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PubMed1991

Clubfoot correction using the Ilizarov technique.

Idiopathic clubfeet in children three years of age or older which have not been treated previously or which have recurred, can be treated successfully by using the Ilizarov technique. The authors report on four feet in three children which were treated by this method. Follow-up examinations at 11-24 months found all corrections successfully maintained.

Bone Lengthening↗
PubMed1991

Surgical management of resistant idiopathic congenital clubfoot.

For neglected clubfeet or clubfeet resistant to conservative treatment, there is an increasing tendency towards early and tailored release. From November 1983 to November 1987, we operated on 37 children with 53 neglected or resistant clubfeet which included 23 with limited release and 30 with radical release. Their ages ranged from 4 months to 8 years with an average age of 1 year 5 months. Operative treatment was indicated if the clubfeet had been neglected or had shown no corrective change after 12 weeks of intensive plaster treatment. We used the Cincinnati incision for one-stage release. The average follow-up was 3.5 years (range 2-5.5 years). Evaluation criteria included physical, functional and roentgenographic findings. The results were good or excellent in 96% of the feet based on the modified Magone rating scale. There was no significant difference in the operation results between different age groups. Both the limited and the radical release groups had a high rate of satisfaction. The limited procedure only effectively improved the tibio-calcaneal angle to a significant degree (p less than 0.01), while the radical operation changed every angle significantly (p less than 0.01). Complications included calf muscle atrophy in 4 feet, overcorrection in 3 feet, undercorrection in 3 feet, superficial skin necrosis in one foot, pin tract infection in one foot and residual metatarsal adductus in one foot. In conclusion, neglected or resistant clubfeet can be treated by early and adequate release with a high rate of success. Complications can be avoided by a thorough understanding of their pathoanatomy and by a meticulous surgical approach and release.

Child↗
PubMed1991

[Rehabilitative therapy after correction of congenital clubfoot in children].

There have been analysed 49 children with congenital club foot (79 feet). All patients before arrival were treated according to the common methods and 42 children (64 articulations) were subjected to operative or apparatus-made correction of the club foot recurrence. In spite of the treatment obtained all children arrived with the residual signs of club foot. There are described the mechanisms of the club foot recurrence development, proposed a method of stage-by-stage redressment, needle and manual therapy realization.

Adolescent↗
PubMed1977

[Early surgery of the soft tissues in congenital clubfoot].

The role and position of early complete operative procedures on the soft tissues in the treatment of the congenital club foot is discussed in the article. The authors report on the operative indications in principles and in their own practice. Closed and operative treatment are not contradictory but complementary terms. The aim of the operative treatment is to bring all residual contractures following conservative treatment to an end. It must be done by relatively minimal intervention on the soft tissues and as early as possible. Thus the proper development of the foot and the prevention of bone deformation can be attained.

Child↗
PubMed1991

[Current surgical therapy of congenital clubfoot].

The operative treatment of congenital club foot deformity in childhood consists of a release of soft tissues which are retracted in fibrous "knots" at the hindfoot and midtarsus. This release is more or less extensive, depending on the importance of the contracture and allows reduction of the triple deformity i.e. varus and equinus of the hindfoot and adduction at the midtarsus. Surgery is performed preferably before walking commences in order to take advantage of the functional self-treatment by bearing weight after removal of the cast. During the last several years, the different operative procedures employed for release have gained in precision and efficiency by addressing the deformity at their precise location. The difficult aim of the surgical procedure is to avoid insufficient release causing pseudo-recurrencies or overcorrection.

Clubfoot↗
PubMed1991

[Pathogenesis of congenital clubfoot].

Experiments, carried out by the author, have shown that the pathogenesis of congenital talipes is based on congenital muscular disbalance between flexors-supinators and extensors-pronators at the expense of strengthening of the former and insufficiency of the latter. An object of treatment of the considered developmental defect is restoration of myogenic balance. The existing methods of conservative treatment result in preservation of insufficiency of the anterolateral group of the crus muscles. Only the method of Vilensky V. Ya. allows to completely solve the posed problem. Operations on the posteromedial section of foot result in reduction of the myogenic disbalance as there is preserved insufficiency of extensors-pronators. Only operations, accompanied by shortening of anterolateral groups of the crus muscles allow to restore the myogenic balance straight on the operating table. The cause of recurrencies in case of congenital talipes is preservation of myogenic disbalance between flexors-spinators and their antagonist more frequent at the expense of insufficiency of the latter.

Clubfoot↗
PubMed1991

[The indications for and limits of "extensive" posterior lysis in the surgical treatment of congenital clubfoot (talipes equinovarus supinatus)].

The authors present the preliminary results (after 4-7 years) of 69 cases of congenital torsive equino-varus-supinated foot treated operatively from 1982 to 1985 (of a total of 25% cases treated from 1982 to 1989). Both the modalities and the stages of execution of the treatment are described. After the initial clinical evaluation and the first weeks of manipulation, the feet were immobilized in corrective plaster casts, which were carefully constructed to correct the varus and supination. After 4-8 months, thorough clinical and radiographic assessment enabled the authors to plan the surgical procedure for correction of the remaining deformity, customizing it for each individual patient. There is an in-depth discussion of the stages of the "widened" posterior release procedure. Using this procedure, the authors achieved satisfactory intraoperative correction in 85% of the patients, correction which was maintained over time in 76.5% of the cases. In this way the medial stage of the surgical procedure, associated "ab initio" to the posterior release, may be reserved to a fewer number of patients (15-20%) under one year of age.

Achilles Tendon↗
PubMed1990

[Reoperations in the management of clubfoot].

The results of 118 operations for club-foot are assessed, of these 57 were reoperations. It is stated that the relapse is most often the consequence of the insufficient primary operation and the relapse and the residual deformity are the more serious the more insufficient was the primary operation. The severity of the deformation is defined first of all by the position of the calcaneus. In milder cases the soft tissue operation only may be successful, in the more severe cases bony operation (Evans' operation in this series of the authors) has also to be performed. After their own primary operations reoperation was in 24 per cent necessary. The number of the bony operations was half of the soft tissue operations. The second and rarer case of the relapses was that the foot proved to be even originally rigid, not redressable, "rebel". First of all in these cases may multiple reoperations be necessary and the transposition of the anterior tibial muscle is also useful. The club-foot with a major dominant adduction deformity of the tarsometatarsal joint is thought to be a separate entity and it is corrected with tarsometatarsal capsulotomies or serial metatarsal osteotomies.

Clubfoot↗