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At least 289 records · Page 16Linked to original sources
PubMed1989

Congenital clubfoot. Etiology, pathoanatomy, pathogenesis, and the changing spectrum of early management.

Congenital clubfoot is a common problem of uncertain etiology with a broad spectrum of clinical severity. Much remains controversial and unsolved about this disorder. It is agreed, however, that early management should be conservative and that operative management should comprehensively address the deformities, to avoid if possible, subsequent operations. No single monograph can comprehensively review all aspects of this complex disorder. Our intent has been to touch upon the basic concepts and philosophies, to give perspective to the overall picture, for some, and to provide a stimulus and basis for further investigation and review for others.

Clubfoot↗
PubMedDate not supplied

Clubfoot: a cord retainer.

Using a cord to retain the surgically corrected clubfoot replaces the need for repeated plaster casts and prolonged orthotics. Cords of braided polyester or nylon suture material 0.5 mm in diameter (a pair or more) were stretched between the fifth metatarsal and the lower metaphysis of the fibula. The required strength of the cord was judged from the initial range of motion (ROM) of the ankle and subtalar joints, and a factor derived from the body weight. The mean follow-up in five patients was 26.8 months (range 18-33 months). The peroneal muscles recovered an average of 9 months (range 7-11 months). Our one failure was caused by inaccurate estimation of cord strength.

Bone Wires↗
PubMed1989

[Tibial corrective osteotomy in the treatment of congenital clubfoot].

A wrong torsion of the tibia in case of clubfoot has a restrictive influence on gait. The treatment is only possible with an osteotomy of the lower leg. 13 patients were treated with 17 osteotomies and the results were analysed. Derived from the results, the indication of osteotomy, the surgical technique and the treatment postoperative are discussed.

Achilles Tendon↗
PubMed1987

The anatomical basis for incisions around the foot and ankle in clubfoot surgery.

Skin problems are the cause of a high incidence of recurrent clubfoot problems. With respect to the demonstrated vascular territories (angiosomes) of the ankle and foot, the incisions which seem to be safest are vertical as opposed to transverse, and between angiosomes. The safest of all are the posteromedial incision with an additional vertical lateral incision if necessary, and the posterolateral with an additional medial incision.

Ankle↗
PubMedDate not supplied

Comparative radiographic analysis of congenital idiopathic talipes equinovarus (clubfoot) in infancy: a retrospective study.

Controversy exists regarding the quantitative use and predictive value of standard radiographs in the evaluation of talipes equinovarus in infancy. To address this issue, a comparative study of the three most commonly utilized quantitative radiographic assessment methods has been conducted. This study is retrospective in nature and consists of 56 congenital idiopathic clubfeet resistant to conservative treatment that required surgical correction. The results of this study indicate that the "Simons' standardized method of analytical radiography" of the infant clubfoot is the most clinically accurate in evaluating the type and degree of articular malalignments present, as well as predicting the status of the talonavicular joint prior to the ossification of the navicular. With this knowledge, it is then possible to institute the appropriate treatment regimen at an earlier age.

Casts, Surgical↗
PubMed1987

Congenital clubfoot: pathoanatomy and treatment.

A better understanding of the pathoanatomy of clubfoot, meticulous attention to detail during surgery, and orthotic maintenance of correction to facilitate remodeling should make it possible to improve the results of treatment.

Casts, Surgical↗
PubMed1986

[Long-term results in the treatment of clubfoot].

Long-term results in the treatment of congenital clubfoot are reported. The average follow-up time was 17.7 years (10-29.4 years). All 104 patients (148 clubfeet) were followed up personally. In addition to the clinical examination, a podogram was made and evaluated. Results were good to very good in 97% of patients with regard to complaints, in 83% concerning the level of functional ability, in 69% regarding clinical aspects of the foot, in 58% with regard to measurements of the podogram, and in 27% regarding movement. In clinical aspects and measurement of the podogram, significantly better results were obtained if the first operative correction took place within the first year of life. In patients in whom the anterior tibial tendon had been transferred, there was a higher percentage of falling medial arches. Patients in whom rotational osteotomy of the tibia had been carried out showed better foot position in relation to the femoral axis and worse foot position in relation to the malleolar axis than those in whom this operation had not been performed.

Achilles Tendon↗
PubMed1985

The treatment of relapsing clubfoot by tibialis anterior transfer underneath the extensor retinaculum.

Nineteen patients with 22 relapsing clubfeet were treated by tibialis anterior transfer underneath the extensor retinaculum. This operation is indicated in cases of relapse in which the clubfoot is still supple. It is not indicated in cases with subtalar rigidity. The results were excellent in 19 cases, fair in 2 and poor in one. The fair and poor results were attributable to faulty technique or errors of indication.

Child↗
PubMedDate not supplied

Diastasis of the tibiofibular mortise, hypoplasia of the tibia, and clubfoot, in a neonate with cleft hand and cardiac anomalies. A case report.

In a newborn girl diastasis of the distal tibiofibula joint was associated with cleft hand deformity, and cardiac anomalies. While at least 3 cases of congenital distal tibiofibular diastasis have been reported previously, this patient seems to be the first to have had hand and cardiac defects. The diastasis is believed to be secondary to tibial hypoplasia. The initial presentation was that of an apparent clubfoot deformity and emphasizes the point that roentgenograms of all equinovarus deformities in the newborn should be mandatory.

Abnormalities, Multiple↗
PubMed1978

Neonatal surgery in clubfoot.

Neonatal surgery for clubfoot is conducted according to the following rules: One must work as close to the lesions as possible. It is important to avoid going beyond abnormal tissues. Dissection should be precise and economical. Opening of Lisfranc's joint or sectioning of the medial ligament must be avoided. One must operate with maximal accuracy. All areas of fibrosis must be excised, but care must be taken not to enter the interarticular space. If a bone deformity is present, one must accept an incomplete correction. One must act as soon as possible. This is the inverse of classic management in which orthopedic surgery was postponed. We prefer early surgery followed by intensive postoperative rehabilitation.

Cicatrix↗
PubMed1983

The microsurgical dissection of a stillborn fetal clubfoot.

A microsurgical dissection was performed on a clubfoot of a seven-month-old stillborn fetus with camptomelic dysplasia. The most important anatomic alteration was marked rotation of the calcaneus beneath the talus. The calcaneus was rotated around a vertical axis. Its anterior aspect was rotated medially, while its posterior aspect was rotated laterally. A series of photographs obtained during the dissection shows the degree of realignment achieved by each stage of the progressive or stepwise surgical dissection. Dissection simulating a posteromedial release and plantar release failed to realign the hindfoot. A complete subtalar release was necessary to reposition the bones of the hindfoot completely. In this specimen, metatarsal capsulotomies were required to realign the forefoot, and the osteotomies of the tibia and tibula were required to straighten the angular deformities characteristic of camptomelic dysplasia, as well as the significant external torsion of these bones.

Clubfoot↗
PubMed1978

[On translocation surgery of the tendon of the musculus peroneus brevis (M. fibularis brevis) in clubfoot (author's transl)].

The paper reports on the basis of long-term observations on an old surgical method which used to be practised in infants before arthrolysis around the anklebone (pantalar arthrolysis) was employed in the treatment of insufficient lifting of the outer edge of the foot in clubfoot recidivation. This old surgical method consisted of translocating the tendon of the m. peroneus brevis (m. fibularis brevis) before the outer ankle bone. The method is described, and its mode of action is discussed. Results obtained with 14 operations of this kind, are presented.

Adolescent↗
PubMed1992

[Clinical evaluation of surgical treatment of congenital clubfoot by peri-talar release].

Clinical assessment of the results of surgical treatment of 105 congenital clubfeet by peri-talar release has been carried out. There were 58% of soft and 42% of stiff clubfeet in this group. The average patient age at the operation was 17.8 months. The Wynne-Davies point scale modified by Marciniak was used to assess the results. Forty nine feet (46.4%) were rated good, 28 (26.7%) satisfactory and 28 (26.7%) poor. Fifty percent of stiff feet were rated poor and 68.9% of soft ones were rated good. Plantocontourography revealed marked decrease of internal rotation in the operated feet. The authors conclude peri-talar release is an effective method of treatment of soft congenital clubfoot.

Ankle Joint↗
PubMed1994

[Congenital clubfoot. Analysis of 260 cases followed from birth].

INTRODUCTION: This study is a critical analysis of the results in a homogeneous series of 260 cases of congenital clubfoot followed from birth. MATERIAL AND METHODS: This series of congenital club feet was divided in 2 groups: the stiff forms (144 cases) and the supple forms (116 cases). Daily physical therapy and Denis Brown's splints were begun from the first examination. This method did not allow full correction of deformations in 213 cases. A posterior medial surgical release was performed. Its importance depended on the criteria of radio-clinical analysis before surgery. 46 feet were operated twice. RESULTS: Follow up averaged 7 years. 39 per cent of patients had completed growth, only 18 per cent of feet were not operated. With the surgical treatment, the results were ""very good'' and ""good'' in 75.1 per cent of cases, according to an analysis using Seringe's criteria. 21 per cent were operated again, on an average between 3 and 8 years, with poorer results than at first surgery. DISCUSSION: The quality of the results depends on the quality of the functional treatment. Poor control of equinism with Denis-Brown splints can be corrected by using Seringe's articulated splints or by a series of plaster casts. CONCLUSION: Many technical factors influence the results. The quality of post-operative contention is stressed.

Child, Preschool↗
PubMed1993

[The radiographical changes with age of the treated clubfoot].

One hundred and eighteen feet out of 83 cases of congenital clubfoot treated mainly by early posterior release were examined for changes with age in radiographical measurements. They were classified into three groups according to treatment courses. Group I is the cases treated conservatively, group II is the cases which received early posterior release and group III is the cases that needed other operations or treatment courses. In all groups, talo-calcaneal index (TC index) decreased and calcaneal pitch (CP) increased with age but no remarkable change occurred in talo-1st-metatarsal angle (TMA). Though the patterns of changes of all measurements in each group were similar to those of controls, the values were lower than controls' except CP. In TC index, the difference between controls and group II was about 20 degrees at each age. The mean TC index of group III was always the lowest in all groups. The mean TMA value differed about 10 to 15 degrees from those of controls in group I and II, and about 20 degrees in group III constantly till twelve years of age. The values of CP approached the controls' values gradually with age in all treatment groups. In order to maintain good radiographical findings, the values of TC index and TMA should be approached to those of control group after serial casts of initial treatment.

Adolescent↗
PubMedDate not supplied

Clubfoot: its pathological anatomy.

The pathologic anatomy of clubfoot is complex, and the opportunities to examine neonatal specimens are inevitably rare. Three clubfeet were dissected and compared with a normal foot. The shape, orientation, and alignment of the bones were gauged, and tibial torsion was measured. Particular attention was paid to the "medial tie," and its etiologic role was considered.

Calcaneus↗
PubMed1993

Tarsal navicular position after complete soft-tissue clubfoot release.

The navicular position was evaluated (according to Simons' criteria) on anteroposterior and lateral roentgenograms of 45 clubfeet that were treated with complete soft-tissue release without internal fixation. The evaluation was performed an average of 28 months after surgery. Position of the navicular correlates well with the functional rating score system. Navicular position can be viewed as an indicator for clubfoot correction. Internal fixation of the talonavicular joint was correlated with favorable correction of deformity.

Child, Preschool↗