Postermomedial surgical approach with or without selective medial release of the subtalar joint in clubfoot surgery

Congenital clubfoot is a variable three dimensional complex system of chondroosseous and joints deformity. Its treatment possess a controversial issue since dates of Hippocrates. In clubfoot surgery many complications as stiffness, overcorrection, talar avascular necrosis and subsequently poor functional results were postulated by many as a sequlae to simultaneous complete subtalar release . This is a prospective study of 33 patients with 40 idiopathic clubfeet. There were 28 males [84.8%] and 5 were female [15.2%] patients.The affected sides were [left =11; right= 15; bilateral = 14 feet]. The feet were divided randomly into 2 equal groups [A and B][20 feet each]. The initial deformity was very severe in 32 feet and severe in 8 by using the Simon scale and allocated equally in both groups. All the feet were treated at a mean age of 8 months by means of posteromedial surgical soft tissue release. In addition selective medial capsular release of the subtalar joint with release of talocalcaneal interosseous ligament was done in group [A] feet where it was left intact in group [B]. At a mean follow-up period of 26 months range [24-30], the total satisfactory results were [85%]. In both groups the result was [90%] satisfactory in group [A] and [85%] in group [B] feet . When their mean overall clinical and radiological scores were investigated and comparing their satisfactory results together, group [A] feet showed statistically significant improvement of clinical and radiological parameters than those of group [B]. This was reflected clinically on better hindfoot alignment with the release of the TCIL in group [A] feet. Neither any evidence of overcorrection nor talar avascular necrosis was detected either clinically or radiologically by conventional x-ray as well as by MRI of all the studied feet in both groups. Posteromedial surgical approach with release of TCIL proved to be a good contribution in the treatment of severe and relapsing clubfeet, which gave significantly better hindfoot alignment without aforementioned serious complication

An incomplete form of lumbocostovertebral syndrome in association with atrial septal defect, arthrogryposis and clubfeet.

The present study describes a 9-month-old infant who presented with congenital lumbar hernia, kyphoscoliosis, atrial septal defect, congenital talipes equinovarus and arthrogryposis. To the best of our knowledge, this is the first case in English literature with this combination of defects. The case could be considered an incomplete form of the lumbocostovertebral syndrome. We also discuss the etiopathogenesis of these malformations.

Down's syndrome presented with clubfoot deformity: a case report.

A 1 month old girl was referred to the orthopaedic clinic with bilateral clubfoot deformities. At birth, clinical examination showed the typical characters of Down's syndrome and the diagnosis was confirmed by chromosome study. These two conditions appear improbable as their basic pathologies are entirely different. In our patient, the translocation type at the long arm of chromosome 21 was determined in the chromosome study. This result has never been reported in the literature.

Análisis de las causa de reintervención en el pie equinovaro congénito / Analysis of the causes of reintervention in congenital equinovarus talipes

El objetivo de la cirugía del pie equinovaro congénito es obtener una adecuada y permanente corrección del defecto en un solo tiempo quirúrgico mediante la liberación de los componentes de la deformidad y la restauración anatómica del retro y medio pie, para así lograr un desarrollo normal de las articulaciones. En este trabajo analizamos 86 pies de 65 pacientes tratados quirúrgicamente, de los cuales 29 requirieron reintervención por persistir diversos componentes de la deformidad; de éstas, la más común fue el aducto de antepié seguido del varo y posteriormente el equino. La causa más frecuente de reintervención fue una insuficiente liberación con la que se obtuvo una corrección incompleta, así como falla en la valoración radiográfica transoperatoria

Tratamento cirúrgico da deformidade em varo do pé na paralisia cerebral / Surgical treatment of varus foot deformity in cerebral palsy

Apresentam-se os resultados do tratamento cirúrgico da correçäo da deformidade em varo do retropé, de 33 pés em 30 pacientes com paralisia cerebral. Após abordarem aspectos semiológicos importantes, concluem que as cirurgias de alongamento intrabaínha do músculo tibial posterior, a osteotomia valgizante do calcâneo, ou a associaçäo das duas, mostraram-se eficientes na correçäo da deformidade em varo. Salienta-se que as técnicas utilizadas devem ser consideradas antes de se realizar uma cirurgia definitiva como a artrodese tripla do pé