Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CLUBFOOT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Percutaneous tendo-Achilles lengthening with a large-gauge needle: a modification of the Ponseti technique for correction of idiopathic clubfoot.

The Ponseti technique has become standard for the treatment of congenital idiopathic clubfoot. Treatment includes serial manipulations and casting, accompanied by percutaneous tenotomy of the Achilles tendon. In this article, the authors describe a modification in the Achilles tenotomy technique by using a large-gauge hypodermic needle in the outpatient setting.

Achilles Tendon↗
PubMedDate not supplied

[Early results of the Ponseti method for the treatment of idiopathic clubfoot].

AIM: The Ponseti method for the treatment of congenital clubfeet has been propagated due to the sometimes disappointing functional results after surgical treatment. The aim of our study was to evaluate our early results and experiences with the Ponseti method. METHOD: Between December 2002 and December 2004 a total of 87 clubfeet in 59 patients were treated using the Ponseti method at our department. Only patients in whom treatment was initiated within the first three weeks of life were included in this study. Rate of successful correction without open release surgery, radiological findings, classification according to Pirani at the time of the last follow up, recurrence rate and duration of treatment were defined as outcome measures for this prospective study. RESULTS: Fifty-nine cases in 37 patients met the inclusion criteria. Ninety-three percent of all cases (55 feet) were corrected without open surgery. The mean duration of active treatment was 11.4 weeks (8-20 weeks). The mean tibiocalcaneal angle 3-4 weeks after the percutaneous tenotomy of the Achilles tendon was 69 degrees, the mean a.-p.-talocalcaneal angle measured 33 degrees and the lateral talocalcaneal angle 36 degrees. A recurrence was seen in one patient with bilateral clubfeet (3.6 %). CONCLUSION: Open release surgery can be averted in most cases of idiopathic clubfoot using the Ponseti method. Scarring of the soft tissue and especially of the joint capsule can thereby be avoided.

Achilles Tendon↗
PubMedDate not supplied

[Corrective dynamic shoe fitting of the functional clubfoot in patients with infantile cerebral palsy].

Providing CP Patients with functional clubfoot with orthopaedic shoe modifications has not a good evaluation in the literature. An own concept of fitting this kind of spastic foot deformity is demonstrated. It is based on stabilizing shoe modifications combined with spasticity inhibiting posture of the foot in the shoe. The results based on a follow-up examination of nearly five years can be considered positive.

Child↗
PubMedDate not supplied

Treatment of clubfoot by posterior capsulectomy.

Posterior capsulectomy is a complete excision of the posterior tibiotalar and talocalcaneal capsule with a release of the distal tibiofibular connection. The operation is proposed for a resistant or relapsed clubfoot, where remaining equinus is the major problem. A follow-up of 29 operations showed that the average talocalcaneal angle became normal in the AP and lateral views. The best results were obtained with long postoperative cast immobilization, i.e. 6 months.

Achilles Tendon↗
PubMedDate not supplied

Central compartment pressure monitoring following clubfoot release.

Thirty-nine clubfeet undergoing primary soft tissue release for idiopathic clubfoot deformity had intrinsic compartment pressure monitoring for 36 h after surgery. This was done to determine whether pressures might be elevated to levels, and for durations, such that an intrinsic compartment syndrome might develop. Two groups were identified: in group 1 (23 feet) pressures were never elevated to > 20 mm Hg; in group 2 (16 feet) pressures > 30 mm Hg for a duration of at least 12 h were found. In a subgroup of group 2 (4 of 16 feet), pressures were > 50 mm Hg for at least 12 h. There was no statistical correlation between pressure recordings and surgeon, tourniquet time, severity of deformity, extent of release, and type of cast used. Thus 40% of feet are at risk of developing pressures that could cause an intrinsic compartment syndrome.

Clubfoot↗
PubMedDate not supplied

Regional fasciocutaneous flap closure for clubfoot surgery.

Skin closure after a comprehensive posteromediallateral release of clubfeet through a Cincinnati incision may be difficult. This is especially true for cases of severe deformity either primary or recurrent. To deal with this, certain techniques have been developed. These consist of casting the foot in an undercorrected position with subsequent serial cast changes, leaving the incision completely or partially open for closure by secondary intention, using tissue expanders, and using different flap techniques. Five patients with nine clubfoot deformities who were treated with a comprehensive posteromedial-lateral release through a Cincinnati incision and underwent fasciocutaneous flap closure since June 1998 were included in this study. These flaps allowed correction and complete wound closure at the end of surgery without any skin tension. These flaps were constructed either in a rotational or V-Y advancement manner. None of the patients had any major complications. In summary, this new fasciocutaneous flap is a simple and reliable method in cases with primary skin-closure difficulties. It does not require special equipment or a plastic surgeon.

Casts, Surgical↗
PubMedDate not supplied

Nonoperative clubfoot treatment using the French physical therapy method.

Ninety-eight patients (142 clubfeet) treated nonoperatively by the French physical therapy method were reviewed to determine the effectiveness of this technique. All were 3 months old or less when treatment began and were rated for initial clubfoot severity using the Dimeglio scale (moderate, severe, very severe). Follow-up averaged 35 months (range 20-62 months). Forty-two percent of the feet needed no surgery to achieve a plantigrade position, 9% needed heelcord tenotomies, 29% needed posterior releases, and 20% needed comprehensive posteromedial releases. The Dimeglio scale was prognostic for outcomes, with moderate feet having the best results and very severe feet having the worst results. The French physical therapy method significantly reduced the need for operative intervention at the authors' institution.

Clubfoot↗
PubMedDate not supplied

Congenital idiopathic clubfoot.

Clubfoot or talipes equinovarus is a complex deformity characterized by three distinct manifestations. The foot is in an equinus position; the forefoot and heel are in varus; and the entire foot is supinated. While the exact etiology of this problem remains unknown, many advancements have been made in the treatment of clubfeet. The surgical procedure is progressive and tailored according the severity of the deformity. Pain management, thorough neurovascular assessments, and education of the family are essential to caring for these patients.

Clubfoot↗
PubMed1976

A perspective focus on the indicated surgical treatment of resistant clubfoot in the infant.

Ligamentous contracture is the chief factor in maintaining clubfoot deformity. Precise plans of segmental ligamentous release are called "selective segmental syndesmotomies." Critical segmental assessment by roentgenograms is required to choose the proper syndesmotomy. Proper early correction of resistant subtalar and midtarsal deformity by selective segmental syndesmotomy can solve much of the persistent trouble confronting the surgeon.

Achilles Tendon↗
PubMed1976

Avascular necrosis of the body of the talus after combined medial and lateral release of congenital clubfoot.

A retrospective study was made of 203 patients with 321 congenital clubfoot deformities who had at least one operative procedure at the Shriner's Hospital in Greenville, South Carolina, in a period from 1944 to 1973. The five cases of avascular necrosis of the talus occurred among the 35 patients having combined medial and lateral releases. These five clubfeet were recurrent and recalcitrant and required extensive soft tissue release to achieve sustained correction. It is recommended that dissection of the subtalar joint, except at the talonavicular joint, be avoided and that extensive lateral ankle dissection, especially when the sinus tarsi is included, should not be performed simultaneously with the medial release unless absolutely necessary to achieve the desired anatomic relationship.

Arteries↗
PubMed2004

Evaluation of calcaneal malposition by magnetic resonance imaging in the infantile clubfoot.

Magnetic resonance imaging (MRI) can clearly visualize both the ossification centers and surrounding cartilage of growing bones and enable a three-dimensional analysis of their positional relationships by using overlapping images. The calcaneal position was evaluated based on five newly proposed parameters of magnetic resonance images in 30 clubfeet of 18 infants with the bimalleolar and lower leg axes as reference lines. Sixteen unaffected feet in the unilateral cases were analyzed as normal feet. MRI showed that the calcaneus in clubfoot rotated internally, medially and posteriorly with reference to the bimallelar axis and that it took an equinus and a varus position with reference to the lower leg axis as compared with the normal foot. These five parameters and their normal values on the calcaneal position should be useful for the evaluation of infantile clubfeet.

Calcaneus↗
PubMed2004

Functional treatment of clubfoot: a new series of 350 idiopathic clubfeet with long-term follow-up.

A new series of 350 previously unreported cases of clubfoot treated by the functional method are reported. One hundred and eighteen clubfeet were unilateral and 116 were bilateral. The follow-up ranged from 11 to 18 years, with an average of 14 years. The improvements in the technique of physical therapy increased the rate of good results up to 77% compared with our previously published series. In an effort to objectively compare these results with other series, the authors assessed all clubfeet using the "at birth classification" published in 1995. Outcome evaluation was performed when the patients were 6 years old, and final evaluation at the end of growth of the foot. This is the first major series to be assessed according to such objective criteria, as much before the inception of treatment as at the end of growth. The results of this new series have been compared with those obtained in our former series.

Adolescent↗
PubMed2005

Modified Turco procedure for treatment of idiopathic clubfoot.

UNLABELLED: Since 1980 we have used a modified Turco procedure for treating congenital clubfoot. The modifications include: (1) lateral position with the unaffected side on top; (2) Cincinnati-type transverse heel crease incision from the base of the first metatarsal around the ankle up to the lateral border of the tendoachilles; (3) complete excision of the abductor hallucis muscle; (4) complete tibialis posterior tendon tenotomy in the sheath; (5) no lengthening of long toe flexors; (6) no K wires for maintaining the correction; and (7) special splints instead of Denis Browne splints. Thirty-three feet in 18 patients were followed up prospectively at a mean of 13.8 years (range, 10-16 years). There were no wound complications. The mean Laaveg and Ponseti score was 87.2 (range, 49-98). Twenty-seven (82%) of 33 feet had good to excellent results. There were seven feet (21%) with recurrent deformities, which included two feet (6%) with recurrence of all deformities, two feet (6%) with forefoot adduction, one foot each (3%) with equinus and heel varus, and one (3%) with cavus. Ninety-four percent of patients were very satisfied or satisfied with the results. We think this modified approach has helped us to reduce the recurrence of forefoot adduction deformity and wound complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group). See Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMedDate not supplied

Anterior tibial tendon transfer in relapsing congenital clubfoot: long-term follow-up study of two series treated with a different protocol.

Two series of patients with relapsing congenital clubfoot were treated by transfer of the anterior tibial tendon to the third cuneiform under the extensor retinaculum. The two series were reviewed at the end of skeletal growth to evaluate the effectiveness of the surgical procedure. The first series included 19 clubfeet and the second 16. The two series of clubfeet were initially treated by two different manipulative techniques and two different complementary soft tissue release operations. In relapsing clubfeet, the foot dorsiflexion/eversion activity of the tibialis anterior was suppressed and the muscle functioned as an invertor. At follow-up the functional results of the second series of patients, in whom the relapsing deformity was passively correctable at the time of surgery, were better than those of the first series of patients, in whom the relapsing deformity was sometimes less passively correctable. None of the operated patients had a further relapse. In both series, the angles formed by the longitudinal axis of the navicular and the first cuneiform, the calcaneus and the fifth metatarsal, and the calcaneus and the cuboid, evaluated both by plain radiographs and by CT scan, were smaller than in normal feet and in the clubfeet that did not relapse. Transfer of the anterior tibial tendon to the third cuneiform underneath the extensor retinaculum corrects and stabilizes relapsing clubfeet by restoring their normal function of foot dorsiflexion/eversion. As a consequence, the cuneiforms and the cuboid were shifted more laterally than normal, as shown by both x-rays and CT scan.

Adolescent↗
PubMedDate not supplied

Evaluation of outcome of treatment of congenital clubfoot.

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible. Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems. The feet were also evaluated using a new scoring system that has 3 domains of evaluation, viz, morphological, functional, and radiological. Comparison of the scores in each of these domains showed that there was a correlation between morphology, function, and radiological measurements of tarsal alignment. Several of the criteria used in this new scoring system were reproducible.

Ankle Joint↗
PubMed1996

Critical aspects of neonatal surgery in clubfoot.

Good results after early operative treatment of clubfoot has been reported by some investigators. Most have recommended early conservative treatment and later surgical procedures in resistant cases. Operation immediately after birth is demanding, and the operative team must master all problems of neonatal surgery, anesthesiology, and postoperative care. Conservative treatment in experienced hands may lead to a satisfactory result in one third of cases. We recommend primarily conservative treatment, but patients with resistant cases must undergo operation at age 2-5 months. We need more prospective studies and generally accepted grading systems of results.

Clubfoot↗
PubMed1996

Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot.

The efficacy of orthopaedic treatment and its influence on clubfoot surgery has never been truly demonstrated. In the unsorted mass of clubfeet treated, it is difficult to determine exactly how effective orthopaedic treatment is for severely affected feet. If properly performed, perfectly synchronized, and supported by a Kinetec machine, such treatment can noticeably reduce the rate of operation and, when operation is still required, reduce its extent. In grade II soft > stiff feet with scores of 5-10, Kinetec-supported orthopaedic treatment is extremely effective. Operation is required in 32% of cases only, and posterior surgery is often sufficient. Lateral release, in this category, is never required. In grade III stiff > soft feet, with scores of 10-15, the efficacy of orthopaedic treatment associated with the Kinetec machine is far from negligible and operation most often includes posterior and medial release (PMR), variably associated with plantar release. Lateral release is exceptional (15%), and operation is necessary in 75% of cases. In grade IV stiff = stiff feet, with scores of 15-20, orthopaedic treatment with the Kinetec machine has a true, though limited, effect. In this category, operation is necessary in 90% of cases. Lateral release is performed in 50%. In the postoperative period, orthopaedic treatment combined with use of the Kinetic machine must be continued. Orthopaedic treatment coordinated with use of the machine has considerably shortened the duration of plaster cast immobilization; 2 months when operation included posterolateral-medial (PLMR) release or PMR, and only 1 month when operation was posterior release (PR). The machine has noticeably changed the results and has indisputably influenced operation on the whole.

Clubfoot↗
PubMed1996

Sonographic assessment of clubfoot deformity in young children.

We report a new diagnostic imaging technique for talipes equinovarus. Sonographic assessment of the medial border of the foot offers insight into the center of tarsal malalignment at the talonavicular joint. Technique, observations, and interpretation of the findings are delineated and compared with current radiologic evaluation of talonavicular alignment according to the method of Simons in 38 cases. The TnCE-angle is introduced as a sonographic measure to quantify talonavicular malalignment in clubfeet. Sonographic results of clubfeet are compared with those of a group of 98 normal feet. The practical implications of the method as a means for planning and control of treatment in clubfoot deformity are discussed.

Casts, Surgical↗