Severe Clubfoot Research Articles

Outcomes of Management of Severe Clubfoot among Children by Ilizarov External Fixator.

Clubfoot remains the most common birth defect involving the musculoskeletal system. There are various surgical and non-surgical treatment options available for the management of clubfoot. Using the minimally invasive Ilizarov external fixator method has been reported to have good success rates and fewer complications. This study aimed at analysing the morphological and functional outcomes of treating severe clubfoot by Ilizarov external fixator among children from July 2017 to March 2020. Thirty-two children who had either failed Ponseti / surgery or neglected with 44 clubfeet of Dieglio type III and type IV were included in the study. A short-leg walking cast was applied for an additional six weeks after removing of Ilizarov frame and additionally followed by an orthosis for another six weeks. Outcomes were measured by the functional rating system by Laaveg and Ponseti and interpretation done at 1 month and 12 months after the ankle-foot arthrosis. About 86.4% of the patients had good or excellent outcome scores. Pre and post-Demeglio scores and functional rating scores were statistically significant (p<0.001) by using Paired t-test. Complications included superficial pin site infections in 13 feet (29.54%), 5 feet (11.36%) had claw toes, 3 feet (6.81%) had linear skin necrosis and 2 feet (4.54%) had calcaneal fractures which were manageable with minor interventions. The study findings highlighted that the Ilizarov external fixator method can correct complex foot deformities of severe clubfoot with minimum morbidity. Further larger and long-term studies are needed to investigate the effects of the stiff hindfoot and possible degenerative changes on the function and symptoms of these patients as adults.

First report of SYNE1 arthrogryposis multiplex congenita from Saudi Arabia with a novel mutation: a case report

BackgroundMyogenic Arthrogryposis Multiplex Congenita type 3 (AMC-3), is a rare congenital condition characterized by severe hypotonia, club feet, and multiple joint contractures often affecting both arms and legs which start prior to birth.Case presentationWe report a full-term neonate born to first-degree cousins from fourth-generation consanguineous families, who had with antenatal history of reduced fetal movements. At birth, he was noticed to have bilateral club feet, arthrogryposis, severe hypotonia, and absent deep tendon reflexes. The patient developed difficulty in breathing probably attributed to his generalized severe hypotonia, necessitating mechanical ventilation.His creatinine-phospho-kinase, electromyogram, and brain magnetic resonance imaging were normal. Whole-exome sequencing (WES) was requested for the genetic diagnosis of the case.WES identified a novel homozygous variant c.23415-3799C > G p. in the synaptic nuclear envelope protein1 [SYNE1] gene. Seven out of 20 bioinformatic in silico programs predicted a pathogenic effect for this variant. Segregation analysis of the variant in the parents and siblings revealed that both parents and one sibling were heterozygous for the same mutation which proved the variant significance and its autosomal recessive pattern of inheritance.ConclusionsAMC3 should be suspected in patients with decreased fetal movements, severe hypotonia, absent deep tendon reflexes, and arthrogryposis. SYNE1 gene mutations can be the underlying genetic defect and molecular genetic testing can prove the diagnosis.

Rational selection of treatment methods in recurrent clubfoot

Objective.Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods.The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results.In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion.In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method?

BackgroundCongenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial.MethodsPatients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented.ResultsOne hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %( n = 12). The mean initial Pirani score (P < 0.001) and the mean initial Dimeglio score (P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) (P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction.ConclusionIn our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature.

Change in the severity of congenital clubfoot in the first week of life

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction.&#x0D; Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment.&#x0D; Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores.&#x0D; Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth.&#x0D; Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

Management of clubfoot in children above 5 years with differential distraction using joshi external stabilizing system

Introduction: Ponsetti's technique is the recommended procedure for treating idiopathic clubfoot in children below the age of 2 years, and the same is also followed in some severe clubfoot deformities including neglected, recurrent and resistant forms who eventually may need surgical intervention. In children >5 years of age (children belonging to 5–10 years), open surgical procedures make the foot rigid with soft-tissue surgery, and bony operations can make the foot even smaller. Simultaneous correction of all aspects of deformity by differential distraction using external fixator rescues the foot from such complications. Joshi's external stabilizing system (JESS) can be used to gradually correct the deformities by differential distraction. In comparison to Ilizarov ring fixators, these are lighter in weight, shorter, cheaper, and have an easier application. Purpose: The purpose of this study is to analyze the role of JESS fixator in correcting cases of clubfoot in children >5 years in terms of morphological, functional, and radiological outcomes which were assessed using the International Clubfoot Study Group (ICFSG) scores. Materials and Methods: Five consecutive children with eight clubfoot >5 years underwent differential fractional distraction in our hospital. Period of correction varied from 6 to 8 weeks, including the distraction phase and static phase. Follow-up was done by application of cast in plantigrade position for double the duration of corrective distraction. Patients were assessed preoperatively and postoperatively at 6 months for morphology, functionality, and radiological correction by the ICFSG score. Results: Excellent to good results were obtained in all cases, which were assessed using ICFSG score, with only minor complications in patients. Conclusion: JESS frame is simple, versatile, and best suited for correcting clubfoot deformities, which were neglected, resistant and recurrent, and also with residual deformity, even in the children above the age of 5 years with advanced osteoarticular development and higher rigidity.

The treatment of neurotrophic foot and ankle deformity of spinal bifida: 248 cases in single center

Objective:To evaluate the functional outcome of foot and ankle deformity secondary to spinal bifida treated by various methods.Methods:A retrospective analysis of 248 patients with foot and ankle deformity secondary to spina bifida with an average age of 25.5 years and underwent surgical treatment in our hospital from March 2012 to April 2016. The deformity correction was achieved by various methods like soft tissue procedure, bony procedure combined with external fixator application. All the patients were followed up at regular interval. Post operative rehabilitation and protective splints were provided after fixator removal. The final outcome was evaluated with American Orthopedic Foot and Ankle Society (AOFAS) score and Qin’s criteria for deformity correction, matched T-test was used to compare the data pre and post surgery.Results:According to the short term follow up, all these patients were achieved complete correction and able to achieve full weight bearing. Out of 248 patients, 13 patients were lost follow up. 235 patients were followed up for an average of 28.5 months. We noted various minor complications like superficial pin tract infection was seen in 5, pin breakage in 4, pin tract burn injury in 1, and recurrence of deformity was noted in 20 patients especially in children, anterior dislocation of the tibiotalar joint in 3 patients with severe clubfoot deformity. At the final follow up, the mean AOFAS score increased to 88.7, with a significant improvement compared with the score before surgery (P &lt; 0.05). Based on Qin’s criteria for deformity correction, the outcome was graded as excellent in 180 patients, good in 55, and fair in none of the cases.Conclusion:Through orthopaedic treatment, combination of soft tissue and bony procedures along with external fixator helps to achieve complete correction of deformity, healing of ulcer, restoration of functional activity for spinal bifida sequelae patients.

A novel 3D evaluation method for assessing bone to bone relationships in clubfoot.

Clubfoot is a complex congenital three-dimensional foot deformity, which affects 150,000-200,000 newborn babies annually around the world. A good understanding of the alignment of the two osseous columns and the lower leg of the ankle and foot complex is essential for evaluating the severity of clubfoot. The purposes of this study were to (1) develop an automated three-dimensional (3D) surface model of severe clubfoot based on two-dimensional (2D) slices of computed tomography (CT) images, (2) evaluate the alignment of foot bones relative to the ankle in severe clubfoot, and (3) examine the structural changes in the shape of the clubfoot. Two-dimensional CT image was taken from a four-year-old child with a severe clubfoot. Subsequently, an automated and detailed 3D surface model of the severe clubfoot was developed from the 2D images by using MATLAB software programming. Then, the x, y, and z coordinate angles were automatically calculated for each bone in the foot relative to the ankle (lower end of the tibia) to determine the orientations and relationships among the bones. The relative position or orientation of each bone of the foot to the ankle of the severe clubfoot was objectively measured which was used to determine the orientation of each bone in the foot. Among the x, y, and z axes of the interested tarsal bones, the z axis represents the smallest moment of inertia, and the results showed that the bones in the x axis shifted medially with higher relative angle. This 3D objective measurement method for assessing clubfoot can be used to determine and classify the severity of clubfoot, as well as evaluate and monitor the progress of the clubfoot intervention based on the relative position of the tarsal bones. The method can also be used to quantify the relationship between the tarsal bones of the foot and lower end of the tibia. In addition, angular measurements can be used to assess other pathological conditions of the foot such as pes cavus and pes planus.

Early results of clubfoot management by Joshi's external stabilizing system

Introduction: With the use of Ponseti's technique, majority of children with clubfoot do not need operative treatment; however, some severe clubfoot including neglected, recurrent, and resistant forms cannot be managed by conservative methods and needs surgical intervention. The foot becomes rigid with soft tissue surgery, and bony operations can make the foot even more smaller. To avoid it, a simple alternative is to use joshi's external stabilising system (JESS) and distractor components which are used on the principle of controlled differential fractional distraction histogenesis. JESS distractors allow gradual distraction of contracted soft tissues and align all the joints of the foot so as to bring corrections of all aspects of deformity of the foot simultaneously. Purpose: To analyze the role of JESS fixator in correcting case of clubfoot in terms of cosmetic, functional, and anatomical outcome which were assessed by International Clubfoot Study Group (ICFSG) scores. Materials and Methods: Total of 6 Clubfoot underwent differential fractional distraction in AIIMS, Raipur. Patients were assessed preoperatively for morphology and functionality and radiologically by ICFSG score. Period of correction varied from 5 to 8 weeks. Once correction is obtained, then apparatus is locked in that position for the same period and later converted to cast in plantigrade for maintenance and followed up regularly. The results were analyzed with ICFSG score. Results: Excellent to good results were obtained in all the cases which were assessed by ICFSG score. There were only minor complications in patients. Conclusion: JESS frame is simple, versatile, and best suited for correcting clubfoot deformities which were neglected, resistant, and recurrent.

Complex iatrogenic clubfoot: is it a real entity?

In our study, we aimed to demonstrate whether a complex iatrogenic clubfoot really exists; identify the causative mechanisms; and determine the outcome if properly treated. We observed 54 clubfeet previously treated unsuccessfully by manipulation and casting elsewhere. All the feet had been classified at diagnosis as typical clubfeet. In 26 cases, the cast had slipped down, entrapping the foot in a plantar-flexed position. Nine clubfeet out of those 26 cases presented the clinical features of a complex iatrogenic deformity. These were treated with the modified Ponseti protocol and evaluated at follow-up according to the International Clubfoot Study Group Score. The length of follow-up averaged 7.2 years. Two feet showed an excellent result, five feet showed a good result, and two feet showed a fair result. The relapse rate was 55% in complex clubfeet. Relapsed clubfeet were treated by Achilles tenotomy or lengthening and anterior tibial tendon transfer. We believe that faulty manipulation and a poor casting technique may convert a typical clubfoot into a complex iatrogenic deformity. Risk factors include severe clubfoot, short and stubby foot, and unmolded casts slipping down.

Perfusion Is Not Measurably Decreased in Idiopathic Clubfoot

Vascular aberration has been accepted as a potential etiology of clubfoot, and abnormal vasculature has been observed in as high as 85% of children with severe clubfoot. The perfusion index (PI) corresponds to the ratio of pulsatile to nonpulsatile blood flow at a monitoring site and can be used to quantify perfusion of the extremities. The purpose of this study was to use PI to compare the perfusion of clubfeet to controls in order to further assess the role of abnormal vasculature in clubfoot.A Masimo Radical 7 Pulse Oximeter (Masimo Corporation, Irvine, California) was used to measure the PI and oxygen saturation (SpO2) of the feet of children 5 years of age and younger with and without clubfoot. The sensor was placed on the great toe. Patients with clubfoot undergoing non-operative treatment and control patients undergoing treatment in a clinic for orthopedic concerns not involving the foot and with no known vascular issues were assessed. The PI and SpO2 for the following three groups were compared: 1. affected feet of patients with bilateral or unilateral clubfoot, 2. unaffected feet of patients with unilateral clubfoot, and 3. control feet.One hundred and twenty-eight patients were enrolled, 64 with clubfoot (31 bilateral and 33 unilateral) and 64 controls. No significant differences in PI or SpO2 were found between: 64 clubfeet and 64 feet of controls (PI of 2.9 vs. 2.9, p = 0.984; SpO2 of 97.1 vs. 98.1, p = 0.192); unaffected feet of 30 patients with unilateral clubfoot and 64 controls (PI of 3.0 vs.2.9, p = 0.907; SpO2 of 96.9 vs. 98.1, p = 0.224); and affected and unaffected feet of 30 patients with unilateral clubfoot (PI of 3.3 vs.3.0, p = 0.500; SpO2 of 97.4 vs. 96.9, p = 0.527).No difference was observed in the PI or SpO2 when comparing affected clubfoot limbs with unaffected limbs, suggesting that vascular anomalies cannot fully explain the development of clubfoot.

Arterial tree anomalies in patients with clubfoot: an investigation carried out at Soba University Hospital.

Vascular deficiencies and reduced perfusion of the anterior tibial artery and the dorsalis pedis artery were suggested as causes of congenital talipes equino varus (CTEV). In this study, we assessed the prevalence of arterial abnormalities in patients with CTEV (50 patients; 74 feet) compared with a normal control group (16 patients; 32 feet) by Doppler ultrasound and Ankle Brachial Index. The flow was normal in the control group and was deficient in 39.19% of clubfoot patients. In severe clubfoot cases, the deficiency was found to an extent of 76.67%. In conclusion, the anterior tibial artery and dorsalis pedis artery are deficient in CTEV patients; to avoid postoperative skin sloughing, arterial supply must be protected using a judicious incision.

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

The Pirani and Dimeglio scoring systems both have excellent inter-observer and intra-observer reliability, but no research has been conducted to determine their inter-observer reliability and their relationship at different levels of deformity. A total of 173 idiopathic clubfoot cases were reviewed using Pirani and Dimeglio scoring systems, and the number of casts needed was also recorded. For clubfeet with a cast number equal to 2 or 7 and 8, the inter-observer reliability of the two scoring systems was poor or moderate, and there was no correlation between the two scoring systems. There was also no correlation between the Dimeglio scoring score with the number of casts for grade II or IV clubfeet. A binary regression of the number of casts on initial Pirani or Dimeglio scores showed that there was a Quadratic or Cubic relation between the scores and the cast numbers. In conclusion, in the case of mild and very severe clubfoot deformity, the interobserver reliability and its ability to predict the number of casts needed for clubfoot deformity correction was poor. A more objective evaluation system may be required.

Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet.

The purpose of this study was to determine the long-term results, at an average follow-up of 22 years, in 66 patients (105 clubfeet) with very severe congenital idiopathic clubfeet according to the Dimeglio-Bensahel scale. Patients were treated with an extensive soft tissue release in infancy. Results of the treatment were assessed according to the 100-point system of Ghanem-Seringe. At the latest follow-up, all participants were evaluated with regard to pain and the overall function of the lower extremities. At the latest follow-up, anteroposterior and lateral radiographs of the affected foot and the contralateral normal foot, when applicable, were performed. In total, 92% of the patients were satisfied. The mean functional score of Ghanem-Seringe was 70.4 points. No foot had an excellent result, 19 feet had a good result, 16 had a fair result, and 70 had a poor result. A total of 86 feet were painful after strenuous activities or during walking. Eleven patients walked with a limp. In total, 82 feet were stiff. Ankle dorsiflexion and plantar flexion averaged 4.0±4.5 degrees and 19.9±10.7 degrees. Bone deformations such as flattening of the talar dome were observed in 93 feet. Among these feet, the Ghanem score was significantly lower (P<0.05). Necrosis of the navicular was present in 28 feet and subluxation in 82 feet. In total, 32 feet had moderate osteoarthritis. Results revealed that despite anatomically and radiologically imperfect clubfeet, most patients demonstrated satisfaction. Satisfaction was not significantly correlated with residual deformity, but with the sensation of a normal gait by the patient and the high initial Dimeglio-Bensahel score. Female patients were significantly less satisfied than male patients because they were more constrained in their social life than boys. Their main dissatisfaction was the atrophy of the calf. We noted several residual deformations. Plantar release seems to contribute to the high rate of overcorrection in our series. Extensive posterolateral and plantar releases in very severe clubfeet was responsible for sequelae, morphologic, anatomic, and functional, especially in adulthood. Deterioration of results over time was confirmed by our series. Level IV.

Medial to posterior release procedure after failure of functional treatment in clubfoot: a prospective study.

PurposeTwo conservative techniques for clubfoot treatment are still being debated and depend upon the institution’s expertise. For >40 years, the current institution has been a pioneer in the development of the physiotherapy method; however, some severe deformities remain resistant to this method which causes pain, sprains, and difficulties wearing shoes. Therefore, a surgical approach was developed simultaneously for the treatment of these residual or recurring clubfeet. The procedure reproduces the same chronological steps by performing forefoot derotation before correcting hindfoot equinus. The aim of the current study was to assess the results of this surgical technique.MethodsAll clubfeet undergoing surgery between October 1995 and February 2009 were prospectively included. Initial severity was based on Dimeglio’s classification and final outcomes on the International Clubfoot Study Group (ICFSG) outcome evaluation system. Last follow-up results were assessed by physical examination and radiographs.ResultsA total of 137 patients with severe clubfeet (mean Dimeglio score 12.0) underwent surgery. At the mean follow-up of 10.8 years, mean ICFSG score was 4.3 (range 0–23), and 12 % required revision surgery. The rate of undercorrection and overcorrection was low (17 pes-plano-valgus ft and 11 ft with undercorrection). Eight feet had a fixed deformity.ConclusionsSevere deformities are more resistant to conservative techniques even for institutions with large experience. These deformities require further treatment, including surgery if necessary. The medial to posterior soft-tissue release is a valuable technique with stable results.Level of evidenceLevel IV.

Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method

Abstract Objectives The purpose of this study was to determine the compliance of parents of children with clubfeet treated with the Ponseti method and to identify factors that may predict brace non-compliance. Methods A myriad of factors affecting families' compliance were assessed by administering questionnaires to 108 patients with clubfoot from December 2009 to January 2012. The family's demographic data, including monthly income, educational level of the parents, number of children in the family, and other factors, were studied and statistically analysed. Results All 108 patients had severe clubfoot. The parents of 72 (66.7%) patients complied with the use of the brace compared to 36 (33.3%) parents who did not comply. Unilateral clubfoot was a significant risk factor for non-compliant parents compared to bilateral clubfeet (p = 0.05). Parents with 3 or more children had more non-compliance (66.7%) compared to those with less than 3 children (38.9%). All non-compliant parents reported that their babies cried during the application of the brace in contrast to 25% of the complaint parents (p Conclusion More children per family, unilateral clubfoot, and the inability of a single parent alone to apply the brace were found to be major risk factors for brace non-compliance. Families' awareness about the importance of the brace and encouragement might improve brace compliance.

300 neonatal clubfeet evaluated at birth: statistical analysis

Aim - to study the initial parameters of clubfeetbefore treatment, to analyze clubfoot population.— Materials and methods. The research includes196 neonates with a total of 300 clubfeet. All feetwere initially evaluated during the first day of life.Patients with myelomeningocele, arthrogr yposisand other syndromes were not included. The initialclubfoot severity was evaluated according to Piraniand Dimeglio scales. Patients with Dimeglio I and IItypes of clubfeet were excluded from the study. Thefollowing criteria were analyzed: gender, unilateralor bilateral involvement, family history and prenatalclubfoot visualization.— Results and conclusions. Female/male ratio was1 : 2,16. Unilateral/bilateral clubfoot ratio was 1 : 1,13.Left side/right side ratio in unilateral clubfoot groupwas 1 : 1,79. Family history was positive in 24 of196 patients (12,2 %). Clubfoot was prenatally detected in 98 patients (50 %). Most of clubfeet had Dimeglio III type (88 %) and only 12 % were Dimeglio IV. In bilateral cases the right foot was more severely affected than the left one in 64 % of the patients. 48 clubfeet in 34 patients were evaluated at birth and on 7th day of life provided no treatment was performed. The deformity increased significantly in 100 % of cases. Clubfoot was more often observed among boys. In cases of unilateral clubfoot it is the right foot that is involved more often than the left one. Most patients do not have any family history of clubfoot. The most severe clubfoot type (Dimeglio IV) was found much more rarely than Dimeglio III. The clubfoot severity progressed significantly in all the affected feet during the first week of life.

Extracorporeal Shock Waves in the Treatment of Equinovarus Foot in a Duchenne Patient: A Case Report

Background: Duchenne muscular dystrophy (DMD) is characterized by a progressive muscular weakness, with loss of independent ambulation. When the disease results in the complete loss of ambulation, one of the purposes of treatment during the latest phase is to prevent or reduce complications such as foot deformities. A 20-year-old DMD patient had a complete loss of muscular strength in the inferior and superior limbs and a severe bilateral clubfoot deformity. Active movements were not possible, while passive motion was very limited in dorsiflexion and pronation, inversion and eversion, with stronger limitation on the right foot.

Ponseti casting for severe club foot deformity: are clinical outcomes promising?

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13 ± 7.2 versus 9.2 ± 18), it was not significant (P = 0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was 16 ± 3.4 and at the end of follow-up it was 1.6 ± 6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents' were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

Conservative treatment of severe clubfoot using a novel functional dynamic splint.

Forty-six severe clubfeet in 29 patients were treated by serial castings, followed by a newly developed dynamic splint. The mean period of splint usage was 59.9 months and the mean period of follow-up was 81.5 months. Of the patients, 76.1% were satisfied, 87.0% had no functional deficit, and 84.8% had no pain. Radiographical evaluation showed good correction. The mean dorsiflexion angle was -0.8° at the end of cast treatment and 13.6° at the time of the final follow-up. This study clearly showed the effectiveness of a functional dynamic splint for the correction of equinus in cases of severe clubfoot.