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At least 811 records · Page 45Linked to original sources
PubMed2004

Dynamic foot-pressure measurement in the assessment of operatively treated clubfeet.

BACKGROUND: Decreased motion of the subtalar joint is common after operative treatment of idiopathic clubfeet. The purposes of this study were to validate parameters of dynamic foot-pressure measurement that enable detection of physiological pronation of the subtalar joint and to analyze the consequences of absent or decreased pronation following clubfoot surgery on long-term functional results. METHODS: To validate parameters of dynamic foot-pressure measurement, we initially analyzed two control groups: one of forty asymptomatic normal feet and the other of five feet with a previous subtalar joint arthrodesis. The resulting parameters were then applied to a group of nineteen patients with twenty-four idiopathic clubfeet for whom initial conservative treatment had failed and in whom a posterior surgical release (lengthening of the Achilles tendon and release of the posterior ankle capsule) had been performed at a mean age of twenty months. The mean duration of follow-up was forty-one years. All feet were evaluated radiographically, and the clinical results were assessed with the American Orthopaedic Foot and Ankle Society score. RESULTS: An interruption in the rise of the pressure-time curve and a short medial deviation of the center of pressure path immediately after heel strike are reliable and objective characteristics of pronation movement of the subtalar joint. Nineteen clubfeet had a demonstrable pronation movement, and five clubfeet did not. The nineteen feet with pronation movement were either asymptomatic (twelve feet) or mildly painful on occasion (seven feet). The mean American Orthopaedic Foot and Ankle Society score for the nineteen feet was 87 points. The five feet without pronation movement were moderately painful during strenuous activities only (four feet) or were nearly always painful (one foot). The mean score for those feet was 57 points. There was a significant difference between these two groups with regard to the pain scores and the total scores (p < 0.001), but there was no appreciable difference regarding function and hindfoot motion. It was not possible to distinguish between these two groups on the basis of the findings of the physical or radiographic examinations. CONCLUSIONS: Idiopathic clubfeet with preserved hindfoot pronation have a better long-term prognosis. Preservation of functional mobility of the subtalar joint is a key factor in the treatment of clubfoot deformity.

Adult↗
PubMed1995

Role of talectomy in the treatment of rigid talipes equinovarus deformities.

The authors provide a review of the principles of talectomy as a surgical treatment option for severe, rigid, and resistant clubfoot deformities. Such deformities are associated with a high recurrence rate and frequently involve a large number of surgical interventions to attain a satisfactory result. Talectomy has been successfully used as both a primary and salvage procedure to treat such deformities, often eliminating the need for subsequent surgeries. A discussion of the operative technique, indications, advantages, and common complications associated with the procedure is presented. In addition, a case report of talectomy used to treat a severe, bilateral clubfoot deformity in a 4-year-old boy is included.

Child, Preschool↗
PubMedDate not supplied

Resistant talipes equinovarus associated with congenital constriction band syndrome.

Thirty-seven clubfeet in 28 patients with concomitant congenital constriction band syndrome were reviewed. The bands were considered to be of significance if located in the calf region (zone 2). The severity of the bands was classified. Grade 1 bands involved subcutaneous tissue, grade 2 bands extended to the fascia, grade 3 bands extended to the fascia and required release, and grade 4 bands were congenital amputations. The patients were divided based on neurologic deficit. Group A consisted of 26 clubfeet without neurologic deficit and had 1.4 surgeries per clubfoot. Group B consisted of 11 clubfeet with neurologic deficit and had 3.7 surgeries per clubfoot. Children with grade 3 bands in zone 2 were most likely to have a neurologic deficit. Twenty-three clubfeet had a good clinical result, seven clubfeet fair, and seven clubfeet poor. Group B had poorer results than Group A. These feet ultimately required numerous and more extensive surgeries to obtain correction, and ultimately had a poorer result.

Amniotic Band Syndrome↗
PubMedDate not supplied

Residual bone cysts after Ilizarov treatment of relapsed clubfeet.

The Ilizarov technique is well established as an effective method of treating clubfoot deformities. A complication of this method is the development of cysts in the bones of the foot. The purpose of this study was to clarify the incidence, presentation, and etiology of these cysts. The radiographs of 17 feet that had undergone Ilizarov treatment for a clubfoot deformity were reviewed. In nine of the feet, discrete, well demarcated lucencies of bone were detected. They occurred in both tarsal and metatarsal bones, but most commonly in the base of the fifth metatarsal. Magnetic resonance imaging examination of two feet demonstrated a normal marrow signal. suggesting that the cysts are due to localized trabecular resorption with the space being filled with marrow fat.

Bone Cysts↗
PubMedDate not supplied

Leg-length discrepancy and bone age in unilateral idiopathic talipes equinovarus.

The goals of this retrospective review were to evaluate leg-length discrepancy in patients with a unilateral clubfoot and to determine the relationship between bone age and chronologic age in the same population. Thirty-two of 47 patients referred for scanograms had a discrepancy more than 0.5 cm. Shortening was predominantly in the tibia, and four patients had radiographic evidence of growth disturbance. Five had been treated surgically at the time of review. If clinically indicated, a scanogram and standing radiographs of the ankle are necessary to determine the location and magnitude of discrepancy. Although the literature supports a neurologic etiology in some patients, and bone age may be delayed in certain neuromuscular conditions associated with limb shortening (hemiplegia), the authors' results suggest that bone age is statistically equivalent to chronologic age in the unilateral clubfoot population. These findings do not provide indirect support for a neurologic etiology.

Age Factors↗
PubMedDate not supplied

Diastrophic dwarfism.

Diastrophic dwarfism is an unusual variety of short-limb dwarfism characterized by the pathognomic triad of ear calcifications, hitch-hiker thumbs, and severe clubfoot. Other clinical features include joint contractures and subluxations, symphalagism of the fingers, kyphoscoliosis, hip dysplasia, and occasional cleft palate. Radiographic findings include flaring of the metaphyses of tubular bones and flattened epiphyses which appear late. The major orthopedic problem in diastrophic dwarfism is correction of the recalcitrant clubfoot deformity; cervical spine subluxation or kyphoscoliosis may also require intervention. This disorder is inherited as an autosomal recessive condition.

Bone and Bones↗
PubMedDate not supplied

Correlation of foot radiographs with foot function as analyzed by plantar pressure distribution.

The goal of this study was to correlate radiographic measurements to the dynamic plantar pressure of the residual clubfoot. This was done by comparing radiographs and EMED plantar pressure results in 61 idiopathic clubfeet in 39 children at an average of 8 years after complete subtalar release. Radiographic measures were obtained using the standard method outlined by Simons, and pressure data were collected for eight regions of the foot. Pearson correlation analysis was performed and the most significant correlation was found between the calcaneal/first metatarsal angle in the lateral radiographic view (r = 0.72) and the midfoot contact area. In the anteroposterior view there was mild correlation between the talus/first metatarsal angle and both the peak pressure and plantar contact area. The results of this study indicate that radiographs used in concert with dynamic plantar pressure analysis will provide a more complete assessment of the corrected clubfoot.

Child↗
PubMed1990

Revision surgery in clubfeet.

Twenty-nine reoperated clubfeet were reviewed. The age range of the patients at the time of the revision surgery was 1-12 years. The average follow-up period was 30 months (range 9-36 months). The surgical procedure used most often in the revision surgery was complete soft tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular first-cuneiform joint and the first-cuneiform first-metatarsal joint. In 27 of 29 feet the results were considered acceptable (19 of 29 were rated excellent or good). An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective functional rating system to evaluate long-term results in revision clubfoot surgery.

Child↗
PubMedDate not supplied

Talipes equinovarus: two case reports and literature review.

Clubfoot, or talipes equinovarus, was introduced into the medical literature by Hippocrates in 400 B.C. The clubfoot deformity is a pathologic condition consisting of inversion and adduction of the forefoot, equinus of the ankle, and inversion of the heel. The condition has also been described as a congenital subluxation of the talocalcaneonavicular joints. This manuscript will review the literature with respect to history, incidence, etiology, anatomy, classification, radiology, and treatment. Two case reports are also presented.

Clubfoot↗
PubMed1978

Analytical radiography and the progressive approach in talipes equinovarus.

1. A radiographic method is described for making the diagnosis of talonavicular subluxation before ossification of the navicular occurs. 2. Seven basic deformity combinations are thought to occur in clubfoot. 3. Preoperative analytical radiography enables the surgeon to determine which of these combinations exists in a particular foot. 4. The progressive approach, a comprehensive sequential plan of corrective surgery, indicates the appropriate treatment for each of the seven deformity combinations that may exist in a clubfoot following initial conservative treatment. 5. At the time of surgery the surgeon uses analytical radiography during the operation to determine whether the surgery has been successful or whether the next stage of the progressive approach will be required to correct the deformity combination.

Biomechanical Phenomena↗
PubMed1992

[Genu recurvatum--etiopathogenesis and treatment].

A case of 12 years old girl operated on because of genu recurvatum and paretic clubfoot after buttock and thigh phlegmon in infancy has been presented. There were 2 stages. In the first one the correction of clubfoot was performed, m.quadriceps was elongated in the second one. Good cosmetic and functional result has been achieved.

Abnormalities, Multiple↗
PubMedDate not supplied

Rotation fasciocutaneous flap for neglected club feet--a new technique.

Skin necrosis and wound problems complicate surgical release of severe neglected clubfoot. This is primarily due to excessive tension on the skin edges and a poor understanding of abnormal vascular anatomy in clubfoot. We report a technique of primary skin closure using a local rotation fasciocutaneous flap using the conventional posteromedial skin incision (Turco). Primary uncomplicated wound healing was achieved within 2 weeks in all 16 rigid and neglected clubfeet (1-7 years) operated by this technique. This flap is scientifically logical, technically easy and ensures primary wound healing.

Child↗
PubMed1999

[Osteotomy of the hind-foot in children and adolescents].

The position of the talus and the os calcaneum has consequences for the architecture of the forefoot. Medial tilting of the talus with vertical position provokes flattening of the medial arch and abduction of the forefoot. Varus position of the calcis and lateral direction of the talus (as in residual clubfoot), however, causes supination and adduction of the forefoot. Repair of deformities in the hindfoot therefore also influences the forefoot. A large number of various osteotomies have been proposed at both bones. The most popular ones are Dwyer's osteotomy at the corpus of the calcis and its modification described by Mitchell at the same location for correction of the cavus foot and the residual clubfoot, and the lengthening osteotomy at the neck of the calcaneum according to Evans. Indication and operative technique of these three procedures are described in detail. The closing wedge osteotomy according to Dwyer is indicated in cases of cavus feet. In clubfeet the os calcis is usually too short and the medial opening wedge osteotomy provokes skin problems. In these cases an osteotomy according to Mitchell with lateral displacement of the tuber calcanei is more suitable. In flat- and skew-feet a lengthening osteotomy at the neck of the calcaneum according to Evans can be indicated, especially when the load of the foot is bigger medially under the talus rather than at the lateral margin of the foot. If these procedures are carried out carefully, they have low complications rates.

Adolescent↗
PubMed2004

Use of talectomy in modern foot and ankle surgery.

Talectomy is a procedure that is undertaken rarely in modern orthopedic surgery; however, it has been performed for many years. Talectomy has been used most commonly in pediatric orthopedics with some degree of success in severe clubfoot deformity, arthrogryposis multiplex congenita, myelomeningocele, tuberculosis, and tumors. In adults, talectomy has been used in salvage procedures that involve nonunion of ankle fusions, failed total ankle arthroplasty, inflammatory arthropathy, neuroarthropathy, failed talar prostheses, failed pantalar fusions, adult neglected clubfoot, posttraumatic avascular necrosis talus, and deformities that are due to sciatic nerve palsy and compartment syndrome. This article consider what place talectomy has in modern adult foot and ankle surgery.

Adult↗
PubMedDate not supplied

Maternal smoking and birth defects: validity of birth certificate data for effect estimation.

OBJECTIVES: The authors sought to assess the validity of birth certificate data for estimating the association between maternal smoking and birth defects. The US standard birth certificate includes check boxes for maternal smoking and for 21 congenital anomalies. The sensitivity and specificity of birth certificate data have been studied, but previous studies have not addressed the validity of these data for estimating the association between birth defects and maternal smoking or other risk factors. METHODS: US public-use natality data (1997-1998) were used to calculate the prevalence ratio (adjusted for maternal age, race/ethnicity, and education) for the association between maternal smoking and 13 defects/defect categories. All analyses were restricted to 45 states, New York City, and the District of Columbia because they collect both maternal smoking and birth defect data. RESULTS: Maternal smoking was associated with an increased prevalence of hydrocephaly (adjusted prevalence ratio [PR] = 1.24; 95% confidence interval [CI] = 1.08, 1.43), microcephaly (PR 1.47; 95% CI 1.15, 1.88), omphalocele/gastroschisis (PR 1.37; 95% CI 1.22, 1.53), cleft lip/palate (PR 1.35; 95% CI 1.25, 1.45), clubfoot (PR 1.62; 95% CI 1.49, 1.75), and polydactyly/syndactyly/adactyly (PR 1.33; 95% CI 1.23, 1.43 ). Previous studies have indicated an association between maternal smoking and gastroschisis, oral clefts, and clubfoot with effect estimates of similar magnitude to this study. CONCLUSIONS: These findings suggest that birth certificate data may be useful for exploratory or corroborative studies estimating the association between birth defects and some risk factors recorded on birth certificates.

Adult↗
PubMedDate not supplied

Malformations reported in chorionic villus sampling exposed children: a review and analytic synthesis of the literature.

PURPOSE: To determine whether the frequency of vascular disruption defects, other than limb defects, is increased in reports of chorionic villus sampling (CVS) exposed children compared with an unexposed population. METHODS: Only studies that reported the total number of CVS-exposed pregnancies and details of pregnancy outcome, including all the malformations, were included. Twenty-five articles met these criteria. RESULTS: The frequencies of gastroschisis, intestinal atresias, and clubfoot were significantly increased among the CVS-exposed infants as compared with the baseline unexposed population. The frequencies of other vascular disruption defects, including Poland sequence, amniotic band sequence, and cleft lip/cleft palate, were not increased. CONCLUSION: CVS-exposed children have an increased frequency of intestinal atresia, gastroschisis, and clubfoot compared with the nonexposed population. The fact that an increased frequency of other defects attributed to vascular disruption was not found may be due to under-ascertainment, misclassification, or "lumping" of the defects identified in previous studies.

Chorionic Villi Sampling↗
PubMed2006

Early results of a new method of treatment for idiopathic congenital vertical talus.

BACKGROUND: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of this study was to evaluate a new method of manipulation and cast immobilization, based on principles used by Ponseti for the treatment of clubfoot deformity, followed by pinning of the talonavicular joint and percutaneous tenotomy of the Achilles tendon in patients with idiopathic congenital vertical talus. METHODS: The cases of eleven consecutive patients who had a total of nineteen feet with an idiopathic congenital vertical talus deformity were retrospectively reviewed at a minimum of two years following treatment with serial manipulations and casts followed by limited surgery consisting of percutaneous Achilles tenotomy (all nineteen feet), fractional lengthening of the anterior tibial tendon (two) or the peroneal brevis tendon (one), and percutaneous pin fixation of the talonavicular joint (twelve). The principles of manipulation and application of the plaster casts were similar to those used by Ponseti to correct a clubfoot deformity, but the forces were applied in the opposite direction. Patients were evaluated clinically and radiographically at the time of presentation, immediately postoperatively, and at the time of the latest follow-up. Radiographic measurements obtained at these times were compared. In addition, the radiographic data at the final evaluation were compared with normal values for an individual of the same age as the patient. RESULTS: Initial correction was obtained both clinically and radiographically in all nineteen feet. A mean of five casts was required for correction. No patient underwent extensive surgical releases. At the final evaluation, the mean ankle dorsiflexion was 25 degrees and the mean plantar flexion was 33 degrees . Dorsal subluxation of the navicular recurred in three patients, none of whom had had pin fixation of the talonavicular joint. At the time of the latest follow-up, there was a significant improvement (p < 0.0001) in all of the measured radiographic parameters compared with the pretreatment values, and all of the measured angles were within normal values for the patient's age. CONCLUSIONS: Serial manipulation and cast immobilization followed by talonavicular pin fixation and percutaneous tenotomy of the Achilles tendon provides excellent results, in terms of the clinical appearance of the foot, foot function, and deformity correction as measured radiographically at a minimum two years, in patients with idiopathic congenital vertical talus.

Ankle Joint↗
PubMed1988

A case-control study to evaluate the risk of congenital anomalies as a result of allylestrenol therapy during pregnancy.

The 1980-1984 data base of the Hungarian Case Control Surveillance System for Congenital Anomalies was used to evaluate possible teratogenicity of allylestrenol therapy during pregnancy. In an initial global analysis, three of the 24 congenital anomaly groups studied (ie, clubfoot, multiple anomalies, and hypospadias) had a significantly higher incidence of allylestrenol use. A case control analysis, however, excluded a pathogenetic role for allylestrenol in the etiology of clubfoot and multiple congenital anomalies. A greater use of allylestrenol in the first global evaluation was explained by a higher incidence in these groups of impending miscarriage and preterm labor, which are indications for allylestrenol therapy. The case control analysis did indicate a greater use of allylestrenol in the hypospadias group, but this difference was not statistically significant in the critical period for induction of hypospadias (ie, the third and fourth months of gestation). The causal role of subfertility in the etiology of hypospadias was an indirect factor, explaining the greater use of allylestrenol during pregnancy in this group; in Hungary, women with a history of infertility frequently receive hormonal support in the first trimester. The authors conclude that the data analyzed do not indicate any teratogenic effects of the use of allylestrenol during pregnancy.

Abnormalities, Drug-Induced↗