[Nonoperative treatment of clubfoot] 814 cases

ABSTRACT

814 feet which have congenital talipes equinovarus of 537 children were followed at the surgical and Pediatric orthopedic clinic of the Casablanca children's hosp ital during the period February 1976 to September1990. 64,2% of the feet were examined during the first three months after birth and 70,4% of the children were masculin. The bilateraly was noted in 51,6% of the cases and 42,3 of the feet were irreducible [classified type III]. 15 cases of congenital dislocation of the hip were associated to clubfoot as well as to other malformations. The functional [orthopedic] treatment was applied at the service since 1980, in the form of manipulations with the utilization of posture splints. 131 feet of 81 children benefited from a series of plasters before hand. The aim of manipulations is to correct the various and the supination at first; the peroneus muscles stimulated by a toothbruch during the second phase. At the end, the equins is corrected in pulling the heel downwards. The Denis Brown splints are borne continuously, and are removed only during their-education sessions or in case of complications. Bearing this equipment needs surveyance on the part of the physiotherapist and the mother. Cutaneous ulceration may appear following the placement of the splints; they decreased markedly during our study thanks to artifices applied by the physiotherapist of the favorable shoes evolution, wearing reversed ankle shoes is permitted during the daytime. For the evolution of results, criteria of a morphological and radiological as well as of a functional nature were assessed. Only 495 feet of 318 children were able to be judged with sufficient retreat the average period being 5 years. In this way, appraisals were done at birth, and on the third, sixth and tenth month of the functional treatment. The x-rays of the tenth month were particularly decisive; they permitted follow-up on the treatment or else they indicated the necessity for conducting surgery. The global results of the treatment were good in 31,1% of cases. Reviewing the literature allowed a comparative study with our works; thus our results were close to those obtained by Turco [35%] and Seringe [38,7%]; Knowing that all the feet were examined by most of the authors before the 30 th day afterbirth. results obtained were even better [36,5%] when the treatment started during the first three months after birth instead of afterwards [13,7%]; this was the case when the foot was initially reducible [classified type I] [39,7%]. 83,8% the feet classified type II [partially reducible] and treated as type I, responded badly to the treatment. Stiff feet, made flexible by using series of plasters, obtained poor results in 57,3% of the cases. All the feet of group III [with bad results] were proposed for surgery, only 197 were operated of which.56,8% had 8 to 12 months of age. 83,7% of these feet underwent minor surgery of the posteromedial release type