Is the same brace fit for all? The length of abduction bar in Steenbeek foot abduction brace for Indian children-A pilot study.

PURPOSE: We measured the foot size and shoulder width in North Indian children with idiopathic clubfoot and calculated the corresponding metal rod length for abduction brace. The differences in the foot length in unaffected, unilateral and bilateral clubfeet were also measured. PATIENT AND METHODS: Two sets of measurements were taken on each child: feet size and shoulder width. Using statistical analysis, the following were compared: Differences in the manual prescribed and our calculated SFAB bar length, foot size in unilateral clubfoot and unaffected foot and both feet in bilateral clubfoot. RESULTS: There were 156 patients with 76 unilateral (37 left + 39 right) and 80 bilateral feet. The mean prescribed bar length for foot sizes 8-14 in the Steenbeek manual is 30.18 cm. The mean predicted bar length worked out to be 22.33 cm in our series (p < 0.001). In unilateral clubfoot, the mean foot length (11.9 cm) when matched with unaffected foot (12.6 cm) was comparable (p = 0.08). Bilateral clubfeet lengths (12.29 cm versus 12.3 cm) were also comparable (p = 0.978). CONCLUSIONS: There was significant difference between the prescribed and the predicted bar length in foot sizes 8-14 with a smaller bar length measurement of Indian children. The Ponseti treated unilateral club foot length matched the unaffected foot. The foot lengths in bilateral feet disease were also similar.

Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis.

INTRODUCTION: Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot. MATERIAL AND METHODS: We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe. RESULTS: There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet. CONCLUSIONS: Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.

Extended Ponseti method for failed tenotomy in idiopathic clubfeet: a pilot study.

We evaluated the outcome of a new protocol of an extended Ponseti method in the management of idiopathic club foot with residual equinus following failed Achilles tenotomy. We also compared the failed with a successful tenotomy group to analyze the parameters for failure. The Ponseti technique-treated idiopathic club foot patients with failed percutaneous Achilles tenotomy (failure to achieve <15° dorsiflexion) were treated by continued stretching casts, with a weekly change for a further 3 weeks. Final dorsiflexion more than 15° if achieved with the above protocol was recorded as a success. Twenty-six (16%) patients with failed Achilles tenotomy and residual equinus out of a total of 161 patients with primary idiopathic club foot were tested with the protocol. Ten (38.5%) failed patients had bilateral foot involvement and 16 (61.5%) had unilateral foot involvement. A total of seven (26.9%) patients achieved the end point dorsiflexion of more than 15° in one further cast, 10 (38.5%) in two casts, and four (15.4%) in three casts, respectively. Overall success of the extended Ponseti protocol was achieved in 21/26 (80.8%) patients. The patient's age, precasting initial Pirani score, number of Ponseti casts, pretenotomy Pirani score, and pretenotomy ankle joint dorsiflexion were statistically different in the failed compared with the successful tenotomy group. The tested extended Ponseti protocol showed a success rate of 80.8% in salvaging failed tenotomy cases. The failed tenotomy group was relatively older at presentation, had high precasting and pretenotomy Pirani scores, received extra number of Ponseti casts, and less pretenotomy ankle joint dorsiflexion compared with successful feet.

Ankle valgus following non-vascularized fibular grafts in children-an outcome evaluation minimum two years after fibular harvest.

BACKGROUND: The literature on ankle valgus development after procuring non-vascularised fibular grafts in children is still scanty. The non-vascularised fibular graft has distinction of fibular regeneration occurring at the donor site. MATERIAL AND METHODS: We retrospectively analysed the valgus deformities at the donor leg following harvest of non-vascularised fibular graft to determine the various contributing factors in growing children. All these patients had minimum two years post index procedure follow up. The radiological ankle valgus was quantified using Malhotra's distal fibular station (0-3), Lateral distal tibial angle (LDTA <84 degrees) and Talar tilt angle >5 degrees. Clinical parameters, evaluated additionally were pain and neuromuscular deficits in the donor limb, if any. RESULTS: A total of 30 ankles in 23 patients were evaluated. The average patient age was 9.56 years. There was no pain or neuromuscular deficit in the examined limbs at a mean follow up of 39.4 months. The continuity of the fibula in the longitudinal dimension was already restored in 90% limbs. There was presence of radiological valgus deformity in 10 (33%) ankles. The LDTA was abnormal in 80% and talar tilt in 50% valgus ankles. The ankle valgus deformity was found despite the presence of a normal Malhotra station 0. The age of the patient did not seem to influence the ankle valgus deformity. CONCLUSIONS: Radiological ankle valgus is a common occurrence even following non-vascularised fibular harvest. The presence of a regenerated fibula in continuity (90% legs) and almost of similar anatomical longitudinal dimensions (97%) did not deter development of valgus deformity at ankle.