Radiographic Prognostic Factors for Selective Soft Tissue Release After Ponseti Failure in Young Pediatric Clubfoot Patients

2018 ◽  
Vol 39 (6) ◽  
pp. 712-719
Author(s):  
Michael Seungcheol Kang ◽  
Il-Yeong Hwang ◽  
Soo-Sung Park
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Lateral View ◽  
Soft Tissue Release ◽  
Tibialis Posterior ◽  
Idiopathic Clubfoot ◽  
Abductor Hallucis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Metatarsal Angle

Background: Selective soft tissue release (SSTR), which includes a combination of abductor hallucis, tibialis posterior, and Achilles lengthening, has been used in patients with recurrent clubfoot deformity after Ponseti treatment. The aim of this study was to investigate the prognostic factors for recurrence of clubfoot deformity after SSTR. Methods: Consecutive patients with idiopathic clubfoot and residual or recurrent deformity after Ponseti treatment underwent SSTR between 2005 and 2013. The clinical and radiologic characteristics before and after SSTR were analyzed. The ability of radiologic factors to predict recurrence of clubfoot deformity was assessed using multivariate analysis. Rigid deformities of forefoot adduction, and hindfoot varus, and equinus were examined separately. Forty-three patients with 64 clubfeet were included. Results: Postoperative improvement in the talo–first metatarsal angle on the anteroposterior view, the talocalcaneal angle on the lateral view, and the tibiocalcaneal angle on the lateral view independently predicted recurrence after SSTR. Additionally, the preoperative talocalcaneal angles on the anteroposterior and lateral views were also significant predictors, but these angles did not significantly improve after SSTR. Conclusions: SSTR seems to be an effective surgical modality only in milder deformities. Among patients with poor talocalcaneal angles, a high percentage required further surgery. The present results may be useful for the choice of SSTR or more extensive surgery. Level of Evidence: Level III, retrospective case-control study.

scholarly journals Ponseti Casting vs. Soft Tissue Release for the Initial Treatment of Non-idiopathic Clubfoot

2021 ◽  
Vol 8 ◽  
Author(s):  
Jonathan Abraham ◽  
Jon Cooper Wall ◽  
Michel Diab ◽  
Cody Beaver
Keyword(s):  
Soft Tissue ◽  
Initial Treatment ◽  
Operating Time ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Continuous Variables ◽  
Time Data ◽  
Retrospective Case ◽  
Level Of Evidence

Purpose: Ponseti casting has universally been accepted as the gold standard for treatment of idiopathic clubfoot. Conversely, primary treatment for non-idiopathic clubfoot has not been established. The purpose of this study is to compare treatment outcomes following primary soft tissue release (STR) and Ponseti casting of non-idiopathic clubfoot.Methods: An IRB-approved retrospective study of patients treated for non-idiopathic clubfoot between 2005 and 2020 was conducted. Patients were included if they began treatment before the age of 2 and had at least 1 year of follow up. Patients were placed into either the STR group or Ponseti group and variables of interest were documented including reoccurrence of deformity, number of surgeries performed, type of surgeries performed, anesthesia time, and surgery time. Data was analyzed using Mann-Whitney U test for continuous variables.Results: A total of 33 children with 57 neuromuscular/syndromic clubfoot were identified of which 9 (15 feet) were treated with STR and 24 (42 feet) were treated with Ponseti casting. Average anesthesia and surgery time were found to be 291 and 179 min, respectively, for the STR group, and 113 and 67 min for the Ponseti group. The difference in operating time was determined to be significant (p = 0.02, p = 0.01). Patients treated with STR were found to have significantly more surgeries performed over the course of treatment than those treated with Ponseti casting (p = 0.001) with an average of 4.2 surgeries in the STR group and 1.5 surgeries in the Ponseti group. Extracapsular procedures were performed in 100% of the STR group and 97.6% of the Ponseti group (p = 0.55). Intracapsular procedures were performed in 100% of the STR group and 50% of the Ponseti group (p = 0.001).Conclusion: The Ponseti method should serve as the primary approach in the initial treatment of non-idiopathic clubfoot as it can reduce the risk of future invasive intracapsular surgery and shorten anesthesia and surgery times when surgical treatment is necessary.Level of Evidence: Level III retrospective case control study.

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot

2010 ◽  
Vol 92 (8) ◽  
pp. 673-679 ◽  
Author(s):  
Michel Eshak Loza ◽  
Sherif NG Bishay ◽  
Hassan Magdy El-Barbary ◽  
Atef Abdel-Aziz Zaki Hanna ◽  
Yehia Nour El-Din Tarraf ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Major Complication ◽  
Idiopathic Clubfoot ◽  
Grading System ◽  
Residual Deformity ◽  
Abductor Hallucis ◽  
Opening Wedge ◽  
Medial Cuneiform ◽  
Plantar Fasciotomy

INTRODUCTION Adduction of the forefoot is the most common residual deformity in idiopathic clubfoot. The ‘bean-shaped foot’, which is a term used to describe a clinical deformity of forefoot adduction and midfoot supination, is not uncommonly seen in resistant clubfoot. SUBJECTS AND METHODS Fifteen children (20 feet) with residual forefoot adduction in idiopathic clubfeet aged 3–7 years were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) with soft tissue releases (plantar fasciotomy and abductor hallucis release), to correct adduction, supination and cavus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values. RESULTS A grading system for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 2.3 years. Eight feet (40%) had excellent, eight (40%) good, three (15%) fair, and one (5%) poor outcome. There was no major complication. There was significant improvement in the result (P > 0.04). CONCLUSIONS Double column osteotomy can be considered superior to other types of bone surgeries in correction of residual adduction, cavus and rotational deformities in idiopathic clubfoot.

scholarly journals First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

scholarly journals RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY

2020 ◽  
Vol 73 (12) ◽  
pp. 2640-2643
Author(s):  
Oleksii O. Holubenko ◽  
Anatolii F. Levytskyi ◽  
Oleksandr V. Karabenyuk
Keyword(s):  
Soft Tissue ◽  
Recurrence Rate ◽  
Primary Treatment ◽  
Nonparametric Tests ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Results Of Treatment ◽  
Pirani Score ◽  
Serial Casting

The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children’s Specialized Hospital “Okhmatdet”. Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-tests). Statistical data processing was performed in SPSS 17.0 program. Results: The results of Pirani score reveal satisfactory outcomes for both groups. But Ponseti method has the more conservative approach and lower complication rate (11,29±5,27% and 24,24±11,74%, p=0,52). Conclusions: Ponseti method is a safe, effective method for treatment of congenital idiopathic clubfoot in children from first days after birth. Open surgery should be reserved for deformity that cannot be completely corrected or for treatment of recurrences.

Interdigital vs Transarticular Lateral Release With Scarf Osteotomy

2021 ◽  
pp. 107110072110353
Author(s):  
Florian Hartenbach ◽  
Brigitta Höger ◽  
Karl-Heinz Kristen ◽  
Hans-Jörg Trnka
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Rating Scale ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Radiographic Outcomes

Background: We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. Methods: Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot and Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. Results: The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. Conclusion: Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. Level of Evidence: Level III, therapeutic.

scholarly journals Tarsometatarsal bone remodelling after subtalar arthroereisis

2020 ◽  
Vol 14 (3) ◽  
pp. 221-229
Author(s):  
Matthias Braito ◽  
Maria Radlwimmer ◽  
Dietmar Dammerer ◽  
Philipp Hofer-Picout ◽  
Jürgen Wansch ◽  
...  
Keyword(s):  
Bone Remodelling ◽  
Deformity Correction ◽  
Lateral View ◽  
Bone Morphology ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Angular Measurements ◽  
Subtalar Arthroereisis

Purpose Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. Methods We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). Results A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). Conclusion Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. Level of evidence IV

Foot and Ankle Manifestations of Charcot-Marie-Tooth Disease

Foot & Ankle ◽  
1993 ◽  
Vol 14 (8) ◽  
pp. 476-486 ◽  
Author(s):  
James R. Holmes ◽  
Sigvard T. Hansen
Keyword(s):  
Soft Tissue ◽  
Neurological Dysfunction ◽  
Careful Examination ◽  
Soft Tissue Release ◽  
Tibialis Posterior ◽  
Foot And Ankle ◽  
Tendon Transfers ◽  
Charcot Marie Tooth ◽  
Charcot Marie Tooth Disease ◽  
Tooth Disease

The term Charcot-Marie-Tooth disease represents a spectrum of neurological dysfunction more recently described as hereditary motor-sensory neuropathies. An abnormality of myelination is thought to be responsible for the clinical manifestations. While histological findings have been well described, the exact biochemical basis for this disorder remains unknown. Over one half of patients with Charcot-Marie-Tooth disease manifest foot and ankle problems, including pain, weakness, deformity, and, rarely, paresthesias. Characteristic patterns of neuromuscular weakness have been identified. Bilateral pes cavovarus is the most common pathologic foot deformity seen. The specific components include hindfoot varus, anterior or forefoot cavus, and, often, clawtoes. The etiology of this abnormal foot posture usually results from tibialis posterior overpowering peroneus brevis coupled with peroneus longus overpowering tibialis anterior. Multiple treatment options have been described. Rationale for specific tendon transfers, soft tissue release, osteotomies, and arthrodesis is discussed. Results of surgical intervention are difficult to interpret and compare because of the wide spectrum of both neurological dysfunction and described operative procedures. In the presence of flexible deformity, early soft tissue release and tendon transfers may help prevent or delay more extensive bony procedures. The clinical results of triple arthrodesis in the Charcot-Marie-Tooth disease patient appear to deteriorate with time. Genetic transmission, progression of the neurological dysfunction, flexibility of the deformity, distribution of muscular weakness, and anticipated foot demands vary a great deal within this patient population. Treatment decisions, therefore, must be individualized and based upon a clear history, careful examination, and well-defined patient goals.

Derotation of the Talus and Arthrodesis Treatment of Stages II-V Müller-Weiss Disease: Midterm Results of 36 Cases

2019 ◽  
Vol 40 (5) ◽  
pp. 506-514 ◽  
Author(s):  
Chengjie Yuan ◽  
Chen Wang ◽  
Chao Zhang ◽  
Jiazhang Huang ◽  
Xu Wang ◽  
...  
Keyword(s):  
Case Series ◽  
Deformity Correction ◽  
Stage Iv ◽  
Staging System ◽  
Functional Improvement ◽  
Midterm Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Metatarsal Angle

Background: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. Methods: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). Results: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from −6.7 (range, −26.4 to 17.7) to 0.7 (range, −5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar–first metatarsal angle decreased from −15.8 (range, −30.1 to −13.7) to −7.0 (range, −25.9 to −8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from −27.0 (range, −40.4 to −13.3) to −7.8 degrees (range, −20.7 to −1.8) degrees ( P < .001). Conclusion: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. Level of Evidence: Level IV, retrospective case series.

scholarly journals Osteotomies combined with soft tissue procedures for symptomatic flexible flatfoot deformity in children

2020 ◽  
Author(s):  
Xiaodong WEN ◽  
Guanghua Nie ◽  
Hongmou Zhao ◽  
Jun Lu ◽  
Xiaojun Liang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pitch Angle ◽  
Functional Outcomes ◽  
Lateral View ◽  
Foot And Ankle ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Flexible Flatfoot ◽  
Surgery Timing ◽  
American Orthopaedic

Abstract Background: The indications for surgery, timing, and procedure in children with flexible flatfoot deformity remain controversial. For marked deformities, combined procedures are preferred to correct multiple plane deformities. Thus, this study aimed to evaluate the outcomes of osteotomies combined with soft tissue procedures in children with flexible flatfoot aged 9-14 years.Methods: From July 2014 to October 2017, 28 children (47 feet) with flexible flatfoot with an average age of 11.7±2.1 (range 9-14) years underwent osteotomy combined with soft tissue surgery. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Foot and Ankle Outcome Score (FAOS) were used to evaluate the preoperative and postoperative clinical outcomes. The talo-navicular coverage angle (TNCA) and talar–first metatarsal angle (T1MA) on the foot anteroposterior view, calcaneal pitch angle and Meary’s angle on the foot lateral view, and calcaneus valgus angle (CVA) on the Saltzman view were also observed.Results: All patients were followed up for an average duration of 29.7±8.6 months. Mean AOFAS and FAOS significantly improved from 56.6±8.0 and 47.4±9.5 preoperatively to 88.4±3.9 and 83.2±6.8 at final follow-up (P<0.001). respectively. There were statistically significant differences between preoperative and postoperative scores in all FAOS subscales (P<0.001). Radiographic parameters, such as TNCA (P<0.001) and T1MT (P<0.001) on foot AP views, calcaneal pitch angle (P=0.014) and Meary,s angle (P<0.001) on foot lateral views, and CVA (P<0.001) on Saltzman views, were significantly improved. All patients and their parents were satisfied with the functional outcomes.Conclusion: Osteotomies combined with soft tissue procedures are an effective strategy for flexible flatfoot deformity in children, as it results in favorable radiographic and functional outcomes.

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