Posterior Medial Release Research Articles

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Arthrogryposis.

The Ponseti serial casting method is the method of choice in treating children with congenital clubfeet. The arthrogrypotic clubfoot has traditionally been considered challenging to treat, with higher rates of recurrence and the need for more corrective surgeries. However, initial reports have found promising results in using the Ponseti method to treat arthrogrypotic feet. This study aims to compare the outcomes of idiopathic versus arthrogrypotic clubfeet following initial treatment with the Ponseti serial casting method. A retrospective review of medical records from a single institution was conducted. Data was collected from children ages 0 to 18 with idiopathic or arthrogrypotic clubfoot treated from 2002 to 2022 with Ponseti-style serial casting with a minimum 2-year follow-up. Recurrence was defined as the need for additional casting or subsequent surgeries following initial correction. Data was collected on relevant patient demographics, previous treatment, casting records, Achilles tenotomies, and surgical treatments. A total of 352 patients (546 feet) met inclusion criteria. In all, 334 idiopathic and 18 arthrogrypotic patients were analyzed with an average follow-up duration of 3.4 and 4.2 years, respectively. Twelve patients had distal arthrogryposis, and 6 had amyoplasia. In all, 93.4% of idiopathic and 72.2% of arthrogrypotic patients successfully achieved correction with Ponseti casting and Achilles tenotomy. Recurrence rates were significantly higher in the arthrogrypotic group at 83.3% compared with 44.6% in the idiopathic group ( P =0.001). A posterior or posterior medial release was performed in 35.0% of idiopathic and 66.7% arthrogrypotic feet. We report the largest series of arthrogrypotic clubfeet treated by Ponseti casting to the best of our knowledge. In contrast to earlier reports, our investigation underscores that while the Ponseti method may be able to secure initial correction in arthrogrypotic clubfeet, on average, at a 3-year follow-up, the prognosis is less favorable. These patients exhibit higher recurrence and often require operative treatment. Notably, a posterior medial release may eventually be needed in up to 6 of 10 patients. Level III-therapeutic studies-investigating the results of treatment.

Surgical Management of Congenital TEV in Children at PMC Hospital Nawabshah

Introduction: Talipes equino varus TEV is one of the most common congenital anomaly. It is managed by some common ways i-e., conservative & surgical methods. Among surgical methods are Turco’s posterior medial release, posterior soft tissue release operation (Attenborough), four quadrant release (Mc Kay). Objective of this study was to determine the reliability of surgical option like postero medial release in children having congenital TEV. Material & Methods: This study was carried out during the period from October 2002 to March 2005 in the Deptt. of Orthopaedics of PMCH Nawab Shah. The inclusion criteria were children 2 months to 30 months of age having moderate to severe club foot. Clubfoot secondary to some other disorder such as cerebral palsy, arthrogryposis multiplex congenital, myeldysplasia or DDH were not included in this study. The deformity was treated surgically in all cases by postero medial release. Follow-up period was one & half year. Results: A total 57 patients were included in this study with the age range of 2 months-2.5 yrs with moderate to severe deformity. Forty two were male (73.7%) and 15 patients (26.3%) were female, seventeen patients (29.8%) had bilateral club foot while the rest the rest of 40 patients (67.1%) had unilateral deformity. Positive family history of club foot was in 10 patients (17.5%). Results were concluded on 57 patients who completed one & half year follow-up. Excellent results were observed in 41 patients (71.9%), good in 11 patients (19.2%), fair in 2 children (3.5%). No patients lost to follow up.Conclusion: Children up to 30 months (2 months - 2.5 years) age with congenital TEV can be treated with surgery successfully.

Evaluation of a Disease-specific Instrument for Idiopathic Clubfoot Outcome

In 2001, Roye et al. developed a disease-specific instrument (DSI) to measure outcomes of treatment for clubfoot. We assessed this instrument using a cohort of 62 patients, ages 5 through 12 years (mean, 8.6 years), with idiopathic clubfoot who were treated as infants by various methods. Treatment groups were defined by whether the patient received joint-invasive surgery (posterior or posteromedial release surgery) or joint-sparing treatment only (manipulation and casting with or without tendo-Achilles lengthening or anterior tibial tendon transfer). The DSI scales demonstrated internal consistency reliability of 0.74 to 0.85 using Cronbach's alpha. Higher (better) DSI scores were associated with "excellent" general health ratings and better health-related quality of life; lower DSI score were related to special healthcare needs. Patients treated using joint-sparing techniques only (eg, Ponseti technique) had higher DSI scores than those who had received joint-invasive surgery. DSI scores for patients who had received posterior or posterior medial release surgery were very similar to those reported by Roye et al. in New York for a comparable group of patients. Our findings suggest the DSI is sensitive to differences in treatment technique or underlying severity of disease. These data support the use of the Roye DSI as an outcome measure for idiopathic clubfoot in children. Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Correction of the pes equinus component in congenital clubfoot by freeing the triceps surae muscles and by tibiocalcaneal distraction

20 children, average age 9 months, were treated of 27 inborn deformed feet by a new method. It consists in a wide release of m. triceps surae and its tendon, posterior lateral and posterior medial release and lengthening of the muscle with the help of a personal distraction apparatus, leaving the tendon untouched. Control examinations from 9 months to 4.7 years after operation showed correction of the equinus component by an average of 49 degrees and correction of the profile of the talocalcaneal angle by an average of 34 degrees.

Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy

Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy. Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo-first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy. The average preoperative and postoperative talo-first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6 degrees and 26.8 degrees , respectively. The mean reduction in forefoot adduction was 17.8 degrees (P < .05). After the osteotomy, the average talo-first metatarsal anteroposterior angle was 16 degrees , with an average reduction of 10.8 degrees (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years. Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8 degrees was statistically significant and has also proved to be clinically significant in the overall correction of the deformity.

Operative management of congenital talipes equinovarus deformity: experience and reason

Background: Congenital talipes equinovarus is the most common congenital anomaly of the foot and ankle. The prevalence of this condition in our environment is not known due to dearth of medical literature on the subject. The aim of this study was to determine the outcome of our operative management of resistant talipes equinovarus by elongation of tendo-Achilles and posteromedial soft tissue release. Methods: We present a retrospective review of congenital talipes equinovarus treated by Elongation of tendo Achilles (ETA) and Posterior Medial Release(PMR) at National Orthopaedic Hospital Enugu over a 6- year period (January1995- December 2000). Results: There were 63(68%) males and 30(32%) females with mean age of 2.06 years at presentation (range 1/12-18years). There was positive family history in 6(7%) patients. More than half of the patients 63(68%) came without any formal referral. The mode of delivery was spontaneous vaginal delivery in 81(87%) and the first child appears to be more affected 22(24%). The deformities on presentation varied from talipes equinovarus 50(54%) to frank equinus in 3(3%) and fifty-four (58%) were bilateral. Sixty- three (68%) had initial treatment ranging from serial casting in 46(50%) to massage by traditional bonesetter in 2(2%) and the average duration of this initial treatment was 20weeks (range 2-106weeks). The average age at surgery was 2.5years (range 3/12-24 years). All patients received postoperative cast for an average of 13 weeks. The commonest post- operative complication was medial wound breakdown. The average duration of follow-up was 30 weeks (range3weeks-3years). Some patients were lost to follow-up immediately the cast was removed. As at last visit 90% were walking pain-free and do not require special shoe. The commonest residual deformity as at last visit was forefoot adduction in 17(18%) patients. Conclusion: Elongation of tendo-Achilles and posteromedial soft tissue release are common operative procedures for CTEV. The short-term result of these procedures appears very good in our environment. However, the long-term result cannot be effectively analyzed due to high rate of loss to follow-up Orient Journal of Medicine Vol. 18(1&2) 2006: 24-29

Talectomy For Recurrent And Resistant Talipes Equinovarus

OBJECTIVE: To report the results of talectomy in the treatment of recurrent/resistant talipes equinovarus deformity during the last twenty years at the National Orthopaedic Hospital Enugu. Nigeria. METHOD: Seventeen Patients (31 Feet) treated by talectomy for rigid non-bracable equinovarus deformities were reviewed. There were 9 males and 8 females. The average age at talectomy was 4 years. RESULTS: The primary diagnoses were Arthrogryposis multiplex congenital (AMC) in 12 patients, myelomeningocele in 3 patients, recurrent congenital talipes equinovarus (CTEV) in 2 patients. Twenty-seven feet had talectomy as a salvage procedure after repeated failed posterior medial release (PMR). The average follow up was 6.5years (1-14). As at last follow up 26 feet were plantigrade and pain-free and were considered satisfactory. CONCLUSION: Talectomy will not correct associated forefoot adduction Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 94-96

DISTAL CALCANEAL OSTEOTOMY IN RESISTANT TALIPES EQUINOVARUS

In resistant talipes equinovarus deformity, posterior medial release alone may be inadequate. Procedures involving the lateral column are sometimes necessary. Thirty-nine patients were treated by a distal calcaneal osteotomy and plantar fasciotomy. Good results were obtained in 30 of 39 patients; two had fair results and seven of 39 had poor results. Of the lateral column procedures, distal calcaneal osteotomy avoids the articular surfaces and provides for easier rotational positioning and correction of the forefoot. Older patients who have had multiple operations and, potentially, more severe pathology do not do well with this procedure. Preoperative evaluation of certain radiographic parameters is important in patient selection for these procedures.

Distal Calcaneal Osteotomy in Resistant Talipes Equinovarus

In resistant talipes equinovarus deformity, posterior medial release alone may be inadequate. Procedures involving the lateral column are sometimes necessary. Thirty-nine patients were treated by a distal calcaneal osteotomy and plantar fasciotomy. Good results were obtained in 30 of 39 patients; two had fair results and seven of 39 had poor results. Of the lateral column procedures, distal calcaneal osteotomy avoids the articular surfaces and provides for easier rotational positioning and correction of the forefoot. Older patients who have had multiple operations and, potentially, more severe pathology do not do well with this procedure. Preoperative evaluation of certain radiographic parameters is important in patient selection for these procedures.

Medial Subtalar Stabilization with Posterior Medial Release in the Treatment of Varus Feet: A Preliminary Report

The problem of the varus hindfoot in children ages six to 10 has been discussed. A preliminary follow-up is presented on six patients treated by extensive medial release, multiple tendon lengthenings, and subtalar intra-articular arthrodesis. Two of our patients revealed incomplete correction of the deformity because of technical errors in the medial release. However, there have been no failures of fusion and no progression of the deformity to date. This is a preliminary report and further follow-up is indicated. It should be noted that we have now extended our series to 40 patients.