Operative management of the resistant clubfoot.
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Congenital talipes equinovarus (ctev) occurs in approximately 1.2 per thousand live births in the UK. The prevalence is less in Orientals (0.6 per thousand), and higher in Hawaiians (6.8 per thousand) and in East Africans. The aetiology is still obscure, but Ruth Wynne-Davies' view has yet to be challenged, that there is a genetic component with an environmental trigger. There is no recognisable pattern of inheritance, but if one child in a family is affected, the risk that a second will have ctev is 1 in 35.
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Two hundred ninety-three resistant congenital clubfeet (203 patients) were treated surgically as follows. After posterior release of the foot through a posterolateral approach, a medial vertical incision was used to perform the medial and plantar release. Transfer of the tibialis anterior tendon to the lateral border of the foot was carried out to maintain the correction of the foot and to prevent a recurrence of the deformity. No internal fixation was used, but the medial wound was left open. Complete wound healing was observed within two weeks after surgery. The described procedure may be assimilated to a wedge opening of the medial column of the foot. The end results in the 185 feet that had a follow-up evaluation at two to 15 years were as follows: excellent or good, 90.1%; fair, 8.8%; and failure, 1.1%.
Using a relatively conservative approach to the problem, the results were fair to good in two-thirds of the patients in a series of 23 congenital idiopathic clubfeet with an average follow-up of 6 and one-half years.
In 50 congenital clubfeet (in 28 children aged 62-126 months) operated on with subtalar release from dorsolateral and posteromedial approach isometric strength of flexors, extensors, pronators and supinators was assessed with tensometry. All the muscular groups showed decreased momentum if compared to normal foot. The smallest deficit was observed in plantar flexors. Better results were accompanied by greater muscular strength, but statistically significant relation existed between strength of dorsal flexors and the quality of result. Postoperative calcaneus position did not influence the strength of dorsal or plantar flexors of the foot. Additional lengthening of FHL and FDL decreased the strength of plantar flexion.
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