Treatment Of Congenital Clubfoot Research Articles

Chirurgie du pied-bot varus équin congénital au centre pour handicapés physiques Don Orione de Côte-d'Ivoire (À propos de 554 pieds)

Ojectives Treatment of congenital clubfoot improved in occidental country. We have studied the epidemiology, clinical and therapeutic aspects of this malformation in the context of Africa. Patients and methods This was a retrospective study. Two thousand five hundred and sixty-two patients were hospitalised and operated during 12 years, 362 of them were diagnosed with congenital clubfoot. This represented 14,1% of the surgical diseases, with an incidence of 30,2 cases per year. The male to female ratio was 1,6:1, and ages ranged from 4 months to 38 years old, 59% of which were less than 15 years old. Two hundred and four (56,3%) patients had bilateral disease, 93 (25,7%) had right side disease and 65 (18%) had left sided disease. Considering the classification types we noted in our patient population 82% type III, 5% type II, 3% type I and 10% were undefined. Results Posteromedial approach describe by Codivilla was used in 45,5% of cases. Codivilla approach associated with lateral access to the foot in 44,4% of cases, with dorsal access in 2,3%. Few patients (7,8%) have had another approach. One hundred and seventeen patients received physiotherapy prior, but all the patients operated have postoperative physitherapy while wearing orthopaedic shoes. Results obtained were: good in 510 cases (92%), quite good in 35 cases (6,3%), fairly good in 7 cases (1,3%) and mediocre in 2 cases (0,4%). Conclusion The surgical aspect is still only a fraction of the entire treatment. It is imperative that physiotherapy is started immediately and orthopaedic shoes be worn postoperatively.

Evaluation of Outcome of Treatment of Congenital Clubfoot

The study was undertaken to determine whether existing systems of outcome evaluation of clubfoot are comparable; to determine the relationship between the shape of the foot, its function, and radiological tarsal relationships; and to identify which objective variables used in the assessment of clubfeet are reproducible. Fifty treated idiopathic clubfeet were assessed by the scoring systems of Laaveg and Ponseti, McKay, Magone, and Ghanem and Seringe. Although there was a good correlation between the scores, there was very poor agreement between the grading of feet by these different systems. The feet were also evaluated using a new scoring system that has 3 domains of evaluation, viz, morphological, functional, and radiological. Comparison of the scores in each of these domains showed that there was a correlation between morphology, function, and radiological measurements of tarsal alignment. Several of the criteria used in this new scoring system were reproducible.

Factors Affecting Compliance in the Treatment of Congenital Clubfoot: The Uganda Clubfoot Project

Factors Affecting Compliance in the Treatment of Congenital Clubfoot: The Uganda Clubfoot Project

The Ponseti Method for Clubfoot Correction

The Ponseti technique is rapidly becoming the most widely practiced method for initial treatment of congenital clubfeet in infants. It is an easy technique to learn and, when applied accurately, yields excellent results. It consists of gentle manipulation and casting of the feet at weekly intervals. The first cast is applied with the foot supinated and attention directed to elevating the first ray. Subsequent casts are applied to abduct the foot around the head of the talus, taking care never to directly manipulate the calcaneus. At the time of the final cast, the overwhelming majority of infants require a percutaneous Achilles tenotomy to allow sufficient dorsiflexion. The final cast remains in place for three weeks, at which time the infant is placed into a foot abduction orthosis. The orthosis is worn 23 h per day for 3 months and then at night for several years. Good results have been demonstrated at multiple centers and long-term results indicate that foot function is comparable with that of normal feet.

The Ponseti Method of Treatment for Congenital Clubfoot: Importance of Maximal Forefoot Supination in Initial Casting

The correction of cavus deformity requires further supination of the forefoot. In the Ponseti method, the initial cast is applied with the forefoot supinated such that the plane of the metatarsal heads is parallel to the long axis of the tibia. This study reviewed Pirani scores of 27 patients with 38 clubfeet treated over an 18-month period by the Ponseti method to evaluate changes in midfoot deformity after the initial cast. Initial average scores for severity of the lateral border deformity, medial crease, and talonavicular joint reducibility decreased from 0.92, 0.75, and 0.75, respectively, to 0.73, 0.25, and 0.5, respectively, after the first cast. The improvement in Pirani scores provides support for the efficacy of the initial cast to reduce the cavus and also increase the reducibility of the midfoot. Failure to address the cavus deformity with the initial cast as described by Ponseti may lead to persistent rigidity and incomplete correction.

Non-Surgical Treatment of Congenital Clubfoot

Objective: To evaluate how effective was the conserva-tive treatment in managing congenital talipes equinovarus deformity. Methods: This is a retrospective study of 25 children treated with manipulation, casting followed by percutane-ous tenotomy at the age of thee months with casting till age of walking with a follow-up between 2-5 years 25 pa-tients 18 males 7females M\F (2.6-1), 19 bilateral (15 My 4 F), 6 unilateral (3 M, 3 F) total of 44 feet. Result: The first three months offer the skilled and knowledgeable surgeon a golden opportunity to correct the deformity by manipulation and casting. Proper manipula-tive techniques followed by the applications of well-molded plaster casts offer the best and safest correction of most clubfeet in infants. Failures of manipulative treatment usually occur when the surgeon lacks a thorough knowledge of the kinematics and pathological anatomy of the deformity. Conclusion: CTEV can be treated by manipulation, casting and ETA in about 70% of cases with good results if managed early and by skilled orthopedic surgeon. Some feet are unpredictable and in spite of the severity of the deformity, respond well to conservative treatment.

The value of radiological examination in the assessment of the long term results of congenital clubfoot treatment

Aim: The aim of that paper was to analyze correlations between clinical and radiological assessment of the long term results of the congenital clubfoot treatment.

Principles involved in the treatment of congenital club-foot. 1939.

The purpose of this paper is to make a plea for conservative treatment of congenital club-foot and to call attention to certain mechanical and pathological principles involved. It is the author's experience that most club feet can be successfully corrected by a series of plaster casts and wedgings, without the use of anaesthetics, forcible manipulations, or operative procedures, and with far better results. ...Ninety per cent of all cases of club-foot which the author has treated have been corrected by plaster casts and wedgings. The …

Effect of the Denis Browne splint in conservative treatment of congenital club foot

Effect of the Denis Browne splint in conservative treatment of congenital club foot

Effect of the Denis Browne splint in conservative treatment of congenital club foot

Effect of the Denis Browne splint in conservative treatment of congenital club foot

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.

Nonsurgical Treatment of Congenital Clubfoot with Manipulation, Cast, and Modified Denis Browne Splint

Between 1974 and 1988, 113 congenital clubfeet in 76 children were consecutively treated by using a modified Denis Browne splint with an aluminum crossbar between a pair of plastic shoe inserts after a few manipulations and a corrective cast. Splintage was followed by surgery in 41 (36%) feet. Sixty-nine feet that did not undergo surgery were evaluated after an average follow-up period of 12 years. Sixty-six (95%) feet were excellent or good, according to the McKay rating system. The success rate of this treatment was 60% when the 41 feet receiving surgery and the three feet with fair or poor outcome were evaluated as failures. The success rate was 42% in severely deformed feet, 70% in moderately deformed feet, and 100% in mildly deformed feet. This treatment was effective for congenital clubfoot with mild or moderate deformity and was sometimes effective for severe deformity.

Results of Surgical Treatment of Congenital Clubfoot

Results of Surgical Treatment of Congenital Clubfoot

Common errors in the treatment of congenital clubfoot.

The conservative treatment of clubfeet in newborn babies is detailed, and the pitfalls in the treatment are commented.

CONGENITAL CLUBFOOT. FUNDAMENTALS OF TREATMENT. Ignacio V. Ponseti. New York, Oxford University Press, 1996. $125.00, 140 pp.

This fascinating little book emphasizes the importance of a more temperate operative approach to the treatment of congenital clubfoot in children and stresses the importance of manipulation, stretching, and the use of casts. In the preface, the author states: “Our treatment, supported by limited operative interventions and based on a clear understanding of the functional anatomy of the foot, has yielded optimum results in …

The Treatment of Congenital Clubfoot

The clubfoot in otherwise normal children occurs in about 1 in 1,000 live births. In recent times, most orthopaedic specialists regard surgery as the treatment of choice for patients with clubfoot; however, most clubfoot treated in the first weeks of life can be corrected with proper manipulations. J Orthop Sports Phys Ther 1994;20(1):1. doi:10.2519/jospt.1994.20.1.1

Knee, lower leg, foot, and ankle disorders in children.

The literature of the past year increased our understanding of the etiology of some common lower leg disorders in children, and increased our knowledge about the results and complications of some old and new treatment methods. Histochemical and vascular studies and magnetic resonance imaging were used to study the etiology and treatment of congenital clubfoot. Results of early intervention protocols and the ilizarov method were reported. Undercorrection at primary surgery was identified as a major reason for reoperation. Excision of the coalition with interposition of fat or tendon produced good results in selected children with middle facet talocalcaneal coalition. A footprint-measuring system can differentiate among a normal foot, a flexible flatfoot, and a rigid flatfoot. Classification of metatarsus adductus was questioned, and polydacytyly of the foot was classified in detail. The treatment of leg length discrepancy and angular deformities by osteotomy, hemiepiphysiodesis, and external fixation techniques was described. Several treatments were reported for congenital pseudarthrosis of the tibia. In all, the reports of the past year offer hope for improving the results of treatment by better understanding, innovative surgical techniques, and better methods to determine timing of surgery and predicting results.

Treatment of congenital club foot.

Treatment of congenital club foot.

Conservative Treatment of Congenital clubfoot with Strapping and New Ankle-Foot Orthosis

Conservative Treatment of Congenital clubfoot with Strapping and New Ankle-Foot Orthosis

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.