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At least 163 records · Page 9Linked to original sources
PubMed2002

Comparison of posteromedial and subtalar release in surgical treatment of resistant clubfoot.

This preliminary study evalluated two surgical techniques for the treatment of resistant clubfoot: the posteromedial and the subtalar release. Two groups of matched patients with idiopathic clubfoot who underwent surgery between 1983 and 1995 were compared. In group 1 (12 patients, 18 feet), posteromedial release was performed. In this group, the results were satisfactory with a tendency to hypocorrection: 4 (22%) feet needed a secondary procedure (average follow-up: 97.8 months). Group 2 (12 patients, 17 feet) underwent complete subtalar release. The results were clinically better for group 2 (average follow-up: 38.8 months). Only 1 (5.9%) patient needed a secondary procedure. These results suggest complete subtalar release yields better postoperative correction than posteromedial release.

Adult↗
PubMed1999

Treatment of severe residual clubfoot deformity by trans-midtarsal osteotomy.

This study reviews the preliminary results of transmidtarsal osteotomy performed on 11 patients (12 feet) who previously underwent surgery for resistant clubfoot and needed further surgery for severe residual deformities. Opening wedge medial cuneiform osteotomy, closing wedge cuboid osteotomy, and truncated wedge middle and lateral cuneiform osteotomy were performed. The procedure was performed initially on normal cadaver feet. The average improvement of anteroposterior talo-first metatarsal angle was 20 degrees and lateral calcaneo-first metatarsal angle was 16 degrees. The authors conclude that with this simple procedure, angular and rotational correction in three planes can be obtained simultaneously in severe residual clubfoot deformity without the need for extensive soft tissue release.

Cadaver↗
PubMed1999

Surgical treatment of clubfoot: the significance of talocalcaneonavicular malposition correction.

In a retrospective study on the surgical management of clubfoot based on clinical and radiographic assessments, 171 feet in 137 patients were reviewed. The surgical procedure was selected according to the degree of the deformity. The more severe cases (group A, 75 feet) were surgically treated according to Turco's one-stage posteromedial release, whereas the milder degrees of deformity (group B, 96 feet) were corrected by elongation of the Achilles tendon with posterior capsulotomy. The mean age of the patients at surgery was 12.5 months in group A and 5.2 months in group B. The mean follow-up time for both groups was 12.2 years. At follow-up, 24 feet (41%) in group A and 52 feet (68%) in group B required repeat surgery. In group A the results were good in 51 feet (68%), fair in 15 (20%), and poor in 9 (12%). In group B, good results were obtained in 44 feet (45%), barely satisfactory results in 25 (27%), and poor results in 27 (28%). It is suggested that the accurate correction of talocalcaneonavicular and calcaneocuboid malposition is a prerequisite for successful surgical treatment of clubfoot. There was a tendency for a better result in group A when the patients were surgically treated between 6 and 12 months of age.

Achilles Tendon↗
PubMedDate not supplied

Predictive value of intraoperative clubfoot radiographs on revision rates.

The predictive value of intraoperative radiographic assessment and its correlation with short term revision rates is presented for surgical correction of resistant clubfoot. Seventy-three children (115 feet) who underwent a primary procedure at one institution for idiopathic clubfoot between January 1991 and December 1994 were reviewed. A strategy using sequential release guided by intraoperative radiographs was employed in all cases. The intraoperative radiographic findings correlated with the need for early revision surgery, with residual radiographic evidence of cavus deformity associated with the greatest risk for revision. The sequential release strategy resulted in fewer overcorrections compared with historical controls of more complete subtalar release.

Analysis of Variance↗
PubMedDate not supplied

A preliminary report of the use of botulinum toxin type A in infants with clubfoot: four case studies.

This report describes the use of botulinum toxin type A (BTX-A) in four infants with very severe clubfoot deformity. The gastrocnemius and posterior tibial muscles were injected with BTX-A after the patients reached a treatment plateau in physical therapy. Significant improvement in foot dorsiflexion and foot flexibility was seen in two patients, and surgery was not required. Surgical intervention was necessary in the remaining two patients, both of whom were ultimately diagnosed with a demyelinating neuropathy. The use of botulinum toxin as an adjunct to conservative care in infants with clubfoot is discussed.

Anti-Dyskinesia Agents↗
PubMed2001

[Principles of choice of primary operative techniques for congenital clubfoot].

Review article. A definition of the congenital clubfoot as the rotational and torsional disorder in the sagittal, coronal and horizontal plane was described. The method of choice of the operative technique on the basis of clinical and radiographic parameters was presented. It was found that the primary technique used for surgical clubfoot correction is chosen from a set of different procedures, ranging from posterior release to complete subtalar release. The technique can be extended and modified during surgery.

Choice Behavior↗
PubMedDate not supplied

Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method.

Little information exists about the degree of efficacy of the several nonoperative treatments, such as manipulation and casting, used in correcting the pathology of the virgin clubfoot deformity. The steps in the correction of the displacements and anomalies of the skeletal components have never been visualized. The method reported to have the best long-term results is that of Ponseti. A magnetic resonance imaging protocol was devised to image the described chondroosseous abnormalities of the virgin clubfoot deformity and to illustrate the changes that occur with the Ponseti method of treatment. Scans were performed at the beginning of, in the middle of, and at the end of treatment. Images obtained with this protocol largely agree with postmortem studies of clubfeet. All of the major chondroosseous pathology could be visualized in vivo. With Ponseti treatment, all the abnormalities seen on the initial scans either improved markedly or corrected completely. Treatment resulted in correction not only of the abnormal relationships of the tarsal bones, but also of the abnormal shapes of the individual tarsal osteochondral anlages, probably because of the changes in growth resulting from the changes in mechanical loading of fast-growing tissues.

Clubfoot↗
PubMed2001

[Residual clubfoot correction by means of lateral cuboid resection].

The paper presents the late results (after 5-16 years; mean follow-up--9.5 years) of lateral cuboid resection performed in 55 children with pathologic foot adduction. The age of the children ranged from 18 months to 12 years (average age 41 months). This residual deformity resulted from the treatment of clubfoot (both conservative and surgical). The procedure was performed in cases with severe forefoot adduction (type III according to Simondsa). Late results of treatment of 54 feet (75.9%) of the cases were assessed according to the Magone classification yielding good and very good results in 41 (75.9% feet; satisfactory in 10 (18.6%) feet. In 95% of case correction of adduction deformity was achieved. The authors stress the fact, that the degree of correction is correlated to the extent of the primary clubfoot defect. This procedure allowed correction of talo-navicular relation. The described procedure may be performed with no regard to age, although the optimal age is 3 to 8 years.

Adolescent↗
PubMedDate not supplied

Peritalar release in the treatment of congenital talipes equinovarus clubfoot.

It is the purpose of this retrospective study to evaluate the results of the surgical treatment of congenital talipes equinovarus clubfoot. Seven patients affected with congenital talipes equinovarus clubfoot, 2 of which bilateral, treated surgically using peritalar release according to Simons were re-examined. The long-term follow-up results obtained after an average of 4 years were evaluated from clinical, morphofunctional, and radiographic points of view, and with the help of a photopodogram and computed baropodometry. The subjective satisfaction of the patients was also evaluated. Results were considered to be good in all of the cases. In conclusion, surgery involving peritalar release allows for correction of abduction of the forefoot, and restores physiological calcaneal valgus, re-balancing standing on the plantar surface; the persistence of an area of hypostanding in the forefoot operated on and of mild, residual cavus of the plantar arch do not, thus, seem to influence the good results obtained.

Child, Preschool↗
PubMedDate not supplied

Ponseti versus traditional methods of casting for idiopathic clubfoot.

Serial casting is successful in avoiding extensive posteromedial release (PMR) in only 11% to 58% of patients with idiopathic congenital clubfoot. Extensive open surgery is commonly associated with long-term stiffness and weakness. Ponseti claims to avoid PMR in 89% of cases by using his specific technique of manipulation, casting, and limited surgery. The authors report their first 27 patients undergoing the Ponseti technique (34 feet) with a group of 27 matched control patients (34 feet). All patients underwent serial casting, begun within the first 3 months of life. The parameter studied was the need to perform PMR within the first year of life. In the Ponseti group, only 1 (3%) of 34 feet required PMR. In 31 (91%) of 34 feet, percutaneous Achilles tenotomy was performed at age 2 to 3 months. The average duration of casting was 2 months. In the control group, 32 (94%) of 34 feet required PMR within the first year of life, despite a longer casting period. Based on the authors' initial success with the Ponseti method, they no longer believe that PMR is required for most cases of idiopathic clubfoot. Foot abduction splints are crucial to avoid recurrence. Longer follow-up will determine whether the authors can continue to match Ponseti's reported outcomes.

Case-Control Studies↗
PubMed2002

[Pathologic anatomy of congenital clubfoot--review of the literature and personal observations].

The authors present a review of literature of the past 40 years, relevant to the pathological anatomy of congenital clubfoot and their own views--based on intra-operative observations. Performing Goldner's procedure the authors noted the talar bone was rotated internally, as a whole and externally in relation to the forefoot. The head and neck of the talar bone were deviated medially in relation to the trochlear axis. These deformities lead to pronation and supination movements instead of the normal flexion and extension of the foot. The authors believe a wide capsulotomy with resection of the ligaments is necessary to achieve proper clubfoot correction.

Clubfoot↗
PubMedDate not supplied

Pulsed color-flow Doppler analysis of arterial deficiency in idiopathic clubfoot.

This prospective study used pulsed color-flow Doppler sonography to determine differences in the presence and direction of flow through the dorsalis pedis, posterior tibial, and peroneal arteries in a group of children with clubfoot and a comparison group of controls. There was a statistically significant difference in the prevalence of deficient (absent or retrograde flow) dorsalis pedis arteries in children with clubfoot (45%) compared with controls (8%). This indicates that there is an association between some clubfeet and deficiency of the dorsalis pedis artery. There was a trend toward difference in the prevalence of deficiency of the dorsalis pedis artery in the clubfeet that required surgery (54%) compared with those that did not (20%), suggesting that dorsalis pedis artery deficiency may be more prevalent among clubfeet with greater deformity.

Case-Control Studies↗
PubMed2003

Administering caudal anesthesia at completion of clubfoot surgery does not affect postoperative use of narcotics.

In the pediatric population, control of postoperative pain is a challenging and important issue. We conducted this retrospective study to determine whether single-dose caudal anesthesia administered after club-foot surgery helps to decrease postoperative use of narcotics. Fifty-one patients given an injection of caudal anesthesia (bupivacaine) at completion of clubfoot surgery were compared with 41 patients who did not receive a caudal block. Postoperative pain control was assessed by recording how much narcotic was used by each patient during time in the recovery room and during the first 8 hours after surgery. Results show that a single dose of caudal anesthesia administered at completion of clubfoot surgery is not associated with a statistically significant change in use of narcotics during either postoperative period.

Anesthesia, Caudal↗
PubMed2003

[Early results of complete subtalar release in congenital clubfoot deformity].

OBJECTIVES: We evaluated the radiological and clinical results of complete subtalar release in patients with congenital clubfoot deformity. METHODS: We performed complete subtalar release in 30 feet of 20 patients (14 boys, 6 girls; mean age 8 months; range 3.5 to 18.5 months). We employed the Cincinnati incision in all cases. The results were evaluated according to the Simon's clinical and radiological criteria. Tarsal bone problems were analyzed separately. The mean follow-up period was 24.6 months (range 12 to 41 months). RESULTS: Clinical results were satisfactory in 24 feet (80%) and unsatisfactory in six feet (20%). Radiologically, satisfactory and unsatisfactory results were encountered in 19 feet (63%) and 11 feet (37%), respectively. Undercorrection occurred in 13 feet (43.3%) and overcorrection in one foot (1.4%). Revision surgery which was recommended for five undercorrected feet (16.6%) with unsatisfactory clinical and radiological results could be performed in four feet (13.3%). Deep skin necrosis that occurred in two feet (one with Achilles tendon necrosis) was treated surgically. Superficial skin necrosis developed in five feet and soft tissue infection in one feet, all of which responded well to conservative treatment. Other complications included talar head hypoplasia and navicular hypoplasia in two feet, respectively. CONCLUSION: Complete subtalar release allows to correct all components of clubfoot deformity in a single session. The results may appreciably be improved with enhanced surgical experience.

Clubfoot↗
PubMed2003

[Correlation of clinical and radiologic results of complete subtalar release in congenital clubfoot].

OBJECTIVES: We evaluated the mid-term results in patients who underwent complete subtalar release with the use of the Cincinnati incision for congenital clubfoot. METHODS: Complete subtalar release was performed in 30 feet of 23 patients (16 boys, 7 girls; 7 bilateral cases). The mean age at surgery was 17.5 months (range 2 to 84 months). Clinically, cosmetic appearance, adduction of the forefoot, the range of motion of the ankle joint, and muscle strength were evaluated. Radiologic evaluations included talocalcaneal angles on antero-posterior and lateral views, talocalcaneal index, talar-first metatarsal angles, calcaneal-fifth metatarsal angles, and Bohler angles. Talar and navicular bone lengths were compared with the other side in unilateral patients. The results were evaluated according to the Simons' criteria. The mean follow-up was 9 years and 8 months (range 7 years to 14 years). RESULTS: The mean range of motion of the ankle joint was measured as 47 degrees (range 10 degrees to 60 degrees ). The parents of three patients were not satisfied with the clinical results. Clinically, six patients had metatarsus adductus. Radiologically, flattening of the talar head (7 patients) and the talar dome (2 patients) were detected in unilateral patients. Navicular dorsal subluxation was found in seven feet. Compared to the normal side, the mean navicular shortening was 2.6 mm (range 0 to 4 mm), the mean talar shortening was 4.8 mm (range 2 to 11 mm). According to the Simons' criteria, the results were satisfactory in 27 feet (90%) and unsatisfactory in three feet (10%). CONCLUSION: Our results suggest that complete subtalar release for the treatment of clubfoot enables correction of all components of the deformity at a single session, and that its clinical results are more favorable than radiologic results, without requiring a close cooperation of the parents.

Child↗
PubMedDate not supplied

Correction of equinus in clubfoot: the contribution of arthrography.

The equinus deformity in clubfoot is twofold: talocrural and talocalcaneal. No study has been carried out on the link between these two elements and whether they are mutually dependent or independent. This has led to an unvarying operative strategy confined to opening the talocrural capsule and section of the talofibular ligament. To assess the extent to which these procedures are warranted, the authors performed perioperative talocrural arthrography, taking radiographs before and after each stage of operative treatment. In all cases, talocrural equinus seemed to disappear without the need for opening the talocrural capsule or sectioning the posterior talofibular ligament. Capsulotomy produced only an artificial, temporary increase in dorsiflexion due to posterior gaping between the talus and the tibia. The anatomy of the posterior talofibular ligament, moreover, makes it improbable that there is anything to be gained by sectioning it when congenital equinovarus clubfoot is being operatively reduced.

Arthrography↗
PubMed2004

A novel surgical option for the operative treatment of clubfoot.

Clubfoot (talipes equinovarus) is a condition well known since the time of Hippocrates. Numerous conservative treatments have been introduced for this condition; few are still in favour. Conservative treatment was used in our department up to the third month of age. The indication for surgery was failure to correct or maintain the correction after conservative treatment. We report on 134 children (206 feet) who had operative treatment for clubfoot in our department during the period 1990-1996, using a novel surgical technique based on extensive posteromedial release combined with the lateral spread of the "extensor forces" of the foot. This new technique has produced excellent results.

Achilles Tendon↗
PubMed2005

Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot.

BACKGROUND: The preferred conservative treatment for congenital idiopathic clubfoot deformity remains a controversial issue. OBJECTIVES: To compare the outcomes of two groups of CICF patients who underwent two different treatment protocols. METHODS: The study cohort included 72 infants treated in our hospital from August 1998 to December 2002. Group 1 comprised 40 infants (61 clubfeet) who were treated by a traditional method (a modification of the Kite and Lovell technique), and group 2 consisted of 32 infants (48 clubfeet) treated with the Ponseti technique. Both groups were similar in age, gender and severity of the deformity (Dimeglio scoring system). RESULTS: After an average follow-up of 54.9 months (range 44-68), 35 (57%) clubfeet in group 1 required surgical intervention and 27 (44%) clubfeet had a residual deformity at last follow-up. In the Ponseti group, 45 (94%) clubfeet were fully corrected at last follow-up (average 29.2 months, range 16-45) while 3 (6%) clubfeet had residual deformity and required surgery. Achilles tendon tenotomy was performed with no complications in 47 clubfeet (in group 2) at an average age of 2.4 months (range 2-4 months). CONCLUSIONS: Even after a relatively short follow-up period, our success rate with the Ponseti approach already appears to be significantly higher and to bear fewer complications than the traditional treatment, in agreement with the results published by other medical centers. We now endorse the Ponseti technique of conservative manipulative treatment for congenital idiopathic clubfoot in our department.

Achilles Tendon↗