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.

Conservative treatment of congenital talipes equino varus [clubfoot]

The Congenital Talipes Equino Varus is the most common disorder of congenital deformities of foot. Material and This study was conducted know the of conservative treatment of the condition. A total of one hundred and ten patients with 165 Feet having Congenital Talipes Equino Varus deformities were registered for study from July 1998 to June 2000 at Hayatabad Medical Complex Peshawar. All the patients with congenital clubfoot deformity were included in the study and those having deformity secondary to poliomyelitis, cerebral palsy, meningomyelocoele and arthogryposis multiplex congenital were excluded from the study. Ninety-six patients with 144 clubfeet completed their followup of two years. The average age of patients was 19 days, ranging from 01 day to 12 weeks. The deformity was classified according to Harrold and Walker's classification. All the patients were treated non-operatively using Kite and Lovell technique. The were assessed by using Turco's assessment method. 81.24% excellentgood were achieved at two years of follow-up. Conservative Treatment is the best option of treatment for Congenital Talipes Equino Varus [clubfoot], which starts at an early age. It prevents future deformity in children and lessens the burden over the society