Pie equino varo congénito complejo y atípico. Revisión de conceptos actuales

Abstract

Atypical and complex congenital clubfoot have particular characteristics in their pathophysiology, clinical presentation, and management. The omission in its diagnosis prevents from opting for the modified Ponseti method described for these conditions, which results in poor results due to skin complications, deterioration of some deformities and even instability in the Lisfranc joint.Regarding the modification of the Ponseti method, the way in which the forefoot is manipulated stands out: all metatarsal heads are extended simultaneously with both thumbs while avoiding excessive abduction, not only during manipulation and casting, but also with the position of the foot in the postoperative splint.The characteristics of these feet make manipulations and plastering a demanding task, so it is recommended for this treatment to be carried out by personnel properly trained in the Ponseti method and its modifications for complex feet. Characteristics and treatment of these varieties of clubfoot are described in detail in this review.After correction, strict and prolonged follow-up is necessary, since the probability of recurrence and the need for reoperations is greater than that described for typical idiopathic clubfoot. The good results obtained with the Ponseti method in various clinical situations apply to cases of recurrence of atypical and complex feet which means, the modified Ponseti method allows the deformities to be corrected without extensive surgeries. Evidence LevelIV