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At least 361 records · Page 20Linked to original sources
PubMed2003

The effect of inturning of the foot on knee kinematics and kinetics in children with treated idiopathic clubfoot.

OBJECTIVE: To assess the effect of internal foot progression angle (inturning) on knee dynamics in children with treated clubfeet. DESIGN: Prospective study dividing a population of clubfeet according to the factor inturning. BACKGROUND: Excessive internal or external foot progression angle increases knee flexion by a backward shift of the ground reaction force to the knee joint in children with cerebral palsy. Similarly, inturning in clubfeet was hypothesized to shift the ground reaction force backwards with reference to the knee joint, increasing the external knee flexion moment and the maximal knee flexion at stance. METHODS: Three-dimensional gait analysis was performed on 20 children with surgically treated clubfeet (n=28) to assess alterations of knee dynamics related to inturning (>7 degrees ) and on 13 normal children. RESULTS: Inturning occurred in 46% of the clubfeet and was associated during stance, at maximal knee flexion, to an increase in maximal knee flexion (+7 degrees ), external knee flexion moment (+60%) and related lever arm to the knee (+100%) and at minimal knee flexion, to a reduction in external knee extension moment (-62%) and related lever arm (-58%). Inturning was associated with a more frequent prolongation of internal knee extension moment and of rectus femoris activity exceeding 50% of stance. CONCLUSION: Inturning in clubfeet is associated with knee dynamics alteration, which might contribute to the long-term development of knee osteoarthritis. RELEVANCE: The therapeutic correction of inturning in clubfeet would be of importance if the consecutive knee dynamics alteration is shown by further studies to contribute to long-term degenerative knee pathology.

Adolescent↗
PubMed2000

Case report: human neonatus with spina bifida, clubfoot, situs inversus totalis and cerebral deformities: sequence or accident?

An unreported coincidence of malformations has been studied by anatomical dissection in a mature male fetus. Auxiliary, this fetus was examined by computed tomography and the skeletal malformations were three-dimensionally reconstructed. The organs of the thorax as well as of the abdomen showed a visceral inversion. In the lumbar region, a hyperkyphosis was detected in addition to a split-notochord. A hydrocephalus internus with enlarged lateral ventricles and an agenesis of the corpus callosum were apparent. The lower extremities were dystrophic with both showing a talipes equinovarus-deformation. Following the case report, we discuss if this is coincidental or manifestations in consequence of one defect.

Abnormalities, Multiple↗
PubMedDate not supplied

Management of the resistant idiopathic clubfoot: the Kaiser experience from 1980-1990.

Sixty-three congenital idiopathic clubfeet were clinically and radiographically evaluated following a single Turco-type complete posteromedial soft tissue release with internal fixation. Average age at the time of surgery: 12.4 months; average postoperative follow-up: 67.2 months. A new rating system that weighs dynamic functional results more heavily was used to compare our findings. The results were rated as excellent in 29 feet (46%), good in 15 feet (24%), fair in 8 feet (13%), and poor/failures in 11 feet (17%). Ninety-five percent of the parents were satisfied with the current results, although 59% felt that their child would have physical limitations in the future. Clinical complications included the following residual deformities: hindfoot varus (3.2% or two feet), equinus (3.2% or two feet), cavus (22.2% or 14 feet), and forefoot adductus (41.3% or 26 feet). The bimalleolar axis in the 63 clubfeet averaged 74.9 degrees. No calcaneus gaits were present. Radiographic complications included both over-correction (1.6% or one foot) and under-correction (4.8% or three feet) of the talonavicular joint articulation, avascular necrosis of the navicular, (14.3% or nine feet), talus (4.8% or three feet), and calcaneus (1.6% or one foot). Thirty-three feet (52.4%) revealed some degree of abnormal talar dome flattening, 22 feet (34.9%) revealed navicular dorsal subluxation or "wedging." Only 37 (58.7%) exhibited normal talonavicular joint congruity.

Achilles Tendon↗
PubMedDate not supplied

[Surgical correction of clubfoot in patients with myelomeningocele].

Between 1974 and 1991, 100 equinovarus deformities in 65 patients with myelomeningocele have been primary operated at the authors clinic. Aim of our treatment was a plantigrade position of the foot, to give the possibility of an orthetic supply. 75% of our patients reached this result after the first operation, 25% had to be operated once more. The incision was done in the way of Cincinnati. According to the level and type of paralysis the operative treatment had to be adapted. We could reach good results of treatment in group 1 (thoracal to L2) with 64% of plantigrade feed as well as in group 3 (L5 to sacral) with 61%. Group 2 (L4 to L5) was worse with 32%. Within all types of paralysis there was a better result while doing a tenotomy. Paralysed muscles should be cut, innervated muscles should be extended to keep the function. Important is the reconstruction of a balance of the muscles. While you have a forefoot varus, a plentiful medial release is necessary. After the operation a cast was given for 8 to 12 weeks, followed by special shoes and nightly storage in stales. Corresponding to the treatment of idiopathic equinovarus deformity the beginning of therapy should be started after birth and should be completed while the child begins to verticalize.

Adolescent↗
PubMedDate not supplied

[Correction of the pes equinus component in congenital clubfoot by freeing the triceps surae muscles and by tibiocalcaneal distraction].

20 children, average age 9 months, were treated of 27 inborn deformed feet by a new method. It consists in a wide release of m. triceps surae and its tendon, posterior lateral and posterior medial release and lengthening of the muscle with the help of a personal distraction apparatus, leaving the tendon untouched. Control examinations from 9 months to 4.7 years after operation showed correction of the equinus component by an average of 49 degrees and correction of the profile of the talocalcaneal angle by an average of 34 degrees.

Clubfoot↗
PubMedDate not supplied

[Treatment of severe concave clubfoot in neural muscular atrophy].

The deformity with which this neurological condition first shows itself is the pes cavus. During the period of growth a severely instable cavovarus deformity develops. The author avoids operations on children because the results are usually poor; the basic problem cannot be resolved with surgical measures. He recommends that the affected feet be immobilized by plastic boots until puberty is reached, at which time only minor bone resections for correcting the form of the feet are necessary. In cases of severe cavovarus deformity in early adulthood the author does not use the usual treatment, triple arthrodesis, but operates according to a technique developed by himself: a wedge osteotomy of the Chopart joints is performed to the degree necessary to permit an exact correction of the deformity. In cases of pronounced deformities, the wedge must include the entire navicular bone. After the resection the heel automatically assumes a neutral position and subtalar stability is achieved. In a number of cases the Achilles tendon must be lengthened after wedge resection. To make possible dorsal extension of the operated foot it is necessary to translocate the tendon of tibialis anterior to the base of metatarsus V. If the tibialis anterior muscle is weak or paralysed, we translocate the tendon of tibialis posterior. Instead of running this tendon through the interosseous route, we lead it subcutaneously to the distal part of the forefoot. Preoperative toe deformities are much less pronounced following the operation, and only in rare cases is correction of the first toe necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMed1981

[Differential diagnosis of acquired clubfoot (author's transl)].

The article introduces a patient of 14 years of age in whom clubfeet as well as paraspasticity had developed from his sixth year of life. Instead of the previously suspected heredodegenerative disease, a lipoma was found in the distal spinal canal which had prevented ascension of the spinal cord and had thus produced the described phenomenon.

Adolescent↗