Congenital Club Research Articles

MRI study of talonavicular alignment in club foot.

We studied in vivo the talonavicular alignment of club foot in infants using MRI. We examined 26 patients (36 feet) with congenital club foot. The mean age at examination was 9.0 months (4 to 12). All analyses used MRI of the earliest cartilaginous development of the tarsal bones in the transverse plane, rather than the ossific nucleus. The difference in the mean talar neck angle (44.0 +/- 8.1 degrees) in club foot was statistically significant (p < 0.001) when compared with that of the normal foot (30.8 +/- 5.5 degrees). The difference between the mean angles in the group treated by operation (47.9 +/- 6.7 degrees) and those treated conservatively (40.1 +/- 7.5 degrees) was also statistically significant. The anatomical relationship between the head of the talus and the navicular was divided into two patterns, based on the position of the mid-point of the navicular related to the long axis of the head. In the operative group, 18 feet were classified as having a medial shift of the navicular and none had a lateral shift. In the conservative group, 12 showed a medial shift of the navicular and six a lateral shift. All nine unaffected normal feet in which satisfactory MRI measurements were made showed a lateral shift of the navicular. Club feet had a larger talar neck angle and a more medially deviated navicular when compared with normal feet. This was more marked in the surgical group than in the conservative group.

The treatment of congenital club foot by operation to correct deformity and achieve dynamic muscle balance

We operated on 111 patients with 159 congenital club feet with the aim of correcting the deformity and achieving dynamic muscle balance. Clinical and biomechanical assessment was undertaken at least six years after operation when the patient was more than 13 years of age. The mean follow-up was for 11 years 10 months (6 to 36 years). Good and excellent results were obtained in 91.8%. Patients with normal function of the calf had a better outcome than those with weak calf muscles. The radiological changes were assessed in relation to the clinical outcome. The distribution of pressure under the foot was measured for biomechanical assessment. Our results support the view that muscle imbalance is an aetiological factor in club foot. Early surgery seems to be preferable. It is suggested that operation should be undertaken as soon as possible after the age of six months, although it may be carried out up to the age of five years. The establishment of dynamic muscle balance appears to be an effective method of maintaining correction. Satisfactory long-term results can be achieved with adequate appearance and function.

Long-term Results of Surgical Treatment for Congenital Club Feet

Long-term Results of Surgical Treatment for Congenital Club Feet

Bone Lengthening with the Ilizarov Apparatus for Congenital Club Hands

Bone Lengthening with the Ilizarov Apparatus for Congenital Club Hands

Congenital Clubfoot

The medical records of 330 children who were born with uncomplicated congenital clubfoot were reviewed retrospectively. To determine their months of conception, the duration of gestation was extrapolated and those which were less than 40 weeks were noted. The years of conception for the studied children were from 1956 to 1994. Months of the year were ascribed angle values and the distribution of conceptions per month were grouped in radial manner. Using a circular analysis for variance a lack of uniform circular distribution was found for the grouped months of conception. There is a significant seasonal variation in the data. The mean month of conception was June. This finding is at variance with the peak months of conception for the population of the United States for the years 1989 through 1993. The theory that congenital clubfoot is caused by an intrauterine Enterovirus may be supported by this data. The summer and fall peak of Enterovirus infections in temperate climates coincide with the stage of embryologic development (>8 weeks) which would allow an anterior horn cell lesion to lead to a deformity such as congenital club foot.

Congenital club foot with survival motor neuron gene deletion

Congenital club foot with survival motor neuron gene deletion

Congenital clubfoot. Month of conception.

The medical records of 330 children who were born with uncomplicated congenital clubfoot were reviewed retrospectively. To determine their months of conception, the duration of gestation was extrapolated and those which were less than 40 weeks were noted. The years of conception for the studied children were from 1956 to 1994. Months of the year were ascribed angle values and the distribution of conceptions per month were grouped in radial manner. Using a circular analysis for variance a lack of uniform circular distribution was found for the grouped months of conception. There is a significant seasonal variation in the data. The mean month of conception was June. This finding is at variance with the peak months of conception for the population of the United States for the years 1989 through 1993. The theory that congenital clubfoot is caused by an intrauterine Enterovirus may be supported by this data. The summer and fall peak of Enterovirus infections in temperate climates coincide with the stage of embryologic development (> 8 weeks) which would allow an anterior horn cell lesion to lead to a deformity such as congenital club foot.

先天性内反足に対する中足骨骨切り術の経験

Adductional defomity of congenital club foot almost always originates in the Chopart joint, and rarely originates in the Lisfranc joint.We performed metatarsal osteotomy to treat aductional defomity in the Lisfranc joint of four patients with congenital clubfoot.We adopted the “Lowe angle” for evalution of the adductional defomity in the Lisfranc joint. Before surgery the average Lowe angle was sixty degrees and after surgery it was seventy-nine degrees. The average follow up period from the metatarsal osteotomy was seven years (range, 5-11 years) and the average Lowe angle at final follow up was ninety degrees.The operative evaluations of the four cases were all good.We have experienced a case with fatigue fractures of the fourth metatarsal bones on both feet, caused by the adductional deformity in the Lisfranc joints of congenital clubfoot. Metatarsal osteotomy needs a comparatively simple technique. We recommend this operation in order to achieve not only good foot aligrmment but also good function.

Basis of periastragalar reposition surgery of foot bones for congenital club foot correction in children

Treatment results of club foot correction by Zatsepin in 88 children (134 deformed foot) were analyzed clinically and by X-ray method. It was shown that in high number of cases the surgery by Zatsepin did not allow to achieve the total bone reposition in the middle and posterior zones of the foot that resulted in frequent recurrence of club foot . Taking into account all those aspects the operation of periastragalar reposition was elaborated. The method consisted of total restoration of normal interrelation of the calcaneous, cuboid, scapoideus and talus foot bones with their fixation in the position of achieved correction by Kirshner pins. The operation was performed in 20 children with typical club foot (31 deformed foot). Follow up ranged from 1 year 2 months to 4 years 10 months and showed only good and satisfactory results.

Joint kinetic patterns in children with spastic hemiplegia cerebral palsy

Joint kinetic patterns in children with spastic hemiplegia cerebral palsy

Posteromedial release of congenital club foot in children over five years of age

We reviewed 19 children with 24 congenital club feet at a mean of 11 years after one-stage posteromedial release at the age of five years or older (mean 6.8 years). Thirteen feet had undergone previous surgery. Nineteen feet were functionally excellent or good, three were fair and two had required subtalar arthrodesis. Radiographs showed good alignment of the tarsal bones, although mild adduction or varus deformity remained in several feet. Deformities of the bones were more common in feet which had had previous surgery.

先天性内反足にみられる距骨離断性骨軟骨炎５症例の治療経験

This report discusse the treatment and mechanism underlying the development of osteochondritis dissecans of the talus with a flat top talus assouted with congenital club foot. We experienced five cases of osteochondritis disecans of the talus. All patients were males and the time of appearance of the lesion ranged from 9 to 14 years of age. Allfive cases had a prominent flat top talus and had an adduction and an entropion deformity. In all five cases, bone tip only appeared in circumscibed regions anterior to a pulley of the talus.We propose the following factors in the development o osteochondritis dissecans in patients with previously treated congenital club foot; stress of the flat top talus, stress of the retention foot deformity, and increasing activity.

先天性内反足に対する後内方解離術後の足部変形について

The purpose of this study is to analyse the residual deformity of congenital club foot treated by posteromedial release. In our hospital we have treated 47 cases of congenital club foot by posteromedial release.Lateral talocalcaneal angle (LTC) was measured preoperatively. Postoperatively MTR angle and ratio using Meary's method (α) were measured.LTC was significantly related to MTR (r=0.5, p<0.001) and (r=0.53, p<0.001) and also MTR was significantly related to α (r=-0.51, p<0.001).In conclusion, we can say that the residual deformity of congenital club foot treated by posteromedial release, was related to the preoperative severity of the foot deformity.

Treatment of congenital club foot.

Treatment of congenital club foot.

Three-dimensional Reconstruction of the Tarsal Bones in Congenital Club Foot

Three-dimensional Reconstruction of the Tarsal Bones in Congenital Club Foot

先天性内反足における最大背屈位・足部側画像のけいしゅ角・距しゅ角の有用性について

32 cases of congenital club foot operated with postero-medial release were followed up. Preoperatively lateral tibio-calcaneal angle and lateral tolocalcaneal angle were related to MTR angle and the index of MEARY's method significantly (p<0.05-0.001). Therefore, we can suppose the prognosis of the deformity of the foot preoperatively.

Axillary Block for Vascular Insufficiency after Repair of Radial Club Hands in an Infant

Vascular insufficiency may occur after a variety of surgical procedures and has been described after repair of congenital radial club hand. Treatment of vascular insufficiency by use of sympathectomy has recently been reported in the pediatric population. We describe successful use of bilateral axillary blocks to relieve acute vascular insufficiency in a 7-month-old infant after surgical repair of radial club hands

先天性内反足に対する後内方解離術の結果不良例の検討

The purpose of this study is to analyse the results of posteromedial release for congenital club foot and to research the importance of the preoperative correction. 94 feets of 63 cases were followed for an average of 7 years and 2 months in this study.We evaluated the results of the patients by Turco's criteria and the correction of the foot by talocalcaneal angle.The better preoperative correction of the foot yielded better results at follow-up.

Treatment of congenital club foot with a modified Denis Browne splint

We treated 91 congenital club feet in 59 children using a modified Denis Browne splint, and followed them for an average of 6 years and 3 months. The modified splint has an aluminium crossbar holding a pair of plastic shoe inserts moulded into corrected positions, and its use was started in children whose ages ranged from four weeks to nine months. Operation was later required in only 31 feet in 20 children. We have reviewed the other 60 feet in 39 children treated by splintage alone. All 60 feet had excellent or good function and from radiographic assessment, equinus, adduction, varus and cavus deformities had all been well corrected. Our results show that the modified splint can give good results.

Operative treatment of congenital idiopathic club foot.

Operative treatment of congenital idiopathic club foot.