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At least 271 records · Page 15Linked to original sources
PubMed2002

[The effect of deep deltoid ligament release on dorsiflexion in congenital clubfoot treated with complete subtalar release].

OBJECTIVES: We evaluated the effect of releasing the posterior half of the deep branches of the deltoid ligament on dorsiflexion capacity of the ankle in congenital clubfoot treated with complete subtalar release (CSTR). METHODS: Fifty-two feet of 35 patients with clubfeet were treated with CSTR. The patients were divided into two groups depending on the absence (group I) or presence (group II) of posterior deltoid ligament release. The groups consisted of 13 patients (21 feet) and 22 patients (31 feet), respectively. The original Cincinnati incision was used in all cases. In addition to the classical CSTR, posterior half of the deep branches of the deltoid ligament was released in group II. Both groups received the same postoperative care. The mean postoperative follow-up period was 55.5 months (range 36-77 months) in group I, and 24.7 months (range 10-37 months) in group II. The results were evaluated radiographically by measuring the talo-tibial and calcaneal inclination angles. RESULTS: It was observed that the calcaneus remained in equinus in both groups. Although posterior deltoid ligament release appreciably increased the dorsiflexion perioperatively, this did not represent a statistically significant functional improvement in group II. CONCLUSION: Although the foot could be dorsiflexed and the talar dome observed posteriorly upon the release of the posterior half of the deep branches of the deltoid ligament, no beneficial clinical effect was observed because the tendo calcaneus could not be lengthened sufficiently.

Child, Preschool↗
PubMedDate not supplied

Anthropometric study of patients treated for clubfoot.

The anthropometric characteristics of patients treated for clubfoot were used to investigate whether the dimensions of the foot were affected by the method of treatment. A total of 68 patients followed up for an average of 9 years were divided into three groups: group 1, conservatively treated; group 2, surgically treated; group 3, conservatively treated on one side and surgically treated on the other. The following average discrepancies in foot length were obtained: group 1, 0.91 cm; group 2, 1.5 cm; group 3, 1.09 cm. Toe lengths were shorter to the same extent as the other dimensions of the foot. These discrepancies were statistically significant. The following average discrepancies in foot width were obtained: group 1, 0.05 cm; group 2, 0.37 cm; group 3, 0.054 cm; these were insignificant. The authors believe that the degree of discrepancy may depend not solely on the method, but on the severity of the deformity as well.

Adolescent↗
PubMed2003

Fixed forefoot adduction after clubfoot surgery.

OBJECTIVE: Studying the causes of residual forefoot adduction deformity after surgical treatment of congenital clubfoot and their management. METHODS: Revision surgery was carried out by the author for 12 patients (13 feet) in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, during the period between January 1997 to December 1998. RESULTS: In 12 out of 13 feet, K-wire was not used to fix the navicular bone in its reduced position during primary surgery. In all cases, the navicular was found displaced during revision surgery. CONCLUSION: Revision of soft tissue surgery with relocation of the navicular bone improves the outcome of patients with residual fixed forefoot adduction after congenital talipes equinovarus surgery.

Clubfoot↗
PubMed1992

Calcaneocuboid joint deformity in clubfoot.

In the management of congenital clubfoot, recent attention has been given to the deformity of the calcaneocuboid joint in addition to the changes in the talonavicular, talocalcaneal and ankle joints. Fifty-five patients with 86 clubfeet operated on in the past six years were retrospectively studied. Radiographically, the calcaneocuboid subluxations were graded from I to IV by the Thoemtz classification. The grading has some correlation with the gross deformity, although there is no statistical data to confirm it. Postoperatively, those with grade I feet seemed to have satisfactory results with a posterior release only or with a posteromedial release. Grade II-III feet generally required extensive posteromedial and lateral release. Those who had a calcaneocuboid release and reduction obtained better correction than those who did not. We conclude that calcaneocuboid subluxation should be appraised preoperatively and reduced during surgery in order to achieve good results.

Calcaneus↗
PubMed1991

[Technique of surgical treatment for congenital clubfoot using complete subtalar release by the Cincinnati approach].

The technique of congenital clubfoot surgical treatment based on independently described method by Mc Kay and Simons is delineated. We have modified skin incision making it ca 2 cm above the calcanean tuber in order to facilitate an access for elongation of the calcaneal tendon. In some cases the procedure was supplemented with cuneonavicular and first tarsal-metatarsal capsulotomy and tibialis anterior muscle tendon transfer to the dorsum of the first metatarsal bone.

Calcaneus↗
PubMedDate not supplied

[Radiologic evaluation of idiopathic congenital clubfoot and its clinical correlation in Codivilla's surgical technique].

Thirty-seven patients (52 idiopathic clubfeet) were treated with Codivilla's technique between 1971 and 1985. Radiological measurements and clinical evaluation before and after surgery were performed; a correlation was carried out between these evaluations and personal satisfaction. The results were rated as follows: poor in 4 feet (7.7%), fair in 18 feet (34.6%), good in 24 feet (46.2%) and excellent in 6 feet (11.5%) with a total percentage of satisfactory results amounting to 57.7%. Our conclusion is that when the indications are properly established, Codivilla's technique is a good procedure to correct clubfoot.

Child↗
PubMed2003

[Congenital clubfoot].

Owing to the relatively high incidence of this condition (2 in 1,000 neonates) and the poor functional outcome of inadequate treatment, clubfoot represents a major clinical problem. Although its etiology is not fully known, modern three-dimensional analyses have led to a better understanding of the pathomorphology and provide a new basis for a differentiated therapeutic strategy. Of central importance is early diagnosis and immediate postpartum initiation of primarily conservative treatment taking the form of intensive redressment measures. Depending on the residual deformity, an appropriate surgical procedure aimed at achieving complete correction should be done between the age of 4 to 6 months. To ensure a lasting positive outcome, rigorous follow-up physiotherapeutic treatment and close surveillance are essential.

Age Factors↗
PubMedDate not supplied

Part 1. Congenital idiopathic clubfoot.

Although not life-threatening, clubfoot, a non-traumatic deviation of the foot, makes a strong impact on the infant, parents, and family. Serial casting with or without surgical intervention make up the medical plan. Nursing care needs to focus on emotional support of the family and education regarding the diagnosis, treatment plan, and daily care of an infant in a cast.

Casts, Surgical↗
PubMed1991

Fractional lengthening of the flexor tendons in clubfoot surgery.

Massive scarring of the Z-lengthened flexor digitorum and flexor hallucis longus is a constant finding in clubfoot surgery. A method of fractional lengthening of the tendons is described. This method has been proven effective in preventing this complication.

Child, Preschool↗
PubMed1991

Complications in clubfoot surgery.

Thirty percent to 50% of clubfeet will not respond to conservative treatment and will require surgery. The average failure rate in clubfoot surgery is 25% (range, 13% to 50%). Many complications can occur during surgery and postoperatively. Preoperative planning of the appropriate skin incision and special attention to wound closure may prevent some of these complications. Awareness of the multiple complications that can occur such as cavus, persistent adductus, overcorrection of the hindfoot, and recurrent deformity allows the surgeon to prepare and plan for these often unavoidable problems.

Blood Vessels↗
PubMedDate not supplied

Treatment of residual clubfoot deformity--the "bean-shaped" foot--by opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy. Clinical review and cadaver correlations.

Six patients (seven feet) previously treated surgically for clubfoot had a "bean-shaped" foot. Opening wedge medial cuneiform and closing wedge cuboid osteotomies were done, resulting in good resolution of the prominent midfoot supination and forefoot adductus without significant soft tissue dissection and invasion of growing areas in the foot. Cadaver reproductions show that the cuboid closing wedge is responsible for the change in the midfoot, whereas the cuboid and cuneiform osteotomies both contribute to the change in the forefoot.

Cadaver↗
PubMedDate not supplied

Deformity and disability from treated clubfoot.

To identify disability associated with treated unilateral, idiopathic clubfoot deformity, 29 patients and 23 controls were compared by morphometry, radiography, and performance testing. The average period following definitive treatment was greater than 10 years. Treatment regimens varied from prolonged casting to early posteromedial release. The most significant limitations in these treated clubfeet averaged (a) a 42% decrease in normal ankle motion, specifically lacking 65% of normal dorsiflexion, a consistent finding independent of treatment; (b) a 24% decrease in normal plantarflexor muscle strength, correlating directly to the number of heelcord lengthenings per foot; and (c) a noticeable 10% decrease in calf girth, unrelated to total time spent in cast.

Activities of Daily Living↗
PubMedDate not supplied

Results of physical therapy for idiopathic clubfoot: a long-term follow-up study.

Physical therapy without anesthesia or plaster casts was used to treat 338 cases of clubfoot (CF). Our technique is based on progressive sequential manipulations at birth. We first reduce the varus and later the equinus component of the CF. The gentle stretches used in this technique are complemented by active physiotherapy stimulating the muscles, and then a simple splint is suited to the foot to fix its degree of realignment. When used alone, this technique achieves 77% good and fair results. In resistant cases, complementary surgery was used. We obtained 96% good and fair results.

Adolescent↗
PubMedDate not supplied

Clubfoot release without wide subtalar release.

Fifty-two feet treated by clubfoot release without wide subtalar release were evaluated 4.2-10.8 years after surgery. Eleven feet (21%) had undergone additional operative procedures at the time of review, and 82% of feet had good or excellent functional ratings at that time. The mean talocalcaneal index was 49 degrees (range 12-76 degrees), indicating that correction of the subtalar joint occurred in some patients. This procedure satisfactorily corrects many feet but undercorrects some. Overcorrection was rare. Foot progression angles were also determined and are reported in an accompanying article.

Anthropometry↗
PubMedDate not supplied

Histochemistry of abductor hallucis muscle in children with idiopathic clubfoot and in controls.

The histochemical composition of the abductor hallucis (AH) muscle was investigated in 39 children with idiopathic clubfoot (CF), aged 0-11 years, and in 42 controls. In the youngest group of patients (0-2 years) the percentage of type 1 (slow twitch, tonic) fibers was significantly higher than in controls. In older groups, there was no difference between patients and controls. The relative predominance of type 1 fibers could be due to immobilization, passive shortening or stretching, or primary overactivity of this muscle in CF promoted by an unknown neural factor. None of these interpretations could be proven.

Biopsy↗
PubMed1989

[Congenital idiopathic clubfoot. Etiology, pathomorphology, therapy and results].

The congenital clubfoot is still a challenge for any orthopaedic surgeon and a subject of controversial and unresolved aspects. In this study the technique and results of 312 clubfeet which were treated at the pediatric orthopaedics department of the Speising Hospital between 1979-1987 are reported. Conservative treatment was successful in only 15% of our patients. 85% had to be corrected by a surgical intervention, mostly by an extensive posterior release. New aspects of pathomorphology and of surgical management of the deformity are mentioned. The benefit of the Cincinnati-incision is stressed and has been proved by this study.

Casts, Surgical↗