scholarly journals Change in the severity of congenital clubfoot in the first week of life

2020 ◽  
Vol 7 (4) ◽  
pp. 49-56
Author(s):  
Igor Yu. Kruglov ◽  
Nicolai Yu. Rumyantsev ◽  
Gamzat G. Omarov ◽  
Natalia N. Rumiantceva
Keyword(s):  
Deformity Correction ◽  
Varus Deformity ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Study Group ◽  
Congenital Clubfoot ◽  
Initial Examination ◽  
Global Literature ◽  
Equinus Deformity ◽  
Receive Treatment

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction. Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment. Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores. Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth. Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

scholarly journals Z Lengthening of Achilles Tendon through Three Longitudinal Mini Incisions

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Mohamed Mokhtar Abd-Ella
Keyword(s):  
Achilles Tendon ◽  
Mouth Opening ◽  
Deformity Correction ◽  
Distal Portion ◽  
Foot Deformities ◽  
Capsular Release ◽  
Tendon Lengthening ◽  
Risk Of Rupture ◽  
Equinus Deformity ◽  
A New Technique

Category: Ankle Introduction/Purpose: Achilles tendon lengthening is considered an integral step in management of major foot and ankle deformities. Many procedures were described. Selective gastrocnemius recession is sometimes useful but is insufficient in severe equinus deformities in which the Achilles tendon itself needs to be lengthened. Z lengthening is sufficient to correct severe equinus deformities but is associated with marked scarring and tension on the wound after correction of the deformity. Percutaneous triple hemisection is an alternative but has the disadvantages of uncontrolled lengthening and risk of rupture in correcting severe deformities. In this study, a new technique of Z lengthening through three small longitudinal incisions to avoid the disadvantages of open Z lengthening and percutaneous triple hemisection was evaluated. Methods: Three longitudinal incisions of 1 to 1.5 cm were done, one over the most distal portion of the Achilles tendon and the second and third incisions over the midportion and the upper end of the tendon. Through the distal incision, the distal part of the tendon was split into two equal halves and the medial half was detached from the calcaneus and sutured. The suture was then passed using an artery forceps to the middle and then the superior incision with gentle pulling to complete the splitting of the two halves. Then, the lateral half was detached from the tendon proximally. Then, the equinus was corrected and the two halves were sutured together through the middle incision with removal of excess tendon. Longitudinal incisions were preferred to avoid fish mouth opening with deformity correction and to leave a chance to convert to open lengthening should posterior capsular release found necessary. Results: Ten patients with severe fixed equinus deformity alone or as an element of more complex foot deformities with clinically and radiologically reasonable ankle joints that can be preserved were included in the study. Three patients had poliomyelitis, two had Charcot-Marie Tooth syndrome, two had cerebral palsy, two had idiopathic equinocavus deformity and one had posttraumatic deformity. The average age was 24 years (range: 14-36). The follow up was at least six months. Equinus deformity was successfully corrected in all patients and the Achilles lengthening procedure was successful in all cases without need to convert to the classic open technique. No wound healing problems were encountered and the extensive scarring associated with open Z lengthening of the Achilles tendon was not encountered. Conclusion: Z lengthening of the Achilles tendon using three mini incisions can be a good option to treat severe equinus deformities with avoiding the complications of open Z lengthening and the percutaneous triple hemisection. It has however a limitation when posterior ankle capsular release is needed, but in such cases, the incisions can be connected converting the procedure to an open Z lengthening. Further studies are needed with larger number of cases and with comparison to other methods of Achilles lengthening.

scholarly journals Bilateral idiopathic club foot in baby of a rheumatoid mother: A rare case report and its management

2021 ◽  
Vol 7 (1) ◽  
pp. 46-49
Author(s):  
Ranjeet Choudhary ◽  
Alok Chandra Agrawal ◽  
Anupam Pradip Inamdar ◽  
Pandya Raj ◽  
Shilp Verma
Keyword(s):  
Rheumatoid Arthritis ◽  
Club Foot ◽  
Rare Case ◽  
Deformity Correction ◽  
Idiopathic Clubfoot ◽  
Casting Method ◽  
Congenital Clubfoot ◽  
Pirani Score ◽  
Serial Casting ◽  
Female Baby

Congenital clubfoot has a multifaceted etiology, with several hypotheses offered in its etiopathogenesis. The clubfoot has rarely been reported in babies born to women who have rheumatoid arthritis (RA). We present a rare case of a 31-year-old lady with RA on disease-modifying anti-rheumatoid drugs who delivered a child with bilateral congenital clubfoot. She had previously been using Methotrexate, Hydroxychloroquine, and Sulfasalazine regularly, but Methotrexate was stopped seven months before pregnancy. A full-term female baby was born through the cesarean section with bilateral clubfoot deformity and a modified Pirani score of eight out of 10. The deformity correction was done with the Ponseti serial casting method. The final modified Pirani score was two out of ten. In newborns born to rheumatoid arthritis mothers, the club foot deformity was effectively treated with serial Ponseti corrective casts, as was idiopathic clubfoot in babies born to non-rheumatoid mothers. Our findings validate the Ponseti serial casting method for these kinds of patients.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

2021 ◽  
pp. 38-39
Author(s):  
Chunchesh MD Chunchesh MD ◽  
Vani Ahuja ◽  
Kiran S Mahapure
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Cost Effective Treatment ◽  
Pediatric Orthopaedics ◽  
Talipes Equinovarus ◽  
Main Factor

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

scholarly journals Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877236 ◽  
Author(s):  
Anil Agarwal ◽  
Nargesh Agrawal ◽  
Sitanshu Barik ◽  
Neeraj Gupta
Keyword(s):  
Treatment Outcomes ◽  
Deformity Correction ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy ◽  
Female Patients ◽  
Bilateral Group ◽  
Pirani Score ◽  
The Mean ◽  
Treatment Analysis ◽  
Unilateral Group

Introduction: Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot. Material and methods: We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe. Results: There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet. Conclusions: Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.

Limb salvage with Chopart's amputation and tendon balancing

1999 ◽  
Vol 89 (2) ◽  
pp. 100-103 ◽  
Author(s):  
AM Reyzelman ◽  
S Hadi ◽  
DG Armstrong
Keyword(s):  
Tendon Transfer ◽  
Varus Deformity ◽  
Term Result ◽  
Transverse Arch ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon ◽  
Long Term Result ◽  
Equinus Deformity ◽  
Tendo Achillis

For several decades, Chopart's amputation has met with some skepticism owing to reports of significant equinus deformity developing soon after the procedure is performed. However, with appropriate tendon balancing, which generally includes anterior tibial tendon transfer and tendo Achillis lengthening, this level of amputation is often more functional than slightly more distal amputations, such as Lisfranc or short transmetatarsal amputations. The authors offer a rationale for this observation, which includes a discussion of the longitudinal and transverse arch concept of the foot. This concept dictates that the shorter the midfoot-level amputation, the more likely the patient is to develop an equinovarus deformity, thus exposing the fifth metatarsal base and cuboid to weightbearing stress and a high risk of ulceration. Chopart's amputation, in eliminating the cuboid, often obviates the potential varus deformity and thus can have a more acceptable long-term result.

scholarly journals TL 18142 - The Ponseti method in children with clubfoot after walking age

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 91S
Author(s):  
Kelly Cristina Stéfani ◽  
Gabriel Ferraz Ferreira ◽  
Davi Podestá Haje ◽  
Mônica Paschoal Nogueira
Keyword(s):  
Random Effects ◽  
Low Cost ◽  
Ponseti Method ◽  
Cochrane Library ◽  
Idiopathic Clubfoot ◽  
Complication Rates ◽  
Random Effects Model ◽  
Congenital Clubfoot ◽  
Walking Age ◽  
The Cochrane Library

Introduction: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an interventional option for older, untreated children.  Methods: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.  Results: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01) relative to the total analyzed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19).  Conclusion: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures that are likely to cause complications. The obtained results exhibited considerable heterogeneity

scholarly journals APPLICATION OF I.PONSETI TECHNIQUE IN SURGICAL TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

2019 ◽  
Vol 111 (3) ◽  
pp. 6-10
Author(s):  
Oleksii Holubenko ◽  
Anatolii Levytskyi ◽  
Oleksandr Karabeniuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Preoperative Preparation ◽  
Congenital Clubfoot ◽  
High Relapse Rate ◽  
Group I ◽  
Initial Correction ◽  
Prevention Of Recurrence

Summary. One of the most common malformation of the musculoskeletal system in children is congenital clubfoot, which occurs from 2 to 5 cases per 1000 newborns. Treatment of idiopathic clubfoot by the Ponseti method is now standard, and most feet can achieve satisfactory initial correction using this technique. But the high relapse rate (from 20 to 40%) and the existing postoperative complications necessitate the search for approaches to reduce them. One of such approaches is the application of the I.Ponseti technique at the stages of preoperative preparation. The aim of our work is to reduce the incidence of complications in the surgical treatment of congenital clubfoot by applying the I.Ponseti technique. Materials and methods. An analysis was made of the treatment of 62 children (74 feet) with idiopathic congenital clubfoot, who were inpatient and outpatient treatment at the NSH «Ohmatdet» from september 2015 to august 2018. Of these, 39 were patients with recurrence of congenital clubfoot after the initial treatment according to method I.Ponseti and 23 patients with relapsed deformity after initial surgical treatment. Of these, 35 boys and 27 girls. All patients were separated into two groups. Group I – 27 patients (32 feet) who did not use casting according to the I.Ponseti technique before surgical treatment. Group II – 35 patients (42 feet) who underwent staging casting according to I.Ponseti technique at the stages of preoperative planning. The average age of the patients is 4 ± 0.85 years. Result. Use of the I.Ponseti technique at the stages of preoperative preparation in the treatment of congenital clubfoot can significantly reduce the incidence of postoperative complications. The result of which is the possibility of early rehabilitation of patients and prevention of recurrence of deformity.

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