Severe Clubfoot Research Articles

Correction of severe clubfoot by the Ilizarov method

Summary Thirty-four cases of severe relapsed or neglected clubfoot deformity were treated with the Ilizarov external fixator. The method was used in cases where traditional methods were not likely to produce good results. Three types of correction were performed; a ‘closed' correction of the deformity, where the external fixator is put on to the limb, and gradual correction is then performed with no further operation. The second treatment consisted of a combination of softtissue release and gradual correction. An osteotomy through the foot, combined with gradual correction, was performed for the other cases. Good results were achieved in 20/34 patients and satisfactory results in 11/34. A recurrence of the deformity or overcorrection occurred in three of 34 patients. Besides the three bad results there were many problems, but no major complications. In our opinion, the Ilizarov method proved to be advantageous for correction of severe clubfoot deformities.

Correction of clubfoot through a peritalar release using the cincinnati approach

Surgical Principles The Cincinnati approach described by Crawford et al. [1] allows a complete medial, posterior and lateral exposure of hind- and midfoot as well as a correction of any deformity of the subtalar, talonavicular, and calcaneocuboid joints (subtalar joint complex): Correction of the rotational malposition between talus and os calcis with simultaneous reduction of the talonavicular and calcaneocuboid joints. After wound closure the corrected position is maintained by a long leg cast. In severe clubfeet an additional fixation with Kirschner wires of the talonavicular and the subtalar joints may be indicated.

The pathogenesis of club foot. A histomorphometric and immunohistochemical study of fetuses

We studied 16 club feet and 27 normal feet from spontaneously aborted human fetuses in the second trimester of gestation and measured the length of the spring ligament, and the declination angle and size of the talus. We also studied the cellular characteristics of the spring ligament and the immunohistochemical features of the medial ankle ligaments using monoclonal antibodies against type-III collagen, desmin, vimentin, and smooth muscle actin. Histomorphometric results indicated that the talar deformity was not the primary lesion. Histological and immunohistochemical findings showed that the cells and collagen fibres of the medial ankle ligaments of club feet appeared to be the site of the earliest changes, in that they had lost their spatial orientation and had contracted. In severe club feet before the third trimester of gestation, myofibroblast-like cells seemed to create a disorder of the ligaments resembling fibromatosis. This led to contraction and resulted in typical club-foot deformity.

Long-Term Results of a Modified Radical Posterior Release in Moderate to Severe Clubfoot

Long-Term Results of a Modified Radical Posterior Release in Moderate to Severe Clubfoot

The use of a tissue expander in club-foot surgery. A case report and review

Primary skin closure after the surgical correction of severe club-foot may be difficult. We describe the use of a tissue expander to provide sufficient skin, and review some aspects of the use of the method.

Pseudodiastrophic dysplasia: A distinct newborn skeletal dysplasia

Pseudodiastrophic dysplasia is a distinct disorder that differs from diastrophic dysplasia on the basis of clinical, radiographic, and chondro-osseous histopathologic findings. In addition to the rhizomelic shortening of the limbs and severe clubfoot deformity, which suggest the diagnosis of diastrophic dysplasia, distinguishing features are elbow and proximal interphalangeal joint dislocations, platyspondyly, and scoliosis, which are observed in infancy. This disorder has been reported previously in three infants, all of whom died in the first year of life. Two of these were sisters, suggesting autosomal recessive inheritance. We report four new patients with this distinct skeletal dysplasia, including two children now older than 4 years of age. In both of these patients neonatal contractures have improved with physical therapy and scoliosis has progressed significantly.

Plastic AFO for Severe Talipes Varus in Cerebral Apoplexy

Plastic AFO for Severe Talipes Varus in Cerebral Apoplexy

Pathogenesis of Idiopathic Clubfoot

During embryonic development the foot passes consecutively into three different positions: (1) when the embryo is in the 15-mm stage the foot is in a straight line with the leg (initial position); (2) by 30 mm the foot passes to a marked equinovarus-adductus position (embryonic position); and (3) finally, by 50 mm, the foot changes to a slightly equinovarus adductus position (fetal position). The morphologic and structural changes of the foot from the initial to the embryonic position result from the growth of the distal ends of the fibula and of the skeletal elements of the lateral foot during the "fibular phase" of rapid growth (from 21 to 30 mm). The changes from the embryonic to the fetal position are due to the growth of the distal ends of the tibia and of the skeletal rays of the medial foot during the "tibial phase" of rapid growth. Many known noxious industrial chemicals (and probably many more yet to be recognized) have antimitotic and antimetabolic action. Depending on the characteristics of the chemical, some produce permanent arrest and therefore congenital malformation, while others cause temporary growth arrest, e.g., Harris transverse lines, which is frequently unnoticed. Finally, some substances, e.g., glucocorticoids, cause a growth delay. Depending on the developmental stage of the embryo and the duration of the action of the noxious substance, growth arrest of the foot occurs in an attitude close to the embryonic position. If it occurs at the end of the fibular phase and during the first half of the tibial phase, the foot will remain in a permanent and marked equinovarus-adductus position, and a severe clubfoot will result. When a noxious chemical acts only during the last half of the tibial phase, a mild, flexible clubfoot will result because by this stage most parts of the embryonic components have been corrected. If it occurs at the end of the tibial phase, a simple metatarsus adductus deformity will persist. As soon as the growth arrest phase ends, all of the skeletal elements begin to grow again, but only from a later point in development. If the growth disturbance occupies the entire tibial phase, neither the tibia nor the skeletal elements of the foot would be able to complete a rapid growth spurt, since by that stage the moment genetically programmed for such growth has already passed. The morphology of the deformities existing in the clubfoot corresponds to the morphologic program of the embryonic foot.(ABSTRACT TRUNCATED AT 400 WORDS)

A review of the Dillwyn Evans type collateral operation in severe club feet: A. Addison, J. A. Fixsen, and G. C. Lloyd-Roberts. J Bone Joint Surg 65B:12–14, 1983

A review of the Dillwyn Evans type collateral operation in severe club feet: A. Addison, J. A. Fixsen, and G. C. Lloyd-Roberts. J Bone Joint Surg 65B:12–14, 1983

A review of the Dillwyn Evans type collateral operation in severe club feet.

A modified form of the collateral operation originally described by Dillwyn Evans has been used in severe relapsed club feet to correct the sagittally breached or bean-shaped foot. Forty-five feet in 37 patients were followed up for an average of nine years and nine months. Previous operations had been performed on 42 feet. Thirty out of 45 feet were considered satisfactory at review when evaluated by a simple, functional system of scoring. The majority of the feet were stiff but relatively free of pain and able to fit into normal shoes. The collateral operation was considered successful in 42 feet if the patient's ability to take part in any desired sporting and recreational activities was taken as the criterion for success.

SEVERE CONGENITAL TALIPES EQUINOVARUS

1. The movements of the talus are described with particular reference to the anatomy of congenital talipes equinovarus. 2. It is suggested that the fundamental deformity in severe club foot is the fixed plantar-flexion of the talus. 3. Early operation is advised whenever serial stretching fails to bring the heel quickly into its normal position.

FLEXOR ACCESSOREUS LONGUS

1. An unusual muscle anomaly found during an operation for a severe club foot is recorded. 2. This muscle fitted the description of the flexor accessoreus longus and may add support to the phylogenetic theories of development of the long flexor muscles suggested by Wood Jones.

The Radical Treatment of Severe Talipes Equino-Varus in Children

The Radical Treatment of Severe Talipes Equino-Varus in Children