Deformidad en equino del tobillo en edades pediátricas

La deformidad en equino del tobillo ocurre como consecuencia de múltiples entidades. Aunque la primera línea de tratamiento es la conservadora, las modalidades quirúrgicas son necesarias en la mayoría de los enfermos pediátricos. Estas últimas son las más empleadas por zonas del complejo músculo-tendinoso, en especial los alargamientos fraccionados y en forma de Z-plastia. El objetivo de este trabajo es actualizar y brindar información sobre los distintos procedimientos quirúrgicos en la corrección de la deformidad en equino del tobillo. En la búsqueda y análisis de la información se emplearon las siguientes palabras: equinus deformity, equino varus, equino valgus; drop foot deformity y Achilles tendon Z-lengthening. A partir de la información obtenida, se realizó unala revisión bibliográfica de un total de 187 artículos publicados en las bases de datos PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se utilizaron 30, 28 de los últimos cinco años. Se hace referencia a la anatomía esencial de la zona, al igual que a la prueba de Silfverskiöld. Con relación a la imagenología, se describe la técnica para calcular la distancia del tendón a alargar. Se mencionan las técnicas quirúrgicas de alargamiento fraccionado, por Z-plastia, trasposición anterior del tendón de Aquiles y la hemiepifisiodesis.

Equinus deformity of the ankle occurs as a consequence of multiple entities. Although the first line of treatment is conservative, surgical modalities are necessary in most pediatric patients. The latter are the most used for areas of the muscle-tendinous complex, especially fractional and Z-plasty-shaped lengthening. The aim of this work is to update and provide information on the different surgical procedures in the correction of equinus deformity of the ankle. In the search and analysis of the information, the following words were used: equinus deformity, equinovarus, equinovalgus; drop foot deformity and Achilles tendon Z-lengthening. Based on the information obtained, a bibliographic review of a total of 187 articles published in PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape and Medline databases was carried out using the search manager and reference administrator EndNote. Of these, 30 were used, 28 of the last five years. Reference is made to the essential anatomy of the area, as well as to the Silfverskiöld test. In relation to imaging, the technique to calculate the distance of the tendon to be lengthened is described. Fractional lengthening surgical techniques are mentioned, by Z-plasty, anterior transposition of the Achilles tendon and hemiepiphysiodesis.

LOW TEMPERATURE THERMOPLASTIC SPLINTING IN THE MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS

Congenital talipes equinovarus (CTEV) is one of the most common congenital deformities. Treatment of clubfoot should begin at the earliest to have the best outcome. The goal of treatment is to eliminate all deformities of CTEV so that patient has a functional, pain free, plantigrade foot with good mobility within minimum time duration. Treatment includes non-surgical and surgical methods. Conventionally Plaster of Paris (POP) is used for splinting though leather, polypropylene and rubber are also used. Objective of this study is to evaluate the effectiveness of low temperature thermoplastic (LTTP) splinting in CTEV management. This is an on observational study over a period of one year in Thirty-two CTEV patients with Pirani score of less than three. Effectiveness of LTTP splinting was evaluated in detail. It was found that LTTP splinting was cost effective, cosmetically better, reusable, demoldable, and easier to apply. It was of light weight, and required lesser time. It avoids the need for repetitive casting and same splint can be used as maintenance splint also. Pirani score lowered from 3 to 0 after 6 months of splinting. Conclusion –The compliance in donning the splint was high and acceptable among the children studied. Parental satisfaction regarding the splint wearing time and correction of deformity factor was high. Skin complications associated with POP casting were absent in the study population. Hence correction of CTEV with LTTP splinting was more effective than conventional POP casting

Pie bot: conceptos actuales / Clubfoot: current concepts

El pie bot es la deformidad congénita más frecuente de las extremidades inferiores del ser humano, afectando a 1 de cada 1000 recién nacidos vivos. Consiste en la presencia de cuatro deformidades estructurales en el pie y el tobillo: cavo del medio pie, aducto del antepié, varo del retropié y pie en equino.Su registro en la humanidad data del siglo XII A.C. en momias del antiguo Egipto.La fisiopatología de esta deformidad aún no está aclarada. El diagnóstico puede ser prenatal mediante visualización ecográfica, pero la forma más común de diagnóstico es postnatal. La evaluación de estos pacientes se basa en la exploración clínica. Entre las clasificaciones más utilizadas se encuentran: Diméglio, que enfatiza lo reductible ante maniobras manuales de la deformidad; Pirani, que evalúa la gravedad inicial y el progreso del tratamiento; y Ponseti International Association (PIA), que clasifica según etiología.Durante el siglo pasado se describieron numerosos procedimientos quirúrgicos, muchos de los cuales fueron quedando en desuso ante sus resultados insatisfactorios, pies rígidos y dolorosos, con función limitada. Actualmente el método Ponseti es el Gold estándar para su tratamiento, consistiendo en una manipulación y enyesado seriado buscando la corrección sistemática del pie, basado en los fundamentos de la cinemática y la fisiopatología de la deformidad.

Clubfoot is the most frequent congenital deformity of the lower extremities of humans, affecting 1 out of 1000 live newborns. It consists of the presence of four structural deformities in the foot and ankle: midfoot cavus, forefoot adductus, hindfoot varus, and equinus foot.Its records in humanity date from the 12th century B.C., in ancient Egyptian mummies.The pathophysiology of this deformity is still unclear. Prenatal diagnosis by ultrasound imaging is feasible, but most common diagnosis is postnatal. The evaluation of these patients is based on clinical examination. Among the most used classifications are: Diméglio, which emphasizes the reductibility with manual maneuvers; Pirani, who assesses initial severity and progress of treatment; and Ponseti International Association (PIA), which classifies according to etiology.During the last century, numerous surgical procedures were described, many of which were disused due to their unsatisfactory results, stiffness and painful feet, with limited functionality. Currently the Ponseti method is the gold standard for its treatment. It consists of serial manipulation and casting, looking for a systematic correction of the deformity, based on the fundamentals of kinematics and pathophysiology of the deformity.

Results of Ponseti Casting for Clubfoot in a Tertiary Public Hospital

@#INTRODUCTION: Congenital talipes equinovarus (CTEV), also called clubfoot, is one of the most common orthopedic congenital anomalies. However, there is no formal study of the condition here in the Philippines, and data is sparse regarding the epidemiology, treatment, and outcomes in similar third-world countries. METHODS: Retrospective review of data of clubfoot patients seen at the Philippine General Hospital (PGH) Clubfoot Clinic from 2006 up to the present. RESULTS: Records from 75 patients treated at the PGH Clubfoot Clinic from 2010-2016 were reviewed. Idiopathic clubfoot comprised 76% of the patients, while syndromic clubfoot comprised 24%. A good outcome of the Ponseti method was seen in 82% and 88% of the idiopathic and syndromic clubfoot patients, respectively. Idiopathic clubfoot cases that had good outcomes required an average of 11.84 casts to tenotomy or bracing, which was not statistically significant compared to 9.55 average sessions for syndromic clubfoot (p=0.21). The initial Pirani scores for both cases were not significantly different (p=0.95). Idiopathic cases with poor outcomes needed less casting sessions (4.45) because the decision to operate was made early. Age was not found to significantly affect the outcome of treatment for idiopathic clubfoot (p=0.20) and syndromic clubfoot (p=0.64). CONCLUSION: Ponseti casting was found to be effective in treating both idiopathic and syndromic clubfoot patients. The number of sessions did not differ significantly between the two.

Popliteal pterygium syndrome: case report from rural India

The popliteal pterygium syndrome is a congenital malformation that includes orofacial, musculoskeletal and genitourinary anomalies. It is also known as faciogenitopopliteal syndrome. It is autosomal dominant disorder. It has highly variable expressivity and incomplete penetrance. The incidence of the popliteal pterygium syndrome is 1/300000, which makes it an extremely rare condition. The most striking characteristic of this syndrome is popliteal pterygium, which consists of a net of connective tissue spreading from the ischial tuberosity to the calcaneus.In this study, authors present the case of a 1 day old male patient with cleft upper lip, cleft palate, bifid scrotum, popliteal pterygium and congenital talipes equinovarus (CTEV).

Pé torto congênito: método de Ponseti e sua aplicabilidade pelo fisioterapeuta / Congenital clubfoot: Ponseti method and its applicability by the physiotherapist

O pé torto congênito é uma das deformidades mais frequentes de membro inferior que, por sua complexidade com relação às alterações anatômicas, é alvo de dúvidas e divergência de opinião dos profissionais da área quanto ao tratamento mais eficaz. No entanto, o método mais utilizado atualmente e que vem apresentando resultados positivos é o de Ponseti. O objetivo deste trabalho é analisar a eficácia do método de Ponseti e sua aplicabilidade pelo fisioterapeuta. Tratou-se de pesquisa do tipo revisão, com abordagem qualitativa por meio de consulta a publicações das bases de dados Scielo, Lilacs, Medline e Bireme, preferencialmente dos últimos dez anos, e a coleta de dados no mês de outubro de 2016. Foram encontradas 248 publicações e, após análise, foram selecionados 23 artigos para a pesquisa, distribuídas em duas categorias: Eficácia do método Ponseti e Eficácia das técnicas fisioterapêuticas. Diante do exposto, percebese que o método de Ponseti tem se mostrado o mais eficaz no tratamento do pé torto congênito, e suas técnicas são compatíveis com as utilizadas por fisioterapeutas, sendo possível sua aplicabilidade por este profissional, com exceção da tenotomia do calcâneo. Portanto, este trabalho abre espaço para novas pesquisas que corroborem esta temática. (AU)

The congenital club foot is one of the most frequent lower limb deformities that, due to its complexity in relation to anatomical changes, is the subject of doubts and divergence of opinion of professionals in the area regarding the most effective treatment. However, the method most used currently and that has presented positive results is that of Ponseti. The aim of this study was to analyze the effectiveness of the Ponseti method and its applicability by the physiotherapist. This research was a literature review, with a qualitative approach, through consultation of publications of Scielo, Lilacs, Medline and Bireme databases, preferably in the last ten years, and data collection in October 2016. We found 248 publications and after analysis, 23 articles were selected for the research, distributed in two categories: Efficacy of the Ponseti method and Efficacy of physiotherapeutic techniques. The Ponseti method has been shown to be the most effective in the treatment of congenital clubfoot, and its techniques are like those used by physiotherapists, being possible its applicability by this professional, except for tenotomy of the calcaneus. Therefore, this work opens space for new research that corroborates this theme. (AU)

Outcome of clubfoot treatment in the pre-ponseti period in a Nigerian teaching hospital: a 14 year review

Background: Congenital Talipes Equinovarus (CTEV) is a common musculoskeletal congenital disorder. Historically, surgical treatment of various types was popular; however, currently the gold standard of treatment is non-operative care using the Ponseti method. This work evaluates the outcome of this former method of managing CTEV before author adopted the Ponseti Method and compares it with the reported outcomes of the Ponseti method in published literature.Methods: A retrospective review of this data from January 1990 to December 2003 was done, the patients demographics, treatment given, duration and outcome of care were analysed using descriptive statistics. This finding was then compared with outcomes of Ponseti method in literature.Results: Here, 145 patients had initial non operative care; eighteen of those patients (12.4%), eventually require either a posteromedial release, a combined posteromedial and posterolateral releases or a triple arthrodesis.Conclusions: The study shows that the success rate of this method of manipulation preceding the adoption of the Ponseti method is 87.6%. This outcome is inferior when compared to the outcome of Ponseti method in published literature. Also, the extensive nature of eventual surgical intervention required to achieve correction is in contrast to the minimal surgeries needed achieve correction of residual deformities following the use of the Ponseti method.

Comparative Study Of Surgical Correction Of Congenital Talipes Equino Varus Deformity With And Without Internal Fixation (using K-wires)

Congenital Talipes Equino Varus is one of the most common congenital deformity which occurs in 1/1000 live birth worldwide. Regarding management of this clubfoot ,most orthopaedic surgeons agree that approach management of children with congenital talipes equino varus deformity of foot should begin with conservative measures i.e, manipulation and serial casting in position of correction. One or more surgical procedures are often required in patients who had incomplete correction , recurrent deformity , syndromic correction and after repeated manipulation and casts. Recurrence is a common problem following the club foot surgery one of the reason for recurrence can be redisplacement of tarsal bones .This study aims to compare prospectively the functional and cosmetic outcome of two groups of club foot-one in whom tarsal joint were fixed with k-wires after doing posteromedial soft tissue release and one in whom tarsal joint were not fixed after soft tissue release .To know the incidence of congenital talipes equino varus with respect to age and sex predilection over a period of two years which were admitted between October 2017 to October 2019, 28 idiopathic club foot in 20 children range from 4 months to 3 years were treated out of 20 cases 12 were males,8 were females.8 patients had bilateral deformity out of 12 unilateral deformities 8 were on right side and 4 were on the left side. Male and female ratio 1.5:1 and unilateral to bilateral 1.5 :1.In 12 feet turco's posteromedial soft tissue release and internal fixation of tarsal joints with k-wires was done in 16 feet only turco's posteromedial soft tissue release was done. The period of follow up ranges from 6 months to 2 years

Clinical, Radiological, and Functional Outcome of Delayed Presenting Congenital Talipes Equinovarus Cases Managed by Joshi’s External Stabilization System: A Prospective Study

introduction: Clubfoot and its management have been the topic of keen interest to the orthopedics field ever since timeimmemorial and many techniques in the successful management of these have been advocated till date. This study discussesone such technique of management in children with Joshi’s external stabilization system (JESS) fixator.Aim: This study aims to evaluate the role of JESS in the management of neglected, resistant and relapsed congenital talipesequinovarus (CTEV), in the age group of 1–6 years.Materials and Methods: A total of 20 feet in 20 children underwent JESS fixation surgery at the Department of Orthopaedics,Government Rajaji Hospital, Madurai Medical College, from October 2015 to September 2018.Results: Four patients had excellent results, 12 patients had good results with an average score of 78, three patients had fairresults, and poor results in one patient. The average pre-operative Pirani score was 4.5 and post-operative score of 0.93 withP < 0.001 which was statistically significant. The average pre-operative Dimeglio score was 12 (Stage III) which statisticallyimproved post-operative (P < 0.001) to 5 (Stage 1).Conclusion: By controlled differential distraction using JESS apparatus, a painless, Pliable, plantigrade. The perfect sized andcosmetically acceptable foot has been obtained even in children 1 year–6 years. Controlled differential distraction using JESSfixator has got a definite role in the management of relapsed and neglected CTEV and it does not prevent the foot from beingtreated surgically at a later date if needed.

Major Predisposing Factors Influencing the Suicide by Hanging: A Retrospective Study from a Tertiary Care Government Hospital in Kerala State, South India

Introdcution: A variable incidence of hanging is found assecond major group among the total number of autopsiesdone in the Department of Forensic Medicine, Govt. MedicalCollege, Calicut, Kerala state, South India. The incidences arefound to be varying according to the social and economic statusof the society. This retrospective study was done in a tertiarycare Government Hospital to find the major predisposingfactors influencing the suicide by hanging.Material and Methods: Case history were taken in detailfrom questionnaires to the relations of the deceased and fromPolice. The results were analyzed on the basis of history,postmortem findings and results of laboratory investigations.Results: The age group 16-25 was found to be the mostprevalent (75%) for suicidal hanging. Among the religion,Hindu religion showed the highest (80%) number. Morecases were found among the manual labourers and lowermiddle class people. People without children were moreprone to suicide by hanging. Among the precipitating factors,mental illness was the highest factor. Fracture of hyoid bonewas found during autopsy in majority of cases of completehanging.Conclusion: Psychological upset and educational statusplayed an important role in suicidal hanging. The highestincidence was seen among those with lower educational status.Hence, proper identification of such people and presentingthem to effective counselling may reduce the incident rate.

BARRIERS AFFECTING CLUBFOOT TREATMENT IN SARAWAK

@#Congenital talipes equinovarus (CTEV), also known as clubfoot is the most common lower limb congenital deformity among paediatric patients. The outcome of starting clubfoot treatment early is very promising. Patient retention throughout the treatment programme is challenging in Sarawak. In this study, we explored the barriers that parents/caregivers face when seeking clubfoot treatment in Sarawak, Northwest Borneo. A better understanding of the barriers will provide us with the information to formulate effective programmes for clubfoot treatment in this region.Methods: We conducted a questionnaire-based quantitative cross-sectional descriptive survey. We adapted a set of closed-ended questionnaires originally designed by Kazibwe and Struthers in a study done in Uganda in the year 2006.Results: A total of 53 parents/caregivers of children with idiopathic clubfoot were recruited in this study, with 16 defaulter cases and 37 non-defaulter cases. We found 2 statistically significant barriers to clubfoot treatment in Sarawak, with p-value < 0.05, namely the geographical factor (p = 0.019) and logistic factor (p = 0.017).Conclusion: Barriers to clubfoot treatment that influence the compliance to treatment identified in this study are long distance travel, logistics limitations, uncooperative patients during treatment, parents/caregivers having other commitments, unsupportive family members, lack of understanding regarding clubfoot and its treatment, inadequate specialists in clubfoot, traditional socio-cultural beliefs and practices and economic constraints. Enhanced understanding in this matter will guide us in devising culturally admissible ways to increase awareness in parents/caregivers regarding clubfoot and its treatment. A sustainable national clubfoot program will be very beneficial in providing a holistic approach to tackle barriers to treatment in our country

Biomechanical Parameters in Children with Unilateral and Bilateral Clubfoot during Vertical Jumps

Abstract Gait analysis may offer information to choose the best exercise-based clinical intervention for the children with clubfoot. However, other motor abilities are not commonly investigated. The aim of this research was to analyze the biomechanics of countermovement vertical jumping in clubfooted children who had undergone surgery. Fourteen children with idiopathic clubfoot were selected and the control group consisted of 11 children. Clubfooted children showed less dorsiflexion in the jump preparation phase. In the impulse phase, this group showed more knee flexion and less plantarflexion associated with less magnitude of vertical reaction force and less muscular activity in the gastrocnemius medialis. In the landing phase, for clubfoot group, we found high loading rate for the first peak of vertical force, less plantarflexion and more knee flexion. Understanding the biomechanical changes of vertical jump landing should assist in better targeting of physical and sporting activities of this population.(AU)

Expression of Col9a1 Gene in Ankle Tissue of Rat Model of Idiopathic Congenital Talipes Equinovarus / 沈阳医学院学报

Objective:To investigate the expression of Col9a1 gene in ankle tissue of rat model of idiopathic congenital talipes equinovarus (ICTEV) . Methods:ICTEV rat model was established. Immunofluorescence staining and immunohistochemical dyeing technology were used to detect the expression of Col9a1 protein in ankle tissue of model group and control group. Results:The expression level of Col9a1 protein in ankle tissue in model group was higher than that in the control group (P<0.05),Col9a1 gene expressed primarily in soft tissue and cartilage membrane. Conclusion:The increasing expression level of Col9a1 gene in ankle tissue of ICTEV rats may be related to clubfoot deformity.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

PURPOSE: To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. MATERIALS AND METHODS: Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. RESULTS: Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. CONCLUSION: Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.

Dynamic Adduction Angle of Forefoot Measured With a Novel Technique And Its Relationship With Functional Outcomes

Background: Idiopathic clubfoot is commonly treated with the Ponseti method with the extent of invasive treatment involving tendon-Achilles lengthening. Forefoot adduction is a common complication in surgically treated clubfeet. Yet, no method has been described to measure dynamic (walking) forefoot adduction. The aim of this study was to assess the persistent pes adductus in children whose clubfeet were surgically treated using a dorsomedial soft tissue release and to find out correlations between forefoot adduction and clinical outcome measures. Methods: We analysed the dynamic adduction angle in 33 clubfeet using a pressure-sensitive foot platform and compared it to the healthy feet of an age- and weight-matched group of children without congenital foot deformities. The clinical outcome was analysed using the McKay score. Results: Mean dynamic adduction angle was 4.1o in the surgically corrected clubfeet, whereas it was 6.4º in unaffected feet of patients with unilateral clubfoot and 7.1o in control group. The McKay score were excellent in 1 patient, good in 5, average in 13, and fair in 4 of the 23 patients. There was no correlation between dynamic adduction angle and McKay score using paired t test (P > 0.05). Conclusion: High occurrence of dynamic adduction angle in surgically treated clubfeet was detected. In conclusion, no correlation between forefoot adduction, dynamic forefoot adduction angle and clinical outcome measures within the study was observed.

Post-activation depression of the lower extremities in stroke patients with spasticity and spastic equinovarus deformity / Depressão pós-ativação das extremidades inferiores de pacientes com acidente vascular cerebral que apresentam espasticidade e deformidade equinovarus por espasticidade

This study aimed to investigate changes of post-activation depression in two groups of patients with or without spastic equinovarus deformity (SED). Paired and independent t-tests were used to compare post-activation depression within and between the groups, respectively. There was a significant positive correlation between diminished post-activation depression and spasticity severity. The soleus and tibialis anterior (TA) post-activation depression values were significantly decreased on the affected sides of patients with SED compared to those without. In patients without SED, the soleus post-activation depression was significantly decreased on the affected side; however, TA post-activation depression was higher on the affected side. Both the soleus and TA become active, but the onset time may be different. The imbalanced muscle tone between the soleus and TA in the early stage after stroke may be related to equinus deformity.

O principal objetivo deste estudo é a investigação da depressão pós-ativação em pacientes com deformidade equinovarus espástica (DEE). Os pacientes foram divididos em dois grupos. Student-t testes pareados e independentes foram utilizados para comparar a depressão pós-ativação intra- e inter-grupos, respectivamente. Houve uma correlação positiva significativa entre a diminuição da depressão pós-ativação e a gravidade da espasticidade. A depressão pós-ativação dos músculos sóleo e tibial anterior (TA) estavam significativamente diminuídas no lado afetado dos pacientes com SEE em relação aos membros sem SEE. Em pacientes sem SEE, a depressão pós-ativação do músculo sóleo encontrava-se significativamente diminuída do lado afetado. No entanto, a depressão pós-ativação do músculo TA era maior no lado afetado que no lado não afetado. Tanto o sóleo quanto o TA serão ativados, mas o tempo para isso pode ser diferente. O desequilíbrio entre o tônus dos músculos sóleo e TA nos estágios iniciais pode estar relacionado à deformidade equina.

Short-Term Effect of Botulinum Toxin A Injection on Spastic Equinovarus Foot in Cerebral Palsy Patients: A Study Using the Foot Pressure Measurement System

OBJECTIVE: To evaluate the therapeutic effect of botulinum toxin A (BTX-A) injection on spastic gastrocnemius (GCM) and tibialis posterior muscles (TPo) by using the foot pressure measurement system (FPMS). METHODS: Eighteen ambulatory CP patients were recruited in this study. BTX-A was injected into the GCM at a dose of 6-12 units/kg and TPo at a dose of 4-9 units/kg according to the severity of equinus and varus deformity. Foot contact pattern, pressure time integral (PTI), coronal index using the FPMS and Modified Ashworth Scale (MAS), and visual inspection of gait pattern were used for evaluation of the therapeutic effect of BTX-A injection. Clinical and FPMS data were statistically analyzed according to the muscle group. RESULTS: A significant decrease in the MAS score of the GCM and TPo was observed, and spastic equinovarus pattern during gait showed improvement after injection. The GCM+TPo injection group showed a significant decrease in forefoot, lateral forefoot pad, and lateral column PTI, and a significant increase in hindfoot PTI and coronal index. In the GCM only injection group, forefoot PTI and lateral column PTI were significantly decreased and hindfoot PTI was significantly increased. The TPo only injection group showed a significant decrease in lateral column PTI and a significant increase in the coronal index. Change in PTI in the hindfoot showed a significant correlation with the change in MAS score of the GCM. Change in PTI of the lateral column and coronal index showed a significant correlation with the change in MAS score of the TPo. CONCLUSION: The FPMS demonstrated the quantitative therapeutic effect of BTX-A on abnormal pressure distribution in equinovarus foot in detail. The FPMS can be a useful additional tool for evaluation of the effect of BTX-A injection.

Epithelioid hemangioma of distal femoral epiphysis in a patientwith congenital talipes equinovarus

Epithelioid hemangioma (EH) is a rare benign vascular lesion of soft tissue and bone, characterized by endothelial cells with epithelioid or histiocytoid appearance. Though tubular bones, flat bones, vertebra and short bones are common sites for this lesion, the epiphyseal involvement is extremely rare. We present an unusual case of EH of the distal femur in a young boy. Case report: A 12-year-old boy who had congenital talipes equinovarus of the right foot presented with progressively increasing pain in the right lower thigh for six months. Physical examination revealed muscular atrophy of the right lower limb and a moderately tender swelling in the medial aspect of the right knee without restriction of knee movement. An X-ray revealed an osteolytic lesion, which appeared iso- and hypointense on T1W and hyperintense on T2W MRI images in the distal epiphysis and adjacent metaphysis of the right femur. A radiological diagnosis of chondroblastoma was entertained. The patient was treated with curettage and bone grafting. Histopathology showed a tumor composed of thin-walled arteriolar capillaries lined by large, polyhedral epithelioid endothelial cells with vesicular nuclei, finely distributed nuclear chromatin, and moderate amount of eosinophilic cytoplasm. The endothelial cells were strongly immunopositive for CD34. Mitotic activity was low and the Ki-67 proliferative rate was <2%. A diagnosis of EH was made. EH is a benign lesion and it should be differentiated from its histologically similar malignant counterparts such as epithelioid hemangioendothelioma and epithelioid angiosarcoma as the lesion can be successfully treated with curettage or resection.

Tratamiento del pie equinovaro congénito irreductible mediante minifijador externo RALCA® / Treatment of irreducible congenital equinovarus foot using RALCA external minimal fixation

INTRODUCCIÓN. El pie equinovaro es una de las afecciones podálicas más frecuentes al nacimiento. La conducta que se ha de seguir ha sido siempre un tema complejo por las características individuales de cada deformidad, y ha quedado un grupo de niños con pies irreductibles y edades en las que el tratamiento se torna aún más difícil. El propósito de este trabajo fue evaluar el uso del fijador externo RALCA® en el pie equinovaro congénito irreductible. MÉTODOS. Se realizó un estudio de intervención de 15 pacientes (21 pies) con edades entre 4 y 10 años, atendidos en el Complejo Científico Ortopédico Internacional Frank País desde el 1ro. de enero del 2007 hasta el 31 de diciembre del 2008 por presentar pie equinovaro congénito irreductible. A todos los pacientes se les colocó un minifijador externo RALCA®. Se aplicó la puntuación para la corrección clínica de Dimeglio/Bensahel y la puntuación de Roye para función-satisfacción. Se midieron además 6 parámetros radiográficos, antes y después del procedimiento terapéutico. RESULTADOS. Se encontró un 100 por ciento de resultados de corrección clínica, valores de función-satisfacción desfavorables en el preoperatorio, un 61,91 por ciento de resultados satisfactorios en cuanto a la corrección clínica, así como un 57,14 por ciento en función y un 61,9 por ciento en satisfacción en el posoperatorio. La posición del escafoides (vista posteroanterior) y la superposición astrágalo-calcánea (vista posteroanterior) fueron los parámetros radiográficos más fiables en cuanto a su relación con los resultados clínicos obtenidos después del tratamiento. CONCLUSIÓN. Estos resultados demuestran la eficacia del minifijador externo RALCA® como método principal de tratamiento, siempre teniendo en cuenta que se trata un pie rígido e irreductible

INTRODUCTION: Equinovarus foot is one of the more frequent podalic affections at birth. Behavior to follow has been always a complex subject due to the individual characteristics of each deformity thus remained a group of children with irreducible feet and ages in which treatment becomes very difficult. The aim of present paper was to assess the use of RALCA® external fixation in irreducible congenital equinovarus foot. METHODS: An interventional study was conducted in 15 patients (21 feet) aged 4 and 10, seen in "Frank País" International Orthopedic Scientific Complex from January 1, 2007 to December, 31 2008 presenting with irreducible equinovarus foot. All patients received the above mentioned fixation. Authors applied the score for Dimeglio/Bensahel `clinical correction and the Roye score for function-satisfaction. Six radiographic parameters were measured before and after therapeutical procedure. RESULTS: There was a 100 percent of results for clinical correction, unfavourable function-satisfaction values during the postoperative period, a 61,91 percent of satisfactory values regards the clinical correction, as well as a 57,14 percent for function and a61,9 percent in satisfaction during the postoperative period. Scaphoid position (posteroanterior view) and the astragalus-calcaneus overlapping (posteroanterior view) were the more reliable radiographic parameters regard its relation to the clinical results obtained after treatment. CONCLUSION: These results demonstrate the effectiveness of RALCA® external fixation as principal treatment method always taking into account that the case is a rigid and irreducible foot

INTRODUCTION. Le pied bot varus équin est l'une des déformations congénitales les plus fréquentes du pied. Le procédé à suivre a toujours été un sujet extrêmement complexe en raison des caractéristiques particulières de chaque déformation, et pas mal d'enfants souffrent encore de cette affection dont le traitement se rend de plus en plus difficile avec l'âge. Le but de ce travail est d'évaluer l'utilisation du fixateur externe RALCA® dans le traitement du pied bot varus équin incurable.MÉTHODES. Une étude d'intervention de 15 patients âgés de 4 à 10 ans, atteints de pied bot varus équin incurable et traités au Complexe scientifique orthopédique international « Frank Pais » du 1e janvier 2007 au 31 décembre 2008, a été réalisée. Tous les patients ont été traités par la technique du mini-fixateur externe RALCA®. Le score de Dimeglio/Bensahel et le score de Roye ont été appliqués pour calculer respectivement la correction clinique et la fonction/satisfaction. On a également calculé six items radiographiques avant et après ce procédé thérapeutique.RÉSULTATS. Dans le préopératoire, les résultats de la correction clinique ont été satisfaisants dans 100 percent des cas, tandis que les valeurs fonction-satisfaction ont été desfavorables. Dans le postopératoire, les résultats de la correction clinique (61,91 percent), de la fonction (57, percent) et de la satisfaction (61,9 percent) ont été satisfaisants. La position du muscle scaphoïde (vue postéro-antérieure) et la superposition astragalo-calcanéenne (vue postéro-antérieure) ont été les items radiographiques les plus fiables vis-à-vis leur association avec les résultats cliniques après le traitement.CONCLUSION. Ces résultats montrent l'efficacité du mini-fixateur externe RALCA® en tant que technique principale de traitement, en tenant compte qu'il s'agit d'un pied rigide et incurable

Treatment of Calcaneovalgus Deformity Following Operative Treatment of Diplegic Equinovarus Deformity in Cerebral Palsy Patient: A Case Report / 대한족부족관절학회지

Calcaneal or calcaneovalgus deformity can occur after surgical treatment of equinus or eguinovarus deformity in cerebral palsy patient. It is a serious complication and the results of many conservative and operative treatments are reported unsatisfactory. We experienced one case of both calcaneovalgus deformity following operative treatment of diplegic equinovarus deformity in a spastic cerebral palsy patient and report about the result of the treatment.