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INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated through telemonitoring. OBJECTIVE: This study aimed to monitor the foot's flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot's flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.
INTRODUÇÃO: A intervenção precoce é essencial para o correto crescimento do pé torto congênito postural (PTC), mas pouco se sabe sobre sua contribuição para essa deformidade quando os pacientes são avaliados por meio de telemonitoramento. OBJETIVO: Este estudo teve como objetivo acompanhar, por telemonitoramento, a flexibilidade do pé de recém-nascidos com diagnóstico de PTC durante os primeiros meses de vida. MÉTODOS: Foi realizado um estudo descritivo longitudinal com recém-nascidos a termo, diagnosticados com PTC em pelo menos um pé, apresentando escore de Pirani ≥ 0,5. Foram excluídos recém-nascidos com outras malformações. Os recém-nascidos foram avaliados nas primeiras horas de vida e 30 dias após a alta hospitalar. Durante este período os pais foram incentivados a mobilizar os pés diariamente e manter a posição por meio de órtese ou bandagem. O telemonitoramento ocorreu semanalmente, e a flexibilidade dos pés foi classificada pelo escore de Pirani. RESULTADOS: Foram incluídos neste estudo treze recém-nascidos (dezoito pés), sete descontinuaram o estudo por faltas nas tentativas de contato e seis foram telemonitorados por 30 dias. A maioria dos RN era do sexo feminino (69%), nasceram com 39 semanas (± 1,18) e 3.346,54g (± 306,51). Um nasceu de parto normal e oito (61%) tinham histórico familiar de PTC. Inicialmente, a pontuação de Pirani variou de 1 a 3. Após 30 dias de telemonitoramento, três pés evoluíram para 0 e quatro pontuaram entre 0,5 e 1. CONCLUSÃO: Este estudo mostra uma melhora importante na flexibilidade do pé de recém-nascidos com diagnóstico de PTC, avaliados por telemonitoramento. O telemonitoramento pode ser um recurso adicional para assistência ao recém-nascido com PTC.
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Pé Torto , Aparelhos Ortopédicos , Recém-NascidoRESUMO
Objective:To evaluate and analyze the ultrasonic findings of idiopathic clubfoot and positional clubfoot deformities.Methods:Forty-nine newborn babies with congenital clubfoot were examined in the Department of Ultrasound of the Third Affiliated Hospital of Zhengzhou University from December 2020 to January 2022, Including 21 newborn babies(32 feet) with idiopathic clubfoot, and 28 babies(53 feet) with positional clubfoot. Twenty-two normal infants in the same period and the normal feet of the single clubfoot were selected as control group. The distance between medial malleolus and scaphoids of all feet were measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone, medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data of idiopathic clubfoot group, positional clubfoot group and control group were statistically analyzed.Results:A total of 71 newborn babies with 142 feet were evaluated.The idiopathic clubfoot group had born and joint changes in the medial, lateral and posterior side, and the differences were statistically significant compared with the control group (all P<0.05). Compared with the control group, there were statistically significant differences in the medial and lateral side of the positional group(all P<0.05). But no significant changes in the posterior side( P>0.05). There were significant differences between medial and posterior side of idiopathic and positional clubfoot group (all P<0.05), but no significant differences in lateral side ( P>0.05). Conclusions:Ultrasonography can clearly display the tarsus bones in clubfoot, and observe the deformity changes of the idiopathic clubfoot and positional clubfoot.
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Objective:To evaluate the deformity changes in the treatment of congenital clubfoot in infants by ultrasound, and to explore its clinical application value.Methods:Seventeen infants with congenital clubfoot treated in the Department of Pediatric Orthopaedics of the Third Affiliated Hospital of Zhengzhou University from March 2020 to June 2021 and 27 normal infants in the same period were selected. The distance between medial malleolus and scaphoids (MM-N distance) of all feet was measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone (C-C distance), medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data before, after treatment and during follow-up were statistically analyzed.Results:A total of 88 feet of 44 infants were evaluated. The mean number of cast was 4.7±1.1, the follow-up time was (96.9±59.3)days. The MM-N distance, C-C distance and posterior tibial calcaneal angle in the clubfoot group were improved after treatment and at the last follow-up, and the differences were statistically significant (all P<0.01). During the treatment, 1 case had false correction, and 2 cases recurred in the last follow-up. Conclusions:Ultrasound can clearly display the medial, dorsal, lateral and posterior articular structures of normal and clubfoot, and can observe the deformity changes of clubfoot during the correction process, which can provide guidance for the clinical treatment of clubfoot.
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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)
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Humanos , Pé Torto Equinovaro , Modalidades de Fisioterapia , Anormalidades Congênitas , Calcâneo , Eficácia , Extremidade Inferior , MétodosRESUMO
Objective: To investigate the effectiveness of Ilizarov technique in treatment of rigid congenital clubfoot in older children. Methods: A clinical data of 55 patients (69 feet) with rigid congenital clubfoot (Diméglio grade Ⅳ) between September 2005 and September 2015 were retrospectively analyzed. There were 33 boys and 22 girls with an average age of 11 years (range, 6-14 years). There were 41 cases of unilateral clubfoot and 14 cases of bilateral clubfeet. The degree of foot deformity was rated as fair in 24 feet and as poor in 45 feet according to International Clubfoot Study Group (ICFSG) score before operation. Sixty-nine feet were treated by Ilizarov external fixator combined with limited soft tissue release, and 21 feet were combined with individualized V-shaped osteotomies. Results: All patients were followed up 2-10 years ( mean, 4.2 years). The incisions healed well after operation. Five cases of needle tract infection occurred and were cured by local dressing change. The effectiveness was excellent in 39 feet, good in 21 feet, and fair in 9 feet according to ICFSG score, with the excellent and good rate of 87.0%. During the follow-up, X-ray films showed that no blood supply disorder or necrosis of talus, scaphoid, cuneiform, metatarsal, calcaneus, and cuboid occurred. No osteomyelitis occurred. Conclusion: Ilizarov technique combined with limited soft tissue release or V-shaped osteotomy for the older children with rigid congenital clubfeet is safe and can obtain significant orthopedic effectiveness.
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PURPOSE: This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot. MATERIALS AND METHODS: A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace. RESULTS: Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace. CONCLUSION: The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.
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Humanos , Braquetes , Pé Torto Equinovaro , Complacência (Medida de Distensibilidade) , Anormalidades Congênitas , Seguimentos , Pé , Recidiva , TenotomiaRESUMO
[Objective]To compare the differences in using Ponseti method treating congenital clubfoot (CCF) patients older than six-month and younger than six-month of congenital clubfoot(CCF). [Method]Five hundreds and forty-four feet in 378 cases of CCF were treated with Ponseti method. According to the age differences, they were divided into older infancy group (﹥6 month, 227 feet in 157 cases and younger infancy group(≤6 month,317 feet in 221 cases). The deformation degree of CCF was evaluated by the Pirani scoring system. A scoring of 0-0.5 was regarded as being excellent. For each group, we evaluated the percentage of excellence result according to the Pirani score, the number of casts used, and the percentage of percutaneous achillotenotomy. The result was compared between the two groups. [Result]The excellence rate showed no significant differences between the two groups (P﹥0.05). Both the number of casts used and the percentage of percutaneous achillotenotomy in the younger infancy group were more than that in the older infancy group. There was obvious difference between the two groups (P
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0.05).There were no serious side reactions such as total spinal anesthesia and local anesthetic intoxication.Conclusion:Combined basal anesthesia and perpendicular sticking caudal anesthesia is a feasible method for congenital clubfoot surgery in infants.It has the advantages of simplicity,time saving,safety,less injuries,etc and is worth applying clinically.
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PURPOSE: To analyze the incidence and influencing factors of residual forefoot adduction after clubfoot-surgery. MATERIALS AND METHOD: A total of 133 clubfeet of 94 patients that had been surgically treated more than 3 years ago were followed up. For comparison purposes, we divided them into 3 groups. The first group was treated using a one-stage posteromedial release (PMR, 84 feet), the second group by posterolateral release (PLR, 34 feet), and the third group by medial release and lateral column shortening (Lichtblau, 34 feet). The forefoot adduction was characterized by Bleck's method and the effects of influencing factors, such as sex, laterality, methods of operation, and age at the time of operation were examined. Preoperative and postoperative calcaneocuboidal angles were also measured. RESULT: 40.2% of residual forefoot adduction was observed. Persistent grade 2 calcaneocuboidal malalignment showed 81.4% residual forefoot adduction. Forefoot adduction was unlikely to persist following posteromedial release procedure in the 1 to 2 year old age group. CONCLUSION: Age at the time of operation and the correction of calcaneocuboidal malalignment were significant factors for the development of residual forefoot adduction.
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Pré-Escolar , Humanos , IncidênciaRESUMO
The authors have reviewed 63 resistant clubfeet of 40 patients who were treated by modified Turco's operstion at the Department of Orthopaedic Surgery, Seoul National University Hospital during the eight years period from July, 1979 to June, 1987. The procedure performed by the senior author(D.Y.L.) is essentially similar to Turco's original technique, but with the following modifications :(a) A curvilinear skin incision instead of Turco's straight oblique incision. (b) Aponeurotic tenotomy of the abductor hallucis. (c) Medial capsulotomies of the first metatarso-medial cuneiform joint, medial cuneiformnavicular joint and release of the medial extension of the tibialis anterior insertion. (d) Z-plastic lengtening of the tibialis posterior tendon instead of tenotomy (e) Plantar fasciotomy The average age at the time of operation was 23.4 months, the youngest being 4 months and the oldest being 6 year and 7 months. The follow-up period was minimum 12 months and maximum 6 years, the average being 27.4 months. The cases were analysed radiologically and clinically, and following observations were made. l. AP and lateral talocalcaneal angles were corrected satiafactorily in 60 feet(95%) and 59 feet(94%), respectively. The Talocalcaneal indices were corrected satisfactorily to over 40 in 60 feet(95%). 2. The talo-first metatarsal angles, which reflect adduction of the fore-foot, were corrected satisfactorily to within +10°in 55 feet(87%). 3. Good and fair results were obtained in 54 feet(86%) in the radiological evaluation. 4. Adduction deformity of the forefoot was responsible in most cases of radiologically unsatisfactory results. 5. Among 40 feet of 26 pstients who were evaluated clinically by the Wynne-Davis method, 33 feet were rated good and 7 feet were rated fair. No poor results were found clinically. 6. Senior author's modification of additional forefoot medial release is an important addition to Turco's original technique and effectively reduced unsatisfacotory results.
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Humanos , Pé Torto Equinovaro , Anormalidades Congênitas , Seguimentos , Pé , Articulações , Ossos do Metatarso , Métodos , Seul , Pele , Tendões , TenotomiaRESUMO
The treatment, etiology, and even pathological anatomy of congenital clubfoot unfortunately are still controversial. A universially accepted method of classification of the severity of the deformity is lacking, and no standardized method of evaluating the result of treatment has been developed yet. 66 patients with 94 congenital clubfeet treated in orthopedic department of Kyungpook National University Hospital from 1981 to 1986 with nonoperative and operative method were analyzed. The results were as follows :1. Among 66 clubfeet patients, the sex ratio between male & female was 1.9: 1, bilateral involvement was in 28 and unilateral in 38 patients. 2. 10 patients(15%) were associated with other congenital anomalies. 3. Of 94 clubfeet, flexible type were 73(78%), rigid type were 21 feet. 4. Among 74 feet who were treated conservatively with serial cast, good result was obtained in 57 feet(77%). In patients who had conservative treatment within 3 weeks of life, good result was obtained as 84%, but in patients after 3 weeks, good result was obtained as 69%. 5. The average period of serial cast correction was 7.5 weeks. 6. In conservatively treated patients the talocalcaneal index was 25±7 before treatment and 61±8 after treatment. 7. Of 20 feet who were treated with surgical correction, good and fair result was obtained in 17 feet (85%). Key Words : Congenital clubfoot.
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Feminino , Humanos , Masculino , Classificação , Estudo Clínico , Pé Torto Equinovaro , Anormalidades Congênitas , Pé , Métodos , Ortopedia , Razão de MasculinidadeRESUMO
Objective To investigate the etiology and provide data for clinical treatment and therapeutic assessment of congenital clubfoot(CCF) via neuroelectrophysiology on motor and sensory nerves and ultrastructure of sural nerve.Methods Totally 248 patients diagnosed with CCF(338 clubfeet) were studied.Motor nerve conduction velocity(MCV),sensory nerve conduction velocity(SCV) and wave amplitude were detected for any changes.An ultra-structural study of sural nerve ramification was also conducted in 36 patients(36 clubfeet) under electron microscope.The correlation between deformity degree,nerve conduction abnormality and therapeutic outcomes was analyzed.Results The motor nerve conduction in 291 clubfeet(86.1%) and the sensory nerve conduction in 252 clubfeet(74.6%) were found with different degrees of abnormalities such as prolonged latency,declined/disappeared wave amplitude,etc.The ultrastructural observation of sural nerve ramification demonstrated abnormalities in all the 36 cases,showing proliferation of myelin sheath in peripheral myelinated nerve fibers,formation of vacuoles,segmental demyelinating lesions and so on.Part of axial cord was squeezed by the proliferated myelin sheath,which resulted in disappearance of axoplasm.The correlation study showed that as deformity became more severe,the nerve conduction abnormality was more evident,requiring more complicated treatments,and the therapeutic outcomes were less satisfactory.Statistical analysis by Mantel-Haenszel method showed that:① the abnormality rate of motor nerve in different types of CCF is signifi-cantly different(?2=32.31,P
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Since congenital clubfoot is not a single or uniform entity, one cannot expect a consistently favorable response from a single or uniform method. And one person's ideas or methods of therapy either conservative or operative would be noted insufficient or not applicable to all cases. This report is based upon analysis of records for 44patients seen at National Medical Center from 1971 to 1980. 44 patients with 68 congenital clubfood were seen at the Outpatient Department and 26 in-patients with 40 congenital clubfoot were treated, and the average follow-up period was II. 6 months. If the clubfoot was found early conservative method was applied initially whether it was the flexible or rigid type, and surgery was applied in children whose deformith had not responded to conservative treatment or had been neglected for a long time and proved to be rigid. The results were as follows, 1. Among 68 clubfoot, equinovarus was 64, and calcaneovalgus was 4. Of the 44 patients, 32 were male and 12 were female (2.7:1). 2.Bilaterat involvement was in 24 and unilateral in 20 patients. 3. 35 cases(79. 5%) were idiopathic, and 9 were associated with other congenital abnormalities. Of 40 clubfoot, supple type were 24 feet. and rigid type were 16 feet. In patients under 3 months of age, conservative treatment was found to be quite adequate to obtain good result. 5. 24 feet were treated with a serial cast for the average period of 8 weeks, with the result of 18 good, 3 fair, and 3 poor. To obtain good result, patient's tolerance, parent's eooperation and doctor's skill were all necessary. 6. 18 feet graded good had T-C index of more than 47. Surgical correction was applied in l6 feet of rigid type with the result of 10 good, 2 fair, and 2 poor. Various surgical methods were to be applied according to the age of patients and the main pathology. 8. Modified Turco operation was performed ia 8 patients(6 feet) at the age of 6 months, 8 months and 10 months respectively, and this one stage posteromedial release with K-wire fixation showed the best results in those age groups.
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Criança , Feminino , Humanos , Masculino , Vestuário , Pé Torto Equinovaro , Anormalidades Congênitas , Seguimentos , Pé , Métodos , Pacientes Ambulatoriais , PatologiaRESUMO
Ten feet from 6 idiopathic congenltal clubfoot patients which had failed to respond to conservative mearsured were treated by aggreasive posteromedial release during infancy with generally good results. A modltication of Denis-Browne splint by splitting both aides and using dial lock to hold the foot still ln correeted position was found quite useful for post-operative maintenance.