Congenital Talipes Equinovarus Deformity Research Articles

Functional, clinical, and radiological outcomes of split anterior tibial tendon transfers in patients with sequelae of congenital talipes equinovarus.

This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities. 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up. Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results. Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes. IV Retrospective study.

Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials.

Clubfoot, or congenital talipes equinovarus deformity, is a common anomaly affecting the foot in infants. However, clinical equipoise remains between different interventions, especially those based on the Ponseti method. The aim of this study was to examine the clinical outcomes of the various interventions for treating idiopathic clubfoot. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and CINAHL were conducted. Randomized controlled trials comparing different interventions, including the Ponseti method, accelerated Ponseti method, Ponseti method with botulinum toxin type A (Botox) injection, Ponseti method with early tibialis anterior tendon transfer (TATT), Kite method, and surgical treatment, were included. Network meta-analyses (NMAs) were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guidelines. The primary outcomes were the change in total Pirani score and maximal ankle dorsiflexion. Secondary outcomes were the number of casts, time in casts, and rates of tenotomy, total complications, relapse, adverse events, and additional required major surgery. Eleven randomized controlled trials involving 740 feet were included. According to the SUCRA (surface under the cumulative ranking curve)-based relative ranking, the Ponseti method was associated with the best outcomes in terms of Pirani score changes, maximal ankle dorsiflexion, number of casts, adverse events, and total complications, whereas the accelerated Ponseti method was associated with the best outcomes in terms of time in casts and tenotomy rate. Early TATT ranked best in terms of relapse rate. The Ponseti method with Botox injection was associated with the best outcomes in terms of the need for additional major surgery. The NMAs suggest that the Ponseti method is the optimal treatment overall, despite potential drawbacks such as longer time in casts and higher rates of tenotomy, relapse, and the need for additional surgery compared with other modified approaches. Therefore, clinicians should consider how treatments can be tailored individually. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Frequency and Patterns of Congenital Talipes Equinovarus (Clubfoot) Deformity in Children

Background: Clubfoot, also known as congenital talipes equinovarus (CTEV), is a structural deformity that appears early in pregnancy. Objective: To determine the frequency and patterns of congenital talipes equinovarus (clubfoot) deformity in children. Study Design: Cross sectional study. Settings: Department of Anatomy Dow International Medical College, DUHS Karachi Pakistan. Duration: October 2022 to March 2023. Methods: We initiated a prospective study that aimed to investigate congenital anomalies among neonates. We systematically documented the patterns of clubfoot concerning factors such as gender, the affected side, any coexisting congenital anomalies and maternal demographic details as part of our comprehensive analysis. Results: The number of children with clubfoot deformity recorded during the study period was 125 out of total number of all births at hospital during this period. This gave an estimated clubfoot incidence of 1 in 500 per number of births or 2 per 1000 births. Most patients were infants, with 50.4% aged less than 6 months, while 27.2% were between 6 months and 1 year old, and 22.4% were over 1 year old. Gender distribution showed that 56% were male, and 44% were female. Among the patients, 40% had CTEV on the right side, 20% on the left, and an equal number, 40%, had it bilaterally. The majority, 96%, had isolated CTEV, while a smaller percentage, 4%, had CTEV associated with other medical conditions. Conclusion: The occurrence of clubfoot is higher in males than in females. An equal number of cases presented with bilateral and unilateral clubfoot. Notably, the mode of delivery and a positive family history were found to have significant associations with clubfoot. These initial findings are expected to contribute to future studies in both central India and the broader Pakistani population that focus on similar issues.

Relationship of the severity of talipes equinovarus and age of presentation to time of correction: A focus on Dimeglio scoring

Objectives: The Ponseti method is the mainstay of treatment of congenital talipes equinovarus deformity. This study aims to assess the relationship between the severity of the clubfoot deformity and the time it takes to correct the deformity using Dimeglio scoring system (DSS) with Ponseti protocol. Material and Methods: A prospective observational study carried out for 15 months at the outpatient department of the National Orthopedic Hospital Enugu. Data collected included age at presentation, sex, laterality, grade of deformity, number of casts, and time to correction before the commencement of bracing. Those selected were clinically assessed using the DSS. Data obtained were analyzed using SPSS version 22.0. The association between time, the number of casts to correction, age of presentation, and severity to the time of correction of deformity was also determined. Results: A total of 70 patients (116 feet) were recruited for the study. The mean age at presentation was 21 weeks with a male-to-female ratio of 3:2. The mean DSS at presentation was 10.72. The mean number of casts required to achieve correction was 5, with the last cast left in place for 3 weeks, which gave a mean correction time of 7 weeks. Severe deformity required more cast for correction. There is a weak relationship between age and time to correction. Conclusion: Increase in the severity of the clubfeet was associated with longer correction time and a weak correlation with age at presentation. Dimeglio scoring is an effective, grading, and monitoring system.

PONSETI VERSUS KITE'S METHOD OF TREATMENT FOR IDIOPATHIC CLUBFOOT.

Introduction : Idiopatic congenital talipes equinovarus deformities in infants are difcult to treat due to its complicated pathoanatomy of the growing foot. As clubfoot deformities are pliable in the early weeks of life, treatment preserved is always conservative. Both manipulation and casting methods of Kite and Ponseti are commonly used with good outcomes 1. Though most orthopaedicians prioritize using Ponseti method, advantages and disadvantages of both treatment should be taken into consideration when selecting the treatment. So, we have decide to carry out a comparative study between Kite's and Ponseti method in the treatment of idiopathic clubfoot. 33 patients (48 feets) having idiopathic CTEV were randomized and divided into Materials and methods : two groups. 18 infants (26 feet) were selected and treated by Ponseti method and 15 infants (22 feet) were treated by Kite's method. The results of both group were compared based on Pirani score, time and number of casts required for correction, relapse and percentage of feet corrected. Ponseti Results : method had higher satisfactory correction rate (91.67% versus 80.95%), required less number of casts ( 7.57 versus 11.76), less duration of cast ( 53 days versus 82.35 days) and lesser percentage of relapse ( 8.33 % versus 9.52%). The relapse were corrected by remanipulation in both the groups. In case of bilateral idiopathic CTEV mean Pirani score decreased faster in the Ponseti group compared to Kite's group. The difference was statistically signicant 3rd week onwards in left sided CTEV and 4th week onwards in right sided CTEV. In case of unilateral idiopathic CTEV, the mean Pirani score in Ponseti group decreased faster in Ponseti group compared to Kite's group and the difference was statistically signicant 3rd week onwards. Both Ponseti and Kite's method of casting are effe Conclusion : ctive in correcting idiopathic CTEV deformities. Though correction rate was almost similar in both methods, Ponseti method proved slightly better than Kite's in correcting deformities faster with relatively lesser number and duration of casts. The Kite's method had an advantage of not needing any minor surgical procedure for the correction of deformity.

TO STUDY THE CORRELATION BETWEEN CLINICAL AND RADIOLOGICAL (USG) ASSESSMENT IN MANAGEMENT OF TYPICAL CTEV USING PONSETI TECHNIQUE

Congenital talipes equinovarus (clubfoot) is a joint deformity of the foot in children, which affects one in every 1000 live births. Our study aims to correlate Pirani score and ultrasound in assessing the correction of clubfoot in neonates treated by the Ponseti method. A total of 44 infants with idiopathic congenital talipes equinovarus deformity were prospectively treated by the Ponseti method. Pirani score and ultrasound parameters were measured during every visit, i.e., every week till the completion of treatment. The sonographic evaluation was done in the affected foot's posterior, medial and lateral aspects. Following sonographic parameters were calculated: Tibio-calcaneal distance (TC), Medial Malleolar Navicular distance (MMN) & Calcaneo-cuboid angle (CC angle). The correlation between ultrasound parameters and Pirani score was evaluated using paired t-test. Ultrasound effectively depicts the pathoanatomy in clubfoot. Ultrasound being non-invasive, easily available, and radiation-free, can be safely used for infants to assess the effectiveness of clubfoot treatment. Pirani score and ultrasound correlation were done, and p values for respective parameters were calculated during the treatment.

EP31.06: Prenatal diagnosis and outcome of antenatally detected congenital talipes equinovarus deformity: a single centre study from South India

EP31.06: Prenatal diagnosis and outcome of antenatally detected congenital talipes equinovarus deformity: a single centre study from South India

Comparison Between the Outcome of the Standard and Accelerated Ponseti Casting Methods for Correcting Congenital Talipes Equinovarus Deformity

Background: Congenital talipes equinovarus (CTEV) is a prevalent congenital foot deformity. The Ponseti Method is a non-surgical treatment for clubfoot, which entails a sequence of casts and braces. The accelerated Ponseti method is a modified version of the standard Ponseti method, involving more frequent cast changes. Materials and Methods: A total of 60 patients with idiopathic CTEV under the age of one were carefully chosen and assigned to either group A (Standard) or group B (Accelerated). The Pirani score was used to evaluate each clubfoot before applying a cast. In group A, above-knee casting was performed once a week, while in group B, it was done twice a week Results: The study involved sixty children, accounting for a total of seventy feet. The results indicated a shorter treatment duration with the accelerated Ponseti method, while the occurrence of skin complications was comparable between the two methods. Conclusion: In conclusion, both the accelerated and standard Ponseti methods are equally effective in correcting clubfoot. The accelerated method offers the advantage of reducing the overall treatment duration and has clear benefits, while there is no notable difference in skin complications between the two methods.

Ponseti method under general anesthesia is an effective method of treatment for neglected congenital talipes equino varus: a cohort study.

Background:Neglected congenital talipes equino varus (CTEV) deformity is common in poorer developing countries. If ignored, children with CTEV result in callosity, potential bone and skin infection, and a significant mobility limitation resulting from stiffness. There are many management options that can be used to manage neglected CTEV. Until now, the Ponseti casting technique is a gold standard for treating CTEV without surgery. Ponseti methods effectively correct CTEV deformity in all ages. However, patients treated with the Ponseti process will suffer pain during correction in daily practice. Therefore, it is necessary to give anesthesia to reduce pain and relax soft tissues to achieve a satisfactory outcome when correction is carried out. Methods:This study design is a retrospective. Our study consisted of 32 patients, divided into two groups. Group A is the group that was treated with the Ponseti using general anesthesia (GA), and group B is the group without using GA. The children were anesthetized using isoflurane inhalation with 1-2 mcg/kg. After that, we performed serial casting every week and evaluated the outcome and number change cast between using GA and without GA. Lastly, we used a paired t-test statistical analysis to determine the relationship between before and after therapy. Results:In group A, the mean Pirani score significantly reduced from 5.81 ± 0.403 to 0.625 ± 0.40. In contrast with roup B, where the mean Pirani score slightly decreased from 5.81 ± 0.403 to 4.437 ± 1.093. After the last serial cast, in group A, only four cast replacements were needed to achieve a good outcome, whereas, in group B, the results remained unsatisfactory after 10 cast changes. Conclusions: Ponseti method under GA is an effective treatment and reduced the number of cast changes for neglected CTEV.

Value of Dimeglio Scoring System During Ponseti Correction of Congenital Talipes Equinovarus Deformity

Value of Dimeglio Scoring System During Ponseti Correction of Congenital Talipes Equinovarus Deformity

Clinico-Radiological and Functional Outcome of Difficult Talipes Equinovarus Deformity Corrected With an Ilizarov Fixator

Relapsed, resistant, and untreated congenital talipes equinovarus poses significant challenges in view of functional outcome following conventional serial casting and soft tissue release procedures. The Ilizarov ring fixator here offers significant possibilities as an extended conservative treatment modality. The aim of the present study was to critically evaluate effectiveness of the Ilizarov ring fixator with regard to radiological, clinical, and functional outcomes, in the difficult clubfeet. The study was carried out on patients presenting with relapsed, resistant, or untreated congenital talipes equinovarus deformity, who underwent deformity correction using the Ilizarov ring fixator application. All patients were reviewed at 6 monthly intervals for over 3 years following fixator removal with an objective clinical, radiological, and functional assessment. Twenty-three patients with 30 clubfeet were enrolled in our study. The mean age was 8.3 ± 3.6 (range 4-17) years. The postoperative clinical, radiological, and functional scores showed statistically significant improvement among all patients when compared with the preoperative data. All 30 feet developed varying complications during treatment with pin track infections being the most common. However, they were managed while continuing the distraction correction process. The Ilizarov ring fixator is an effective and reliable solution for difficult and challenging clubfeet. However, one must be aware of a strict adherence to a bracing protocol to avoid recurrence of deformities. A regular periodical functional and clinical follow up must be ensured among these children for a favorable outcome.

The effect of COVID-19 on children with congenital talipes equinovarus in a tertiary service in the United Kingdom.

During the coronavirus disease 2019 (COVID-19) pandemic, many aspects of healthcare have been hindered. The primary aim of this study was to identify what the impact of COVID-19 was on the delivery of outpatient care for children with congenital talipes equinovarus deformity (CTEV) at a large tertiary hospital in the UK. This study reviewed the patients who commenced their Ponseti treatment between March and September 2020, representing the cohort who received hands-on care during the first wave of the COVID-19 pandemic. Equivalent 6-month periods were searched in 2019 and 2018 as control cohorts. This study included a total of 45 children (72 affected feet) presenting for treatment of clubfoot. Twenty-three babies were seen with CTEV in 2020. For the same time period in 2018 and 2019, 11 babies were treated each year. The distance commuted to by families was higher in 2020 compared to 2019 and 2018, although the difference did not reach statistical significance (P = 0.301). Treatment with Ponseti casting was commenced at a mean age of 52 days, with no statistically significant differences between cohorts (P = 0.758). Using strict precautions, the Ponseti service at a large tertiary hospital in the UK grew in size and successfully provided treatment for children presenting with CTEV during the first wave of the COVID-19 pandemic. This study has shown that with careful protocols in place, children with CTEV can be treated successfully during times of pandemic, thereby reducing the post-pandemic burden of older children requiring treatment.

Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.

RECURRENCE OF DEFORMITY IN IDIOPATHIC CTEV TREATED BY PONSETI TECHNIQUE

Congenital talipes equinovarus (CTEV) or clubfoot, is one of the commonest congenital deformity . At present ,Ponseti method is most commonly used successful reliable , essentially conservative technique for correction of CTEV deformity and successful in upto 98% of feets. However there is a chance of the relapse or recurrence . A prospective and observational study after getting institutional ethical clearance was conducted in the department of Orthopedics, at COM and JNM Hospital, Kalyani, Nadai, WB, between August 2018 to July , 2020 including baby with club foot . Total study sample size was 20 according to inclusion and exclusion criteria. The mean age of presentation was 4 ± 2.51 week . The male to female ratio was 1.86:1. Bilateral feet involvement was 50% . In unilateral involvement , right side was affected 70%, left side was affected in 30 % cases. Family history of CTEV was seen in 20% cases. Mean body weight of babies was 2.49 ± 0.17kg . At presentation , mean pirani score was 5 ± 0.48. Tenotomy was done 75% cases . Relapse rate was 15 %, mean age of relapse was 7 ± 1.73205 month , occurred in most common in left side (66%). There was history of non-adherence of abduction brace for >2 month in all three patients adduction score was 0.5 in all child . Most common deformity relapse was adduction of forefoot. Ponseti method is cost effective especially in developing country . Strict adherence to brace protocol and good communication between heath care persons and parents reduces incidence of relapse. Relapse is relatively common even in Ponseti method and most of cases , it manageable by conservative treatment like cast.

Development of customized orthosis for congenital deformity using additive manufacturing

PurposeThis paper aims to develop a customized orthosis for treating congenital talipes equinovarus (clubfoot) deformity. Complications from non-surgical treatment method such as Ponseti method leads to relapse/recurrence of the foot after treated.Design/methodology/approachAn alternate approach for treating clubfoot deformity can be seen as a viable approach to overcome the above-mentioned difficulties. Customized orthosis is designed and developed for a subject affected with right clubfoot deformity through fused deposition modeling of additive manufacturing (AM) technology with ABS plastic as base material. A unique mechanism is used to develop customized orthosis for achieving rotation of the foot along the three axis and range of motions.FindingsDeveloped orthosis is incorporated with a unique mechanism that can be rotated and arrested at the specified angle along the three principle ranges of motion of the foot. Overall weight of the developed customized orthosis achieved is about 284 g, which has a significant 25 per cent reduction in weight when compared to traditional Ponseti casting method. Overcoming the difficulties faced in Ponseti method, customized orthosis can be an alternative method for treating clubfoot.Originality/valueDeveloped orthosis will be an alternative approach for treating clubfoot deformity, and it overcomes the drawbacks faced by Ponseti method.

Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method.

Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method.Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression.Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05).Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.

Ponseti Technique for the Management of Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of 356 Patients.

Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex congenital deformity of the foot that, left untreated, can limit a person’s mobility by making it difficult and painful to walk. Worldwide, 80% of children born with clubfoot are in low- and middle-income countries. The management of clubfoot has a long history. Non-operative management did not become popular, as an increasing number of orthopaedists started leaning towards surgical treatment. The late Dr. Ignacio Ponseti developed a method of clubfoot correction that successfully realigns clubfoot in infants without extensive and major surgery. The aim of the study was to assess the functional outcome of CTEV management by the Ponseti technique, to study the severity of CTEV deformity using the Pirani score, and to evaluate the cost-effectiveness of the technique. A total of 356 cases with 402 feet with CTEV were treated by the Ponseti method. The average age of the children and the number of casts applied before full correction were 4.03 months and 6.91, respectively. There was a good functional outcome in 95.45% of cases (score > 30) at the last follow up. The management of CTEV by the Ponseti technique provides a good functional and cosmetic outcome. In a developing country like India, this technique is a safe, easy, economical method of clubfoot management.

OUTCOME OF PONSETI METHOD IN TREATING CONGENITAL IDIOPATHIC CLUBFOOT: FIVE YEARS’ EXPERIENCE AT A TERTIARY HOSPITAL

Objective: The earliest non-surgical treatment for the correction of congenital idiopathic talipes equinovarus (CTEV) deformity was described by Ignacio Ponseti. He suggested gentle manipulation and serial applications of casts followed by a period of bracing to maintain the correction. The main objective of this study was to evaluate the result of the Ponseti method with a subjective clinical scoring system using Pirani score, to compare the results with the published literature and to evaluate the effectiveness of foot abduction orthosis (FAO) or ankle-foot orthoses (AFO) in preventing relapse following correction.Methods: A cross-sectional study which was conducted at the Paediatric Orthopaedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A minimum of 12 months follow-up casting was observed before the patient was subjected to the subjective clinical scoring system. A total of 25 patients which included 5 right feet, 9 left feet, and 10 bilateral feet with idiopathic clubfeet were treated with Ponseti serial casting. Percutaneous Achilles tendon tenotomy was done for 28 feet (82.35%) to correct the equinus to achieve full correction.Results: Our results showed that the Ponseti method for treating CTEV was comparable to other published studies. Satisfactory and good results were observed in 97% of cases. A total of 41.18% underwent re-tenotomy of tendon Achilles due to recurrent and persistent equinus.Conclusion: The treatment of CTEV using Ponseti method will increase the successful correction. Meanwhile, the FAO gave better results for maintenance and prevention of recurrent deformity, compared to the AFO.

Pattern of congenital musculoskeletal anomalies in a suburban Nigerian tertiary hospital

Introduction: Available data in congenital musculoskeletal anomalies (MSAs) in Africa are sparse; hence, we decided to evaluate the pattern of congenital MSA as seen in Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo state of Nigeria. Materials and Methods: The clinical records of patients who presented to ISTH with congenital MSA over 10 years (January 2005–December 2014) were extracted and reviewed. Demographic data, diagnosis, description of abnormalities, associated congenital deformities, side of the body involved, and bilaterality were noted. Results: Seventy-five patients met the criteria. Fifty patients were male and 25 were female. Male: female ratio was 2:1. Congenital talipes equinovarus (CTEV) deformity was the most common MSA in 46 (61.33%) patients. Others were syndactyly in 20 (26.7%) patients and congenital constriction band syndrome in 4 (5.3%) patients. Among patients with clubfoot were a predominance of bilaterality involved with 44.7% in the idiopathic group and 62.5% of those in the nonidiopathic group. The idiopathic variety constituted 82.5% of clubfoot deformity. Spina bifida cystica was the most common associated deformity among patients with nonidiopathic clubfoot. Conclusion: CTEV was the most common congenital MSA seen in ISTH, Irrua, with a high incidence of bilaterality. Spina bifida cystica was the most associated anomaly in the nonidiopathic clubfoot in this center.

Pediatric Orthogenomics: The Latest Trends and Controversies

The advent of molecular biology has paved way for an era of personalized medicine. Though medical disciplines such as oncology and cardiology are advanced in their use of genomics, implementation has been slower in other specialties, such as orthopaedics. Recent advances in genomic technology have shed light on the underlying genetic basis of various pediatric orthopaedic disorders. Prior understanding of the genetic makeup of a patient may help individualize care in patients with conditions including idiopathic scoliosis, congenital talipes equinovarus and congenital limb deformities. The fastpaced growth of information in orthogenomics often makes it challenging for an orthopaedic surgeon to effectively use this information for patient care. Genetic characterization of a patient will help indicate risk of progression of a condition, recurrence and/or response to a treatment modality, and a collaborative approach between an orthopaedic surgeon and a geneticist can help tailor patient care. The following review article summarizes current understanding in molecular genomics of common pediatric orthopaedic disorders.