Abstract
BackgroundWe reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up.Materials and methodsFifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet).ResultsThe average follow-up was 5 years (1–6 years). In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. In ambulating children, the results were excellent in 5 feet, good in 16, and poor in 3. No major complications were reported. No overcorrections were observed. The need for open surgery was higher in cases of delayed treatment. In cases of relapse, re-casting and/or more extensive surgery was considered.ConclusionsEarly treatment enables a high rate of good correction to be obtained with serial casting and limited surgery. Conversely, if the deformity is observed after walking age surgery should be considered. Serial casting in cases of late observation and relapse have demonstrated encouraging results.Level of evidenceIV.
Highlights
Congenital idiopathic talipes equinovarus, known as clubfoot, is a deformity present at birth that is characterized by a permanent alteration of the morphology of the foot and its relationship with the leg so the foot cannot lean on the ground in a physiological way
Background We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus
Surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet)
Summary
Congenital idiopathic talipes equinovarus, known as clubfoot, is a deformity present at birth that is characterized by a permanent alteration of the morphology of the foot and its relationship with the leg so the foot cannot lean on the ground in a physiological way. Over recent years nonsurgical treatment has been popularized due to excellent results reported by several authors [3,4,5,6]. We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. The results were excellent in 5 feet, good in 16, and poor in 3. The need for Keywords Clubfoot Á Casting Á Re-casting Á Surgical treatment Á Walking age
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