recurrence rates. The technique, however, is difficult and should be performed by surgeons who are familiar with correction of pediatric foot and ankle deformities and are versed fully in Ilizarov fixation techniques.

Adolescent↗
PubMed2004

Centrally adaptations in unilateral idiopathic clubfoot children following conservative treatment.

Adaptations in tiptoe rising were studied in unilateral idiopathic clubfoot (ICF) children, who underwent conservative treatment. The current study concerned 10 ICF children and 10 healthy children of the same range of ages (8-12 year). All ICF children were rated "good" or "very good" treatment results, but showed residual m. Triceps surae atrophy and mild foot alignment flaws. Tiptoe rising task was performed with subjects standing quietly with the feet on separate force platforms. Subjects were instructed to rise onto tiptoes as fast as possible and to maintain the tiptoe erect posture for a few seconds. Surface EMG of muscles Gastrocnemius, Tibialis anterior, Peroneus longus were recorded on both sides, simultaneously with vertical reaction forces (RZ) and centres of pressure (CP) displacements, during a series of 10-15 trials. Foot preferentiality was without influence on the EMG and biomechanical activities of the control group. Although not aware of a deficit in performance, ICF children show less vertical acceleration than healthy children. Timing and magnitude of muscular activities, and Cp and RZ variables of ICF children, evidenced alterations in both affected and sound side, when compared to healthy subjects. Alterations in the affected side activities were well explained by Triceps surae atrophy. Alterations in the sound side were considered as adaptations of central nervous system (CNS), preserving a global symmetry of the task. These results highlight the CNS capacity to adapt even for mild deficiencies. They stressed that it is mandatory to follow ICF children, even if they recovered a normal life.

Acceleration↗
PubMed2006

Adaptation of gait initiation in children with unilateral idiopathic clubfoot following conservative treatment.

Children with unilateral clubfoot (CF) treated conservatively have residual foot deformities and triceps surae m. atrophy. Using surface electromyography of tibialis anterior (TA), gastrocnemius (GA), and peroneus longus muscles, simultaneously with ground reaction forces recordings, the present work assesses the influence of this pathology on the gait initiation process. Ten children with CF and 10 healthy children were investigated. In children with CF, the velocity of the centre of gravity (CG) at the end of gait initiation did not differ from that of healthy children, because of adaptations of anticipation and execution phases. CG velocity at the end of anticipation was lower in children with CF than in healthy children when the swing foot was the affected one, indicating that propulsion was less efficient in this condition. It is shown that this resulted from alterations in anticipation duration, initial centre of pressure position and TA and PL excitations. Execution was shortened when support was provided by the pathological foot: the motor program was adapted to shorten the phase during which equilibrium control might be deficient. Biomechanical characteristics of the execution phase of children with CF did not depend on the swing foot. This indicated that the sound foot cannot be used as a control for accessing residual deficiencies.

Acceleration↗
PubMedDate not supplied

Posterolateral release for idiopathic clubfoot: review of 18 patients.

The authors treated and reviewed 18 patients with 26 idiopathic clubfeet by posterolateral release and elongation of the tendo Achillis at a mean age of 14.6 months (range 7-32 months). The mean follow-up of these patients was 43 months (range 6- 100 months). Function, appearance, and pain were studied. The mean ankle dorsiflexion was 20 degrees at the time of review. In all but one case, the hindfoot equinus had been well corrected. Subtalar movement was 75% of normal in six feet, and 50% of normal in 16 feet. Revision of the posterolateral release combined with anteromedial release was carried out for six patients with residual hindfoot varus and forefoot adduction at an average of 13.5 months following the initial procedure. In one patient, the deformity was overcorrected, but the results of the rest of the revision operations were otherwise good. No skin or wound problems were observed in this series. In conclusion, of 26 feet undergoing posterolateral release for severe clubfoot, 70% had a satisfactory result. Six feet required further surgery (reoperation rate of 23.1%).

Achilles Tendon↗
PubMedDate not supplied

Soft tissue release in clubfoot by double incision.

A procedure for soft tissue release through double incisions in clubfoot is described. It has been practiced in 287 cases of severe, neglected, resistant, and relapsed clubfeet in the last 7 years. Generally, it has been found to be a useful approach without risking any skin necrosis.

Clubfoot↗
PubMedDate not supplied

The neglected clubfoot: a salvage procedure.

The study included 18 patients (28 feet), between 4 and 14 years of age. Complete homogeneous correction of the neglected clubfoot was achieved by performing a trapezoid resection osteotomy from the cuboid bone after performing an extensive posteromedial soft-tissue release. The procedure did not sacrifice any articular cartilage and allowed realignment of the forefoot. Tibialis anterior tendon transfer to the cuboid was performed in all feet to eliminate its deforming action and to help maintain the desired degree of correction. A Dwyer calcaneal lateral closing wedge osteotomy was needed in 12 feet and was performed concomitantly with the other procedures. After an average follow-up of 26 months (range 8-31 months) 14 (50%) feet had a good result with normal features, 11 (39.3%) feet had a fair result with definite improvement, and three (10.7%) feet had a poor result with limited improvement. Both good and fair results were considered satisfactory. Patients with tight ligaments were significantly more likely to have a poor outcome (p < .0005). However, neither the patient's age at the time of surgery nor the severity of the deformity was significantly associated with unsatisfactory results. The procedure is strongly recommended in supple feet with resilient ligaments, even in teenagers with severe deformity. In severely deformed rigid feet, the procedure serves to minimize bone resection, thus preventing excessive shortening of the foot if a triple arthrodesis should become necessary at a later date.

Adolescent↗
PubMed2003

Congenital talipes equinovarus (clubfoot): a disorder of the foot but not the hand.

Idiopathic (non-syndromic) congenital talipes equinovarus, or clubfoot, is a poorly understood but common developmental disorder of the lower limb, which affects at least 2 per 1000 Scottish births (ISD data). It is defined as a fixation of the foot in a hand-like orientation--in adduction, supination and varus--with concomitant soft tissue abnormalities. Despite advances in treatment, disability often persists. The aetiology of the condition has been little studied and is poorly understood. Neurological, muscular, bony, connective tissue and vascular mechanisms have been proposed, but the only firm evidence is that the mildest cases appear to be associated with intra-uterine posture. There is evidence for a genetic contribution to congenital talipes equinovarus aetiology. Its incidence varies with ethnic group, and we found that a family history is present in 24-50% of cases, depending on the population studied. Complex segregation analysis suggests that the most likely inheritance pattern is a single gene of major effect operating against a polygenic background. Possible mechanisms for congenital talipes equinovarus are discussed.

Amniocentesis↗