Prenatal Diagnosis of Clubfoot: Where Are We Now? Systematic Review and Meta-Analysis

The primary methods for prenatal diagnosis of Clubfoot are ultrasound (US) and magnetic resonance imaging (MRI). An ultrasound is performed between the 1st trimester and the 28th week of pregnancy and it is reported to be used as a diagnostic method alone or in combination with MRI. So far, an international consensus on the most effective screening method has not been reached. This systematic review and meta-analysis were performed to establish the most effective and reliable exam for prenatal diagnosis of Clubfoot. The literature search was conducted using a PIOS-approach from May 2021 to June 2021. Studies reporting cases of prenatal diagnosis of Clubfoot made through US and MRI conducted from January 2010 to June 2021 were included in the study and reviewed by 2 authors. The 23 selected studies included 2318 patients. A total of 11 of the studies included details on the accuracy, while the rest were used to obtain information about the primary methodology utilized. In all the selected studies, US was used as the primary diagnostic instrument. Thirteen of the studies used the US exclusively, while three used MRI in addition to US and seven performed karyotyping after US diagnosis. The US has been shown to be the instrument of choice for the prenatal diagnosis of Clubfoot. International guidelines for an ultrasonography classification of congenital clubfoot are required to reduce the inter-variability accuracy of this procedure.

Muscle volume evaluation using 3DCT for congenital clubfoot

Background In congenital clubfoot, the lower leg is very thin and the calf muscles are hypoplasic. However, there are few studies reporting real muscle volume. Purpose The purpose of this study is to assay the muscle volume in congenital clubfoot using 3DCT and to quantify the degree of the hypoplasia. Material and methods From January 2015 to December 2016, nine consecutive patients, seven male and two female, with unilateral congenital clubfeet were recruited for CT scans. Axial transverse sectional CT scans were acquired from the delineation of the fibular head to the tibial plafond. From the data, we rendered the entire muscle in 3D for muscle volume assay, and further segmented the posterior musculature for comparison between the normal and affected sides. Results The whole muscle volume on the normal side was 291.23 cm3 (181.23–593.49) and that on the affected side was 225.08 cm3 (120.71–429.08), for an affected side to normal side ratio of 0.79 (0.72–0.9), which was significantly smaller ( p < .01). Posterior muscle volume on the normal side was 175.81 cm3 (103.72–376.32) and that on the affected side was 106.52 cm3 (58.3–188.39). The ratio of posterior muscle to whole muscle on the normal side was 0.62 (0.46–0.75), and that on the affected side was 0.48 (0.4–0.55), such that the affected side was significantly smaller ( p < .01) Conclusion This study contributes quantitative data supporting the longstanding observations that the posterior calf muscles are significantly smaller on the affected side compared to the normal side in congenital clubfoot, and further underscores the importance of the extending the excursion of these muscles.

Diagnosis and treatment of congenital vertical talus in children under 3 years old (review)

Congenital vertical ram is a rare pathology, the incidence of it is 1 case per 10 thousand newborns. This anomaly is usually manifested by a severe planovalgus deformity of the foot. Moreover, it is often (in 50% of cases) associated with chromosomal syndromes (arthrogryposis, neurofibromatosis, myelodysplasia, etc.), with spinal, neuromuscular anomalies of development. As a result, it is necessary to focus the attention of pediatric orthopedists and radiologists on the parameters of the diagnosis in order to reduce false diagnoses and unreasonable surgical interventions in children, show options for surgical techniques for the treatment of feet with an inborn vertical position of the talus in children under 3 years. The presented review of domestic and foreign literature demonstrates the main advantages and disadvantages of existing approaches in the treatment of children under 3 years of age with congenital vertical ram. Demonstrate the main advantages and disadvantages of existing approaches in the treatment of this pathology. Analysis of the literature showed that the causes of the formation of the congenital vertical talus are not fully explored. In Russia, up to the present moment, its diagnosis is still difficult. Congenital vertical talus is one of the rare problems in world orthopedic practice in comparison with congenital clubfoot, but doctors who are constantly treating children with deformities of the feet have such patients regularly.

Rational selection of treatment methods in recurrent clubfoot

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.

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

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.

Collection 14 / IV

Dr. A. Gerasimova demonstrated patients with rare congenital deformities, one with spina bifida (meningo-myelo cystocele), paraplegic clubfoot and prolapsus recti, and the other with congenital clubfoot and spontaneous amputations.

Development and Test of a Serious Game for Dorsiflexion and Plantarflexion Exercises of the Feet

Congenital clubfoot is the most common disease of the musculoskeletal system, causing deformities in the musculature of the foot and requiring long-term motor rehabilitation. This article shows the design and development of a serious game to support the process of motor rehabilitation of clubfoot through dorsiflexion and plantarflexion exercises. The game is controlled by a wearable device (Papeteshoes), where the accelerometers are responsible for detecting the movement of the foot. A pilot test was carried out withtwo children with and without clubfoot (Congenital Talipes Equi-novarus-CTE) to examine the feasibility of the game as a therapy instrument. Usability and applicability questionnaires were applied after using the game. The results show that both children reacted in the same way to the proposals, performing the necessary movements for the motor recruitment of the muscles related to the leg and foot and maintaining the range of motion of the ankle joint.