Varus Foot Research Articles

Effects of Microselective Neurotomy on Focal Spasticity and Description of the Surgical Technique

We studied the microselective neurotomy (MSN) and its advantages to alleviate disabling spasticity. The best indication for MSN is focal spasticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 patients. The initial causes were: stroke, cranial trauma, postoperative complications and multiple sclerosis. MSN procedures were performed on the median nerve (n = 40) for wrist and finger flexion; musculo-cutaneus nerve (n = 38) for elbow flexion; ulnaris nerve (n = 9) for cubital deviation of the hand; gastrocnemius nerve (n = 98) and soleus nerve (n = 49) for equinus foot, tibial posterior nerve (n = 45) for varus foot, and fascicles (or bundles) of the flexor digitorum for “claw” toes (n = 19). The main preoperative test to identify the responsible nerve was a neuromuscular block with local anesthesia (lidocaine or bupivacaine) injected into the site of the nerve connecting the spastic muscle. During surgery, the identified nerve was exposed and its epineurium opened. Nerve bundles were teased apart into individual rootlets and a number of rootlets cut were previously planned, according to the spasticity. Follow-up was performed for up to 10 years, with a mean period of 29 months. Results demonstrated a reduction of limb spasticity of 2 to 3 points: modified Ashworth scale (MAS). Pain and clonus were also diminished in the affected limb. In some cases, voluntary movement was once again possible. MSN is a useful alternative in those cases of focal spasticity where physiotherapy and nerve block with botulinum toxin or phenol no longer produce satisfactory results.

Arthroscopic Mobilization of the Ankle-subtalar Joint Complex Using a Novel “Infra-fibula-tip” Portal

Category:Arthroscopy; HindfootIntroduction/Purpose:As a minimally invasive surgical option for posterior ankle/subtalar pathologies, the prone hindfoot endoscopy (a.k.a. Van-Dijk’s method) has been becoming the ‘gold standard’ technique. While this technique holds advantage regarding good orientation and safety handling of posteromedial pathologies, it limits access to the anterolateral part, therefore inconvenient when simultaneously dealing with anterior and posterior pathologies. Recently, we have introduced a novel ‘infra- fibula-tip (IFT)’ portal, which permits wide access to the posterior talocalcaneal joint (PTCJ), from anterolateral to posteromedial, with a patient positioned in supine or semi-lateral. The present study reviewed clinical outcomes of a case series of arthroscopic hindfoot mobilization using this new surgical technique, so as to document its clinical utility.Methods:The sequence of surgical procedures is as follows; - Create an IFT portal, from a small incision immediately distal to the fibular tip, through the peroneal tendon sheath (anterior to the tendons, but posterior to the calcanofibular ligament), toward the posterior porch of PTCJ.- Inserting a 30-deg 2.7mm scope to the posterior porch, and broadly observing posterior intraarticular findings.- Gently moving the scope to the anterolateral porch, and broadly observing anterolateral intraarticular findings.- Creating an anterolateral (AL) portal under arthroscopic guidance.- Creating a PL portal at immediately lateral to the Achilles tendon, with guidance of a blunt rod inserted from the AL portal (gently advanced posteriorly through the lateral recess and penetrated the rod toward subcutis).- Executing posterior procedures from the PL portal, while observing from the IFT portal. Executing anterolateral procedures working from the AL portal, while observing from the IFT portal.Results:A total of 7 cases underwent the procedure of interest to date. Subtalar osteoarthritis (OA) occurred in all, with accessory anterolateral talar facet (AALTF) impingement in 3. Ankle OA occurred in 3, with anterior bony impingement in 2. Preceding pathologies included peri-ankle intraarticular fractures (4), talocalcaneal coalition (2), and neurogenic varus foot (1). Mobilization procedures included lateral-to-posterior PTCJ debridement (7), coalition release (2), AALTF removal (3), sinus debridement (2), posterior ankle capsule release (2), anterior ankle debridement (2), talonavicular debridement (1), and Achilles tendon lengthening (1). The surgery duration ranged from 65 to 245 minutes. Postoperatively, of 4 cases followed more than 6 months, remarkable motion improvement (10 degrees or more) occurred in 3, and every case reported symptom relief.Conclusion:The IFT portal accesses the middle of the PTCJ, with a short skin-to-joint distance, allowing flexible exploration of both the posterior and anterior porches. Posteriorly, ability of direct intraarticular access (without extraarticular shaving) reduces surgical invasion, as well as the risk of potential neurovasucular injury. Anteriorly, it helps secure good triangulation for handling sinus pathologies. Since subtalar arthroscopy using the IFT portal is doable in a supine or semi-lateral position, anterior ankle arthroscopy could be simultaneously executed. Arthroscopic hindfoot mobilization using this technique appears to be efficient for dealing with ankle/subtalar contracture due to combined anterior and posterior pathologies.

Design and Analysis of Three-Point Pressure for Varus Foot Deformity

It is known that the deformities that affect the lower limbs are multiple in terms of location and severity of the injury. These deformities are treated with the use of orthosis, which varies depending on the type of deformity and the area of ​​injury. The principle on which the orthosis depends on the treatment of deformities is applying three-point pressures. These pressures are applied during the manufacturing process of the orthosis but with the time when the deformation response to treatment by corrected forces these mean the value and location of these corrective forces will change and this requires the manufacturing of a new orthosis. This requires costs in money and time to re-correct these forces. In this study, a force correction system was suggested that could change the value and location of corrective forces without need to manufacture a new orthosis and within a few minutes by placing an air chamber on the side of the orthosis. When increasing or withdrawing the amount of air inside the air chamber, the magnitudes of corrected force change according to the required value, this process providing comfort to the patient and reducing the effort of the professional staff supervisor (orthotist) to correct the deformity. The result showed that a method of correction forces applied by using the air chamber to correct deformities was successful when applied to a patient with varus foot deformity where the pressure generated from the air chamber on the leg was measured by using the F-Socket devise at the lateral side recorded a higher interface pressure (140Kpa) than the others sides due to pump the air to push the ankle joint for correction deformity without needing to manufacture of a new orthosis to change the values of correction forces thus reducing the cost and time to treat deformity, also the result showed improvement of the gait cycle, the value of ground reaction force on the body and footprint of the patient when comparing the results before and after the use of the orthosis by the patient.

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series.

Introduction:The study purpose was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus tertius or brevis in children with static encephalopathy and varus feet.Methods:A retrospective review of short- and long-term complications, change in ankle range of motion, strength, and gait kinematics. Predictors of postoperative varus or valgus were examined.Results:One hundred thirty-three patients were included (average age [SD] 10.3 [3.7]), with an average follow-up of 3.9 (3.4) years. Forefoot/hindfoot eversion range of motion improved (P ≤ 0.05), dorsiflexor strength was maintained or improved in 76.9% of patients, and dorsiflexion in swing phase was maintained. Complications occurred in 6 of 133 patients (4.5%) and included 1 transfer failure, 1 wound dehiscence, and four pressure areas from casts. Successful correction was achieved in 77% of patients. Later onset of recurrent varus (14.4%, 10.6% requiring revision surgery) and pes valgus (8.7%, 4.8% requiring revision surgery) occurred. The length of the follow-up predicted the development of the pes valgus (odds ratio 1.28, 95% CI 1.0 to 1.6).Discussion:SPLATT to the peroneus tertius or brevis is effective, and complications are rare. Subsequent valgus or recurrent varus deformities may occur, possibly requiring repeat surgery.

Interest of circular external fixator in orthopaedic in low-income country

Objective: The purpose of this study was to describe the indications of Ilizarov's technique in orthopedic trauma and their results. Material and method: The study involved a retrospective multicenter cohort. It included patients treated with Ilizarov's technique between July 2014 and September 2019 and followed through to recovery. The analysis focused on types of lesions, intraoperative data, complications, cure and failure rates. Only the pins were the responsibility of the patient and cost between 60,000 to 120,000 CFA (91, 5 – 183 euros). Results: Forty-seven patients were treated. The average age was 37.4 years. Males represented 63.8%. The main diagnoses were: tibial fractures (n = 31; 65.9%), including 14 fractures of the tibial plateau; vicious ankle calluses (3; 6.4%); loss of bone substances (3; 6.4%). The main interventions carried out were: Osteosynthesis (n = 34; 72.3%); ankle arthrodesis (n = 5; 10.6%); equine varus foot correction (n = 4; 8.5%). The average duration of an intervention was 130.5 min. the average ablation time was 98.7 days. The cure rate was 95.6%. The main complications were: infection on a spindle (n = 11; 23.4%); pain (n = 6; 12.8%), stiff knee (n = 7; 15.9%). Conclusion: The rate of positive results is similar to that observed in the literature. Ilizarov's external fixator has achieved satisfactory results for complex leg and ankle injuries at a reduced cost.

Unsuspected tarsal coalitions in equinus and varus foot deformities.

Tarsal coalitions have been reported in the setting of equinovarus foot deformities, but only as rare isolated findings. Failure to recognize this diagnosis may inhibit successful equinovarus correction. Here, we review a series of tarsal coalitions seen in congenital and neuropathic equinovarus deformity at two institutions, to report the breakdown of types of coalitions encountered, and to suggest methodology to facilitate earlier diagnosis. The records of all patients treated by two of the authors for bilateral equinovarus deformities and found to have either a unilateral or bilateral tarsal coalition between 2006 and 2016 were reviewed. Nine feet with tarsal coalition (calcaneonavicular n = 7 and talocalcaneal n = 2) were reviewed. Five of these cases occurred in patients with idiopathic equinovarus and four cases in patients with equinovarus related to a neurologic disease. All patients were definitively diagnosed by computed tomography scans with 3D reconstruction. In 56% of cases, the patient had previously undergone at least one open procedure before the coalition was recognized. The mean age at diagnosis of the coalition was 11.4 years. Our experience suggests that tarsal coalitions, particularly calcaneonavicular coalitions, may occur more frequently in equinovarus deformities than previously reported. Upon recognition and removal of these coalitions, we were able to achieve improved correction of the equinovarus deformities and improved range of motion. We recommend that surgeons maintain an awareness of this potential concomitant problem in all equinovarus foot deformities and consider advanced imaging in cases which fail to respond to traditional treatment.

Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study

ABSTRACTBackground: Functional surgery is an effective approach in the treatment of the rigid equinovarus foot deformity (EVFD). This must be associated with early rehabilitation treatments (ERTs) to prevent muscle rearrangements due to immobilization.Objectives: To assess the effects of EVFD surgical correction in adult stroke patients, when assessed according to the ICF domains.Methods: Variables from 24 adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55 ± 13 years, affected side 12L/12R, time from lesion 5 ± 4 years were analyzed. Body function domain: pain (NPRS), walking speed, clinical global impression of change (cGIC). Activity domain: Rivermead Mobility Index (RMI), FAC, and 6 min walking test (6MWT). Participation domain: Walking Handicap Scale (WHS). Patients were assessed before (T0), one (T1), three (T2) and twelve (T3) months after surgery by a single assessor.Results: All variables but the 6MWT significantly improved (Wilcoxon test, p < .05) at T1 or T2 and this remained until the 12-months mark. Since T1, all patients reached and maintained a supervised independent walking (FAC≥3) and all those wearing an AFO stopped using it. The median cGCI was “much improved” at T1, with a “further minimal improvement” at T3. This was not associated with the improvement measured by both FAC, and WHS (Chi-square test, p = .20 and p = .36, respectively).Conclusions: Functional surgery combined with ERT is effective in improving the patients’ condition according to all ICF domains. Both subjective and objective assessments have to be used when assessing these patients.

Clinical spectrum of congenital tibial hemimelia in 35 limbs of 24 patients: A single center observational study from India

PurposeConsidering the paucity of reports on large series of patients with tibial hemimelia, we assessed the clinical spectrum of this rare congenital disorder in patients seen at a single Indian center over 10 years. MethodsRetrospective review of medical records of patients seen at single center in 10 years. ResultsThirty-five cases of TH, mostly Jones types Ia (18) and II (10), were diagnosed in 24 patients (13 had unilateral TH). Associated foot deformities included equinovarus (22), varus foot (10), absence of the medial row of toes (5) and polydactyly (3). Upper limbs anomalies included split-hand deformity (five patients) and radial club hand (two patients). Nine limbs of seven patients were surgically reconstructed. Modified orthosis was provided to seven patients, custom designed prosthesis fitment in six and amputation with prosthesis fitment in one. Patients presenting at adolescence or later were habituated to their deformity for indoor ambulation; families declined amputation. ConclusionReports of more TH cases will provide input to researchers to consider comprehensive rehabilitation for enhancing indoor and community ambulation.

Foot deformities and gait deviations in children with arthrogryposis

Objectives: Arthrogryposis multiplex congenita is a congenital condition characterized by joint contractures with resulting foot deformities and gait deviations. The aim of this study was to describe gait deviations and foot deformities in children with arthrogryposis objectively and quantitatively with detailed gait analysis, including multisegment foot kinematics and foot pressure analysis. Materials and Methods: Children with arthrogryposis were evaluated retrospectively. Their data were compared to data from typically developing children. Comprehensive data presented include results of a full gait analysis with multisegment or single-segment foot kinematics, kinetics, pedobarograph, physical examination, and radiographic measurements. Children were grouped by age, orthotic use, and history of surgical intervention. Results: Forty-two children with arthrogryposis (2–20 years old) were reviewed. Physical examination and kinematic data showed that children walked with a crouched gait; exhibited stiffness in the hips, knees, and ankles; and showed limitations in their gross motor functioning. Power generation was low at the ankle and was high at the hip. Multisegment foot kinematics revealed stiffness in hindfoot plantar flexion and residual forefoot adduction. Foot pressure showed reduced heel impulse, excessive midfoot contact, and overall varus foot position. Categorization by age revealed greater stiffness at the hips and knees in older children. Children with knee–ankle–foot orthosis showed the most stiffness. Conclusions: Three-dimensional motion analysis and plantar pressure measurements are able to quantify the empirical observations of children with arthrogryposis walking with a crouched, stiff gait and having foot deformities. The use of these technologies in conjunction with clinical examination and functional tests is, therefore, recommended to monitor treatment efficacy and natural progression of gait deviations and joint deformities in arthrogryposis.

Assessment of the Anterior Talofibular Ligament(ATFL) Thickness in Chronic Stroke Patients by Ultrasound

Stroke is one of the commonest diseases affecting people world-wide. Spastic equino varus foot is one of most common disabling deformities observed among hemiparesis patients. The aim of the study is to compare ATFL thickness on the affected and unaffected sides of chronic stroke patients with that of healthy individuals using ultrasonography.

Subtalar Joint Alignment in Ankle Osteoarthritis

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.

Severe cavus varus feet deformity in Charcot-Marie-Tooth: Surgical correction case report

Necrotizing fasciitis is considered to be a severe form of soft-tissue infection that is accompanied with rapidly progressive necrosis to the subcutaneous tissue layer and the superficial fascia. It is also characterized by early development of systemic toxicity. The invasive Streptococcus pyogenes is the most often encountered species as a cause of this disease. The delay in diagnosing is common as the differentiation of the evolving necrotizing fasciitis from cellulitis can be very difficult. Treatments include rapid radical debridement and administration of appropriate antibiotics. However, even with proper treatment, the mortality rate is considered to be high. We reported a 5-month-old girls with fatal necrotizing fasciitis associated with toxic shock–like syndrome due to Streptococcal infection.

CONGENITAL FOOT DEFORMITIES IN PRESCHOOL CHILDREN: CLINICAL ASPECTS AND ALGORITHMIC APPROACH IN THE WORK OF PEDIATRICIANS

Aim - analysis of the incidence of musculoskeletal system diseases and comorbid pathology in children; development of an algorithm for the rehabilitation of young children with congenital foot deformities for their parents and primary care professionals. Materials and methods. 244 cards of complex rehabilitation in rehabilitation centers of the Samara region for the period from January 2013 to August 2016 were studied. The children were divided into two groups: I group - the core group - included children of senior preschool age who were born between 22-37 weeks of gestation with birth weight of 500-2499 g; group II - control group - included children of preschool age who were born at 38-41 weeks of gestation with birth weight 2500-4500 g. Results. The study revealed the incidence of diseases of the musculoskeletal system in children in rehabilitation centers of the Samara region. The number of children with congenital deformities of the foot was 49.7% in the group of prematurely born children; flatfoot composed 42.3%, which proves the importance of the background condition (prematurity) in the development of congenital diseases of the foot. Multivariate analysis showed that the following factors are statistically significant: infantile cerebral palsy (p = 0.004), varus and valgus foot deformity (p

Classification of the Elderly Foot Types Based on Plantar Footprints

The article presents the methodology and the results of the studies conducted in order to develop a rational classification technique of the elderly foot typologies, based on parameters derived from the plantar footprint. The plantar footprints were taken from 67 women, aged between 52-84 years old with RSscan pressure plate and the associated system, Footscan 7 Gait, 2nd Generation, 0,5 Gait Scientific System. To classify the foot typology, Chippaux-Simark Index and Hallux-Valgus Angle have been used. According to the obtained results, the subjects were divided into five categories, subjects with Normal Foot, High Arched Foot, Flat Foot, Hallux-Valgus Foot and Hallux Varus Foot. The authors have developed a method of determining the middle area of a plantar footprint for a more accurate measurement, being able to register it in the same way, for all subjects. Using statistical analysis, differences between age groups have been found, demonstrating the necessity of modelling and designing customized shoe lasts, footwear and prophylactic components according to the age of the subject. A good fit of the shoe on the elderly foot involves modifying the shoe last, but this can only be achieved under certain standards. Having biomechanical data of the foot and a clear classification of it, the customization of the product is simplified, reducing the number of tests and increasing the footwear technological process efficiency.

Split tibialis anterior transfer for dynamic varus foot deviation in children with cerebral palsy – A kinematic and videographic study

The effect of refraction accuracy on the differential light threshold of a Goldmann size III (0.43° diameter) stimulus was evaluated in the right eyes of five normal subjects with randomly ordered sequence of piano, +1.00-, +2.00-, +3.00-, +4.00-, +5.00-, and +6.00-diopter (D) spherical overcorrections. Threshold measurements were performed at 0°, 5°, 10°, 15°, 20°, and 25° eccentricity nasally along the 180° meridian with the F4 program on the Octopus 201 perimeter. The +1.00- through +6.00-D overcorrections decreased the threshold values by an average of 1.4, 2.9, 4.2, 5.6, 6.7, and 7.6 dB, respectively, compared with the piano overcorrection. The depression of the differential light threshold was of similar magnitude at all eccentricities within the central 25°.

Functional clinical typology of the foot and kinematic gait parameters

Background: The foot plays a key role in a standing posture, walking and running performance. Changes in its structure or function may alter upper segments of kinematic chain which can lead to formation of musculoskeletal disorders. Although functional clinical typology provides a complex view of foot kinesiology there is a lack of knowledge and evidence about influences of different foot types on human gait. Objective: The aim of the study was to analyse differences of kinematic gait parameters of lower extremity joints and pelvis between functional clinical foot types in healthy young men. Methods: Three-dimensional kinematic analysis by the Vicon Motion Capture MX System device in synchronization with 2 Kistler force platforms was used to obtain kinematic data from 18 healthy men (mean age 23.2 ± 1.9 years). The functional clinical foot type was clinically examined and sorted into 3 basic foot type groups - forefoot varus (FFvar), rearfoot varus (RFvar) and forefoot valgus (FFvalg). Peak angular values and range of an angular displacement in all of three movement planes were analysed for pelvis, hip, knee and ankle joint. For statistical analysis of kinematic gait parameters differences between foot types Mann Whitney U test at a statistical significance level p < .05 and Cohen's coefficient d for effect size were used. Results: This study showed that functional clinical foot type can affect kinematic parameters of gait in the joints of the lower limb and pelvis. Significant differences were presented in the FFvar in comparison with other two foot type groups with middle and high size of effect. The most alterations were observed in pelvis area and in a sagittal plane of movement. Nevertheless, significant differences between FFvalg and RFvar foot types were not noticed. Conclusions: Functional clinical foot typology provides one of the possible methods to describe foot structure and function. Our results showed that foot type could alter gait. Forefoot varus foot type has more significant influence on kinematic gait parameters then other foot types. These effects should be considered by clinicians during examination of musculoskeletal system disorders especially in lower extremities.

Shoe heel abrasion and its possible biomechanical cause: a transversal study with infantry recruits.

BackgroundExcessive shoe heel abrasion is of concern to patients and shoe manufacturers, but little scientific information is available about this feature and its possible causes. The purpose of this study was to relate this phenomenon with biomechanical factors that could predispose to shoe heel abrasion.MethodsNinety-seven recruits (median age 25) were enrolled in this study. Shoe abrasion was assessed manually with a metric plastic tape on the posterior part of the heel that comes in contact with the ground. The number of sprains, foot alignment, and calf muscle shortening (Silfverskiold test) was also assessed in order to relate it with shoe heel abrasion. After using our exclusion criteria, 86 recruits and 172 were considered for this study.ResultsThe most common abrasion site was the lateral portion of the heel surface (50 %). Forty-four percent of the participants had neutral hind-foot alignment and 39 % had valgus alignment. Twenty-six (30 %) patients have had previous ankle or foot sprains. Neutral foot was related with less calf muscle shortening. On the other hand, valgus hind-foot alignment was more associated with Achilles shortening (p < 0.05). Patients with neutral alignment were associated with more uniform shoe heel abrasion and varus feet were associated with more central and lateral abrasion (p < 0.05). The pattern of shoe heel abrasion was not statistically related with calf muscle shortening nor with number of sprains.ConclusionThis study was able to correlate shoe heel abrasion with biomechanical causes (neutral alignment–uniform abrasion/varus alignment–central and lateral abrasion). More effort has to be done to continue evaluating outsole abrasion with its possible biomechanical cause in order to predict and treat possible associated injuries.

Tibialis Spastic Varus Foot With Calcaneonavicular Coalition

Peroneal spastic flat foot is a well-known condition usually occurring with tarsal coalition. Conversely, tibialis spastic varus foot is a rare condition, which can be difficult to diagnose. Moreover, tibialis spastic varus foot with calcaneonavicular coalition is extremely rare, with only a few published case reports. Resection of the calcaneonavicular bar is performed in the majority of patients. We report a case of tibialis spastic varus foot with calcaneonavicular coalition in an 11-year-old boy with intellectual disability. His family noticed his right varus foot deformity 1.5 years earlier. There was no obvious history of trauma. The deformity gradually worsened with running. Because conservative treatment failed, resection of the coalition was performed that facilitated a good outcome. In this article, we report our experience of tibialis spastic varus foot with calcaneonavicular coalition and review the English literature of this condition. Therapeutic, Level IV: Case report.

Management of congenital talipes equino varus by ponseti method: Our experience

Congenital talipes equino varus (CTEV) or club foot is a common congenital condition encountered for t reatment by orthopaedic surgeons. The incidence of which is aro und 1-2 per 1000 live births. The treatment of Club foot in the 20 th century saw a seasaw of events starting from conse rvative line to surgery & then again returning to c onservative line with the advent of ponseti technique. We at Ha ssan institute of medical sciences treated 50 idiop athic club feet in 38 patients with ponseti technique. The study wa s conducted between August 2012 to September 2014 ‐ with a total follow up of 24 months. Aim of the study was to correct the deformity, achieve plantigrade, pain less foot, prevent usage of special shoes & avoid callosities. Children from 2 days to 12 months were included in our study. Pirani scoring was used to note the severity of the condition. They were all treated with manipulation s & above knee plaster casts with 38 feet needing tenotomy. Total number of casts ranged from 4 to 11 in these patien ts. Average duration of treatment was about 2 months. Maintenance of correction was with foot-abduction orthosis ‐ Dennis brown splint. We concluded that this technique is s imple, economical, easy and effective with a high s uccess rate & patient was happy with an aesthetically acceptable plantigrade look of the foot.

G.P.236: Two siblings with SMARD1, one of them being in “double trouble”

The elder sibling, a boy, had tight heel cords that were noted from the age of 4months. He also developed varus foot position of the feet. At 20months, he could pull himself to standing. Lower leg muscles were atrophic, the ankles were unstable. He did not have a full extension of his fingers when he was crawling, and his pincer grasp was immature. Deep tendon reflexes could not be elicited. He had pectus excavatum. Cognitive function was normal. Neurophysiological investigation was suggestive of a polyneuropathy of axonal type and with predominantly motor affection, involving both lower and upper extremities. The MRI of cerebrum and medulla spinalis were normal. In the younger sister a syndromic evaluation was started in early infancy because of dysmorphic traits. She was hypotonic. At 9months she developed lung infection and atelectasis. She had increasing need for ventilatory support, and she got a tracheostomy. Attempts at weaning from the ventilator were unsuccessful. Additional findings were paradox diaphragm movement and neurophysiological signs of an axonal neuropathy. DNA was sent for the analysis of the IGHMBP2-gene, and she was diagnosed with SMARD1 with compound heterozygote mutations. At the same time, she tested postive for the Kabuki syndrome. Subsequent investigation in the brother disclosed the same mutations in the IGHMBP2-gene as his sister had. At the age 3.5years he can walk with ankle–foot orthoses, is not losing motor skills, and his ventilation is found to be normal. Varying phenotypic expression in siblings with SMARD1 has previously been reported. We can not exclude that the presence of Kabuki syndrome may have contributed to the much more severe SMARD1 phenotype in the sister.