EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS & OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity & complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.& S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER & SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.

Surgical Correction of Foot Deformity in Children under 3 Years of Age

Aim. The study aimed to improve the outcomes for surgical correction of talipes equinovarus in children using the Ponseti method, as well as vertical talus correction using the Dobbs method combined with massage, physiotherapy and therapeutic exercise. Material and methods. In the period from 2015 to 2020, 109 children were examined and treated at the Filatov City Children’s Hospital, Moscow. Results. The study has revealed that without timely correction the orthopedic foot pathology in children is often accompanied by pain, functional changes and a high risk of developing disability in a child, which determines a high social significance of this nosology. After a comprehensive assessment and a combination of conservative and surgical correction techniques, the congenital foot deformity in all children was completely eliminated. Conclusion. The Ponseti method is required to be carefully adhered to in order to achieve a complete pes equino-varus correction. Early start of correction of changes is effective.

The role of social media in clubfoot: information sharing and social support

Purpose Clubfoot is the most common congenital foot deformity in children. Caregivers often seek medical information on the internet. The aim of the study was to characterize how social media is used by caregivers to access medical information. Methods A search was performed on Facebook, Twitter and YouTube platforms. Information was quantitatively assessed. Comments were qualitatively assessed, and the Kruskal-Wallis test was used to study thematic comment distribution. Results In total, 58 Facebook groups and pages, 109 YouTube accounts and ten Twitter accounts related to clubfoot were discovered from 2007 to 2019. Facebook groups and pages had a collective 56 123 members and 80 544 total likes, respectively. YouTube had a collective 3 280 454 views, with 54 969 total comments throughout the accounts. Comment themes most commonly included sharing information and advice (38.7%), appreciation and success stories (12.8%), emotional support (12.7%) and social media as a second opinion (11.9%). Facebook groups contained a significantly higher number of comments related to ‘social media as a second opinion’ compared with Facebook pages (p = 0.001), Twitter (p = 0.016) and YouTube (p < 0.0001) while YouTube contained a significantly lower number of comments related to ‘sharing information’ compared with Facebook groups, pages and Twitter (p < 0.0001). Conclusion Social media continues to be a growing tool for information sharing and the findings of this study highlight the importance placed by caregivers on the advice of their peers. The online presence of caregivers may represent an opportunity for orthopaedic surgeons to communicate with patients and help them make informed decisions. Level of evidence IV

Is foot deformity associated with developmental dysplasia of the hip?

Aims To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Methods Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed. Results Overall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH. Conclusion Compared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH. Cite this article: Bone Joint J 2020;102-B(11):1582–1586.

Is foot deformity associated with developmental dysplasia of the hip?

Aims To assess if congenital foot deformity is a risk factor for developmental dysplasia of the hip (DDH). Methods Between 1996 and 2012, 60,844 children were born in Sør-Trøndelag county in Norway. In this cohort study, children with risk factors for DDH were examined using ultrasound. The risk factors evaluated were clinical hip instability, breech delivery, a family history of DDH, a foot deformity, and some syndromes. As the aim of the study was to examine the risk for DDH and foot deformity in the general population, children with syndromes were excluded. The information has been prospectively registered and retrospectively analyzed. Results Overall, 494 children (0.8%) had DDH, and 1,132 (1.9%) a foot deformity. Of the children with a foot deformity, 49 (4.3%) also demonstrated DDH. There was a statistically significant increased association between DDH and foot deformity (p < 0.001). The risk of DDH was highest for talipes calcaneovalgus (6.1%) and club foot (3.5%), whereas metatarsus adductus (1.5%) had a marginal increased risk of DDH. Conclusion Compared with the general population, children with a congenital foot deformity had a significantly increased risk for DDH and therefore we regard foot deformity as a true risk factor for DDH.

Assistive Technology for Patient with Congenital Foot Deformity

An assistive technology (AT) is any item, equipment or product used to increase, maintain or improve the functional capabilities of people with disabilities. The aim of this study was to design and develop two ATs in order to assist the needs of a male student from Universidad de Monterrey experiencing gait dysfunction and pain due to a congenital foot deformity preventing him from normal performance. These ATs included personalized orthopedic insoles to improve the participant’s posture and stability as well as two ankle-foot orthosis (AFO) to reduce the pain he presented. In order to design the orthopedic insoles, it was necessary to scan the participant’s feet; this was achieved using the photogrammetry technique. For the design of the AFOs, anthropometric measurements of the lower limbs were taken in order to modify a predefined 3D human model and obtain a digital model of the lower limbs. Both devices were manufactured using 3D printing technology. In order to analyze the participant’s progress and validate the effectiveness of the ATs, we developed a methodology for movement analysis based on the marker-less motion capture system Kinect 2. Data obtained was imported into Matlab in order to calculate lower limb joint angles and compare gait before and after using the ATs. Significant improvement was seen in the participant’s gait after two weeks of using the ATs. Moreover, we were able to demonstrate that the use of orthopedic insoles improved participant’s posture based on the correct alignment (180°) of the heel with the ankle. We believe these posture improvements could further impact on participant’s gait performance. Therefore, we expect a significant improvement on participant’s gait after constant use of both ATs developed.