Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CLUBFOOT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources
PubMed1998

[Role of Cahuzac's operation in clubfoot varus equina revision surgery].

PURPOSE OF THE STUDY: The authors report 24 cases of revision in recurrent club foot deformity. They assessed Cahuzac's procedure for treatment of the residual forefoot adduction. This procedure (opening of the first cuneo-metatarsal joint and proximal abduction osteotomy of the second, third, and fourth metatarsals) was generally associated with postero-medial, plantar release, and split tibialis anterior tendon transfer. MATERIAL: Twenty four procedures for 20 children at mean age of five years have been performed. The revision chart comprised 12 clinical and radiological items as proposed by Seringe. RESULTS: Seven feet were considered as excellent, 14 as good, 2 as fair, and 1 as poor. The mean follow-up was four years. DISCUSSION: Treatment of the adduction component with Cahuzac procedure is focused on the fore part of the foot, and on the calcaneo-pedal block by postero medial release, but never on the midfoot, as no Evans or Lichtblau's procedure has been performed. This series was compared to others procedures, and morphological results were equivalent. Cahuzac's operation is riskless for foot growth, and needs two approaches which can be useful for simultaneous procedures as split lateral transfer of tibialis anterior tendon. CONCLUSION: Metatarsal osteotomies (Cahuzac's procedure), associated with soft tissues release and split anterior tibial transfer, seems to be effective in surgical treatment of relapsed clubfeet, but the debate concerning the location of the adduction component of the deformity remains still open.

Child↗
PubMed2004

Outcome of fetuses with clubfeet diagnosed by prenatal sonography.

OBJECTIVE: To determine the outcome of fetuses with clubfoot diagnosed by prenatal sonography. METHODS: We identified all fetuses scanned at our institution from May 1989 to May 2002 in whom clubfoot was suspected or diagnosed on prenatal sonography. From maternal and neonatal medical records, we collected the following information when available: unilateral or bilateral clubfoot, gestational age at diagnosis, other sonographic findings, and pregnancy outcome, including pathologic reports and neonatal findings at birth. RESULTS: One hundred twenty-one fetuses had prenatal sonographic suspicion or diagnosis of clubfoot. Twenty-two had no follow-up information, and 12 fetuses were terminated with fetal parts that could not be evaluated at pathologic examination, leaving 87 study cases. Outcome information was from neonatal records in 51 and from pathologic reports in 36. The gestational age at diagnosis ranged from 12.3 to 39.2 weeks, with a mean of 22.2 weeks. Forty-two (48%) had unilateral clubfoot, and 45 (52%) had bilateral clubfoot on sonography. The false-positive rate was significantly higher with unilateral clubfoot than bilateral clubfoot (12 [29%] of 42 versus 3 [7%] of 45; P < .05). Other anomalies were more common with bilateral clubfoot than with unilateral clubfoot (34 [76%] of 45 versus 23 [55%] of 42; P < .05), the most common being other musculoskeletal anomalies, neural tube defects, and cardiovascular anomalies. Of fetuses with information about chromosomes, the rates of aneuploidy were similar for unilateral and bilateral clubfoot (5 [28%] of 18 versus 10 [32%] of 31; P > .05). CONCLUSIONS: Fetuses with an antenatal sonographic diagnosis of clubfoot often have other anomalies, aneuploidy, or both. The false-positive rate for diagnosis of clubfoot is higher for unilateral clubfoot than bilateral clubfoot. The rate of associated anomalies is higher with bilateral clubfoot than unilateral clubfoot.

Abnormalities, Multiple↗
PubMed2003

Embryo/fetal development studies with hydroxypropyl methylcellulose acetate succinate (HPMCAS) in rats and rabbits.

BACKGROUND: Hoshi et al. [Hoshi et al. J Toxicol Sci 10(Suppl):187-255, 1985a,b,c,d] evaluated the potential for hydroxypropyl methylcellulose acetate succinate (HPMCAS) to produce developmental and reproductive toxicity in a series of studies that included rat and rabbit teratology studies, a rat fertility study, and a rat peri- and postnatal study. The authors concluded that there were no compound-related findings. In the cesarean-section phase of the rat teratology study, however, clubfoot was reported for 0.8, 2.1, 5.5, and 4.1% of fetuses in the control, 625, 1250, and 2500 mg/kg groups, respectively. There were no significant increases in external anomalies, but the apparent dose-related increase in clubfoot was not specifically addressed. In the rabbit teratology study, the number of litters evaluated (12-13 per group) was not consistent with current regulatory guidelines. Therefore, to definitively establish the potential of HPMCAS to produce developmental toxicity, embryo/fetal development studies were carried out in rats and rabbits. METHODS: Groups of 20 pregnant Sprague-Dawley rats and New Zealand White rabbits were dosed with 0, 50, 150, 625, or 2500 mg/kg HPMCAS from gestational day (GD) 6-17 or GD 7-19 for rats and rabbits, respectively. Fetuses were collected by cesarean section and examined for external, visceral and skeletal development. RESULTS: No developmental toxicity was observed as a result of HPMCAS exposure demonstrating that maternal HPMCAS exposure during gestation does not induce developmental anomalies. There were no findings of clubfoot or other limb anomalies in these studies at dose levels equivalent to those that were previously associated with a possible increase in clubfoot. CONCLUSIONS: The conclusion of the earlier study indicating that treatment with HPMCAS at doses up to and including 2500 mg/kg did not produce developmental toxicity was confirmed with these studies. It is likely that the clubfoot noted in the earlier rat teratology study was a misdiagnosis or artifact.

Animals↗
PubMed2006

[Congenital club foot: treatment in childhood, outcome and problems in adulthood].

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to re-align the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. MANAGEMENT OF CONGENITAL CLUBFOOT IN CHILDREN: Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. OUTCOME IN ADULTHOOD: There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree under-correction is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. CONCLUSION: A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; under-correction is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Adult↗
PubMed2002

Chronology of neurological manifestations of prenatally diagnosed open neural tube defects.

OBJECTIVE: To evaluate the incidence and chronology of sonographic markers of neurological compromise in prenatally diagnosed neural tube defects. METHODS: We reviewed our ultrasound database from 1988 to 1999 to identify all cases of prenatally diagnosed neural tube defects. All patients received an initial detailed targeted ultrasound evaluation with subsequent evaluations every 4-6 weeks. Cases involving multiple congenital anomalies, aneuploidy, or inadequate follow-up were excluded. Specific ultrasound markers assessed included the presence of ventriculomegaly (> 10 mm) and clubfoot. RESULTS: Forty-seven cases of neural tube defects were identified over the study interval. After exclusions, 42 cases were available for evaluation. The overall incidence of ventriculomegaly and clubfoot in the study cohort was 86% and 38%, respectively. In the 33 patients with initial ultrasound examination performed at < 24 weeks' gestation, 76% (25/33) had evidence of ventriculomegaly and 30% (10/33) and clubfoot. Only 9% (1/11) of the patients managed expectantly developed evidence of ventriculomegaly and 3/11 (27%) developed clubfoot from the time of the initial ultrasound examination to delivery. CONCLUSIONS: Ultrasound markers of neurological compromise are early and frequent findings associated with fetal neural tube defects. Development of ventriculomegaly is an uncommon occurrence later in gestation, while the risk for developing clubfoot appears to increase as gestation progresses.

Adult↗
PubMed2005

Evaluation of Internet use by paediatric orthopaedic outpatients and the quality of information available.

Parents use the Internet increasingly for information about their children's medical problems. There is no quality control for medical information content. The goals of our study were to assess Internet awareness by families seen in paediatric orthopaedic outpatients departments and the type, quality and reliability of information available, using clubfoot as an example. Parents accompanying children to the outpatient's clinic were surveyed regarding the use of the Internet for medical information. They were asked about their ability to use the Internet, and whether this helped the consultation. To assess the quality of information available, the search phrases 'clubfoot' and 'club foot' were placed in the five most commonly used World Wide Web search engines. Web sites were evaluated for authorship, content and informational value using our own agreed scoring system, ranging from 0-100 points. Sixty-one percent of the questionnaires were completed, the mothers completed 67%. Eighty-four percent reported access to the Internet. Most found their searches useful and 26% were reminded of questions to ask at consultation. When a search for 'clubfoot' was carried out we found 11% of web sites were affiliated to academic institutions. There was a significant difference when the terms 'clubfoot' or 'club foot' were searched. Twenty-eight percent offered conventional information. Thirty-six percent of web sites were not related to congenital talipes equinovarus. The average information value was 26 points (0-98). Parents frequently use the Internet for information about paediatric orthopaedic consultations, prior to consultation. The quality of clubfoot information on the Internet is variable. The development of academic-based websites should be encouraged, as these offer the most useful information.

Adult↗
PubMed2004

[The design and application of synchronized springy lengthening apparatus for the tibia and tendo calcaneus].

OBJECTIVE: To study the role of the synchronized springy lengthening apparatus for the tibia and calcaneal tendon designed by the author in preventing the clubfoot of secondary to the Ilizarov tibia lengthening. METHODS: Based on the Ilizarov tibia lengthening apparatus, a special synchronized springy lengthening apparatus for the tibia and calcaneal tendon was designed. The tibial was made of distal and proximal 2 rings respectively and 4 threaded rods, and the calcaneal was made of a half ring, 2 hinges and a threaded rod with spring. The half ring was fixed to the calcaneus by 2 crossed wires. The fracture tibia and fibula, ankle joint, talocalcaneal joint were attached to the apparatus. At the same time of tibia lengthening, the soft tissue was simultaneously stretched, the ankle joint could move, and the leg could bear weight. If the clubfoot angle was larger, the percutaneous fasciotomy of calcaneal tendon was performed; if the angle was less than 20 degrees, the pes deformities were corrected only by the stretch of calcaneal tendon. RESULTS: Seventy-seven patients' tibia were lengthened averagely 4.6 cm, with an average speed of 0.7 mm/d. The healing made tibia lengthened, and the index was 1.35 months/cm. There were not the secondary varus and valgus deformities and clubfoot in all the patients. The clubfoot with 100-400 angle of the 16 patients were corrected after tibia lengthening. CONCLUSIONS: The new apparatus coincides with the biomechanical principle and can effectively prevent the secondary deformities of foot such as clubfoot, talipes varus and valgus after tibia lengthening procedure.

Adolescent↗
PubMed2002

Talipes equinovarus and maternal smoking: a population-based case-control study in Washington state.

BACKGROUND: Talipes equinovarus (TEV), also called congenital idiopathic clubfoot, true clubfoot and common clubfoot, is one of the most common major birth defects. Its correction is often difficult and expensive. Its etiology is poorly understood and few analytic epidemiological studies have been devoted to exploring specific risk factors for TEV. METHODS: Our population-based study consists of 239 documented cases of idiopathic TEV obtained from hospital and outpatient sources and 365 controls identified via random digit dialing from five Western Washington counties. Structured maternal interviews were conducted by trained interviewers and multiple logistic regression used to evaluate associations between maternal smoking and birth of a child with TEV. RESULTS: Our study shows strong associations between maternal smoking and idiopathic TEV. Case mothers were more likely to have smoked during pregnancy (OR = 2.2; 95% CI = 1.5, 3.3). Increased TEV risk was seen with increased smoking and estimates ranged from 1.5 for the lightest smokers to 3.9 for the heaviest smokers. Gender specific differences in risk were also noted with risk estimates of 1.8 (95% CI = 1.2, 3.0) for boys whose mothers smoked during pregnancy and 2.8 (95% CI = 1.4, 5.4) for girls. Trends for increased risk with higher numbers of cigarettes were noted for both genders. For isolated TEV, the overall odds ratio (OR) for smoking was 2.4 (95% CI = 1.6, 3.6) with a range from 1.4-4.6. No confounders were noted. CONCLUSIONS: As postulated, maternal smoking during pregnancy appears to increase the risk of having a child with idiopathic clubfoot and the number of cigarettes smoked influence that risk. Further delineation of dose-response is warranted as are continued efforts to decrease maternal smoking during pregnancy.

Adult↗
PubMed1999

MRI multiplanar reconstruction in the assessment of congenital talipes equinovarus.

BACKGROUND: Magnetic resonance imaging (MRI) has been shown to be a useful tool in the evaluation of the complex deformities which are present in congenital talipes equinovarus (clubfoot). OBJECTIVE: To evaluate MRI with the multiplanar reconstruction (MPR) technique as a new method for assessment of clubfoot. MATERIALS AND METHODS: Seven infants with 11 clubfeet were studied by using three-dimensional gradient-echo MR sequences. MPR was performed from the acquired image data in orthogonal, single and double oblique planes to demonstrate the complex deformities in clubfoot. Three angles (talar body-neck angle, talocalcaneal left-right angle and the talocalcaneal superior-inferior angle) were defined for measuring the medial angulation of the talar neck and the rotation of the calcaneus in relation to the talus. RESULTS: The method clearly demonstrated the pathological anatomy of the clubfeet, especially the talonavicular articulations. Dislocation of the navicular bone was observed in 9 of the 11 feet. The angle measurements were easily conducted with MPR, and these angles differed considerably among the patients. CONCLUSIONS: The information provided by this method is useful for classification of the severity of clubfoot deformities.

Clubfoot↗
PubMed2006

The Ponseti technique for treatment of talipes equinovarus.

Traditional treatment for clubfoot usually includes initial casting and an extensive posterior medial soft tissue release with biplanar pinning, followed by more casting. This treatment has significant risks, complications, and the potential for a poorer prognosis as the patients age, usually with stiff and scarred feet. In contradistinction, Ignacio Ponseti has been using his unique technique of clubfoot manipulation, casting, and Achilles tenotomy for more than 50 years with a high degree of success. Currently, there are many peer-reviewed and independently verified studies that replicate his success in treating clubfoot. This technique is easy to learn and is becoming the accepted treatment of idiopathic clubfoot all over the world.

Achilles Tendon↗
PubMed2004

Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet.

BACKGROUND: The nonoperative technique for the treatment of idiopathic congenital talipes equinovarus (clubfoot) described by Ponseti is a popular method, but it requires two to four years of orthotic management. The purpose of this study was to examine the patient characteristics and demographic factors related to the family that are predictive of recurrent foot deformities in patients treated with this method. METHODS: The cases of fifty-one consecutive infants with eighty-six idiopathic clubfeet treated with use of the Ponseti method were examined retrospectively. The patient characteristics at the time of presentation, such as the severity of the initial clubfoot deformity, previous treatment, and the age at the initiation of treatment, were examined with use of univariate logistic regression analysis modeling recurrence. Demographic data on the family, including annual income, highest level of education attained by the parents, and marital status, as well as parental reports of compliance with the use of the prescribed orthosis, were studied in relation to the risk of recurrence. RESULTS: The parents of twenty-one patients did not comply with the use of orthotics. Noncompliance was the factor most related to the risk of recurrence, with an odds ratio of 183 (p < 0.00001). Parental educational level (high-school education or less) also was a significant risk factor for recurrence (odds ratio = 10.7, p < 0.03). With the numbers available, no significant relationship was found between gender, race, parental marital status, source of medical insurance, or parental income and the risk of recurrence of the clubfoot deformity. In addition, the severity of the deformity, the age of the patient at the initiation of treatment, and previous treatment were not found to have a significant effect on the risk of recurrence. CONCLUSION: Noncompliance and the educational level of the parents (high-school education or less) are significant risk factors for the recurrence of clubfoot deformity after correction with the Ponseti method. The identification of patients who are at risk for recurrence may allow intervention to improve the compliance of the parents with regard to the use of orthotics, and, as a result, improve outcome. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Achilles Tendon↗
PubMed2006

Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release.

BACKGROUND: Although long-term follow-up studies have shown favorable results, in terms of foot function, after treatment of idiopathic clubfoot with serial manipulations and casts, we know of no long-term follow-up studies of patients in whom clubfoot was treated with an extensive surgical soft-tissue release. METHODS: Forty-five patients (seventy-three feet) in whom idiopathic clubfoot was treated with either a posterior release and plantar fasciotomy (eight patients) or an extensive combined posterior, medial, and lateral release (thirty-seven patients) were followed for a mean of thirty years. Patients were evaluated with detailed examination of the lower extremities, a radiographic evaluation that included grading of osteoarthritis, and three independent quality-of-life questionnaires, including the Short Form-36 Medical Outcomes Study. RESULTS: At the time of follow-up, the majority of patients in both treatment groups had significant limitation of foot function, which was consistent across the three independent quality-of-life questionnaires. No significant difference between groups was noted with regard to the results of the quality-of-life measures, the range of motion of the ankle or the position of the heel, or the radiographic findings. Six patients who had been treated with only one surgical procedure had better ranges of motion of the ankle and subtalar joints (p < 0.004) than those who had had multiple surgical procedures. CONCLUSIONS: Many patients with clubfoot treated with an extensive soft-tissue release have poor long-term foot function. We found a correlation between the extent of the soft-tissue release and the degree of functional impairment. Repeated soft-tissue releases can result in a stiff, painful, and arthritic foot and significantly impaired quality of life.

Adult↗
PubMed1999

[Osteotomies of the mid- and back-foot in recurrent club foot].

There are no clear guidelines on the treatment of relapsed clubfoot, which is a relatively frequent and difficult problem in paediatric orthopaedics. Numerous operative interventions are mentioned in the literature as suitable for correction of a residual deformity of the food. There are numerous soft tissue procedures (release operations, tendon extensions, tendon transfers and redressement by means of a fixateur externe) and osseous interventions (osteotomies, arthrodeses) that can be carried out in isolation or in combination. In the present article two types of osteotomy are described that make it possible to correct the most frequent forms of relapsed clubfoot: combined closing wedge cuboid and opening wedge cuneiform osteotomy for correction of adductus and supination of the forefoot and the calcaneal osteotomy after Dwyer for correction of varus position of the calcaneal part of the foot. The combined osteotomy in the midfoot involves shortening of the lateral ray with simultaneous lengthening of the medial ray, with the wedge out of the cuboid bone inserted into the medial cuneiform bone, which leads mainly to correction of the adductus, but does also make it possible to achieve partial correction of the supination with an osteotomy right through the cuneiform bone. In the case of rigid foot deformities it is advisable to carry out preliminary stretching by means of a fixateur externe, while in the case of a bean-shaped foot a combination of osteotomy and medial and lateral release is recommended. Results of a follow-up study of our own patients treated with this operation have shown that no revision operations were necessary in any of the patients with idiopathic clubfoot. Other types of osteotomy described in the literature as suitable for correction of residual forefoot adductus and supination are also mentioned in this paper. Thecalcaneal osteotomy after Dwyer, for which a lateral approach is always used, generally leads to satisfactory correction of varus position of the calcaneal part of the foot. It the calcaneus is found to have a short posterior part this osteotomy is modified so that instead of taking the form of a wedge osteotomy with lateral closing it is followed by a lateral displacement. In this way it is possible to prevent making the already short posterior calcaneus even shorter. Both the combined midfoot osteotomy and the calcaneal osteotomy after Dwyer can be performed alone or in combination with each other or with different operative interventions.

Bone Malalignment↗