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PubMed1995

[Distal intra-articular resection of the calcaneus in the treatment of severe or recurrent congenital clubfoot].

INTRODUCTION: Secondary adaptive bone changes and joint distorsions in clubfoot may present a barrier to adequate correction of the deformity. The purpose of our study is to show how the lateral excision of the calcaneus distal part as described by Lichtblau, in combination with an appropriate medial release allows better correction of forefoot deformity, with less recurrence rate. MATERIAL AND METHODS: Between 1974 and 1982, 43 feet in 38 patients underwent this type of surgery. Lateral excision o the calcaneus was decided preoperatively in 34 feet, for recurrence of the forefoot deformity following previous surgery. In the remaining 9 feet, this lateral excision was decided intraoperatively, because of an uncomplete correction of the fore part of the foot, despite an adequate posteromedial release. The resected angle from the distal intra-articular part of the calcaneus varied from 10 to 30 degrees with an average of 15 degrees. RESULTS: All our results were evaluated at end of growth. Mean age at follow-up was 15 years and 4 months, with an average period of 10 years and 7 months following surgery. The average forefoot adduction moved from 21 degrees preoperatively to 1 degree at last follow-up. The clinical calcaneocuboid mobility was preserved in 37 cases. Four types of complications were encountered in 7 patients: pain in 5 cases, calcaneocuboid fusion in 6 cases, recurrence of deformity in 2 cases, and overcorrection in 5 cases; this last complication was related to intraoperative overcorrection rather than a progressive deterioration of the result, and had no clinical significance. No overcorrection was seen after calcaneocuboid fusion. We have found no relation between age at surgery, and the incidence of calcaneocuboid fusion, but the two cases operated on children under one year old, ended up with a bad result. DISCUSSION: The resection of a single side of a joint may permit normal joint function to be retained. The resected cartilage is replaced by a fibrocartilage that resembles the original articular cartilage, provided the resected defect is deep enough to allow vascularization from the underlying bone. CONCLUSION: The success of this method depends on an accurate surgical technique, as described by its promoter. It can be of great help in severe and complicated clubfeet. It achieves the goal with a calcaneocuboid function often preserved.

Calcaneus↗

PubMed1997

Congenital idiopathic talipes equinovarus (clubfoot). Current concepts.

Congenital idiopathic talipes equinovarus (clubfoot) is a complex and challenging entity. This article reviews its history, incidence, and classification as well as the current controversies regarding its causes, pathologic anatomy, evaluation and diagnostic techniques, surgical intervention, and treatment assessment methods.

Casts, Surgical↗

PubMedDate not supplied

An independent assessment of two clubfoot-classification systems.

We conducted an independent assessment of two clubfoot-classification systems. In a blinded trial, two orthopaedists scored 55 feet by using the classification systems developed by Pirani et al. and by Dimeglio et al. Thirty-seven of the feet were also scored by a physical therapist. By using the 10-point classification described by Pirani, the two physician examiners tallied total scores that were within one point of one another 89% of the time. The mean difference between the scores assigned by the two examiners was 0.6 points. For the 20-point classification described by Dimeglio et al., total scores tallied by the two physician examiners were within two points of one another 91% of the time. The mean difference between the scores assigned by the two physician examiners was 1.4 points. Correlation coefficients were 0.90 (p = 0.0001) for the Pirani classification, and 0.83 (p = 0.0001) for the Dimeglio classification. Correlation coefficients were much lower for the first 15 feet scored and were also lower when the therapist's scores were included. Overall, both classification systems had very good interobserver reliability after the initial learning phase.

Clubfoot↗

PubMedDate not supplied

Nonsurgical treatment of congenital clubfoot with manipulation, cast, and modified Denis Browne splint.

Between 1974 and 1988, 113 congenital clubfeet in 76 children were consecutively treated by using a modified Denis Browne splint with an aluminum crossbar between a pair of plastic shoe inserts after a few manipulations and a corrective cast. Splintage was followed by surgery in 41 (36%) feet. Sixty-nine feet that did not undergo surgery were evaluated after an average follow-up period of 12 years. Sixty-six (95%) feet were excellent or good, according to the McKay rating system. The success rate of this treatment was 60% when the 41 feet receiving surgery and the three feet with fair or poor outcome were evaluated as failures. The success rate was 42% in severely deformed feet, 70% in moderately deformed feet, and 100% in mildly deformed feet. This treatment was effective for congenital clubfoot with mild or moderate deformity and was sometimes effective for severe deformity.

Casts, Surgical↗

PubMedDate not supplied

Clinical implications of clubfoot histopathology.

Ipsilateral peroneus brevis muscle histopathology was studied in 64 children with idiopathic rigid equinovarus at the setting of initial posteromedial-lateral release. Fifty percent of biopsies demonstrated abnormal muscle fiber morphology, classified as congenital fiber-type disproportion or fiber-size variation. Forty-one infants (59 feet) underwent initial surgical intervention within the first year of life with a minimum 2-year follow-up. Feet with abnormal muscle histology had a significantly greater incidence of recurrent equinovarus deformity requiring reoperation; the relative risk of clubfoot recurrence in children with fiber abnormalities was 5.6. Male patients with bilateral deformity and abnormal peroneus brevis histology had a particularly high incidence of recurrent equinovarus. Developmental internal tibial torsion requiring surgical intervention was also greater in the abnormal-fiber histology group. The incidence of postoperative metatarsus adductus/varus necessitating surgery was comparable despite histologic findings. Thus muscle-fiber abnormalities are prevalent in idiopathic equinovarus. Such fiber-type anomalies may predict recurrent limb deformities.

Clubfoot↗

PubMed1964