[10. Congenital clubfoot. b). The results of the early treatment of congenital clubfoot].
Explore the source record for details and available documents.
Casts, Surgical↗
SEARCH · PubMed Health
Results for “Clubfoot”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Clubfoot analysis with three-dimensional computer modeling.
Which way are the bones rotated in a clubfoot? This question has long been debated by clubfoot surgeons. Opinions have been based on observations from surgery, radiographs, and autopsies. These methods all have pitfalls and are subject to misinterpretation. We used three-dimensional computer modeling to analyze histologic sections of a newborn clubfoot and a newborn normal foot. Relative to the bimalleolar axis in the axial plane, the normal talus demonstrated 5 degrees of internal rotation of its body and 25 degrees internal rotation of its neck. The clubfoot talus showed 14 degrees of external rotation of its body and 45 degrees of internal rotation of its neck. The calcaneus was externally rotated 5 degrees in the normal foot and internally rotated 22 degrees in the clubfoot.
Calcaneus↗
Necrosis leading to amputation following clubfoot surgery.
Amputation after clubfoot surgery is a rare and catastrophic complication. This case report involves an amputation necessitated by postoperative necrosis on the medial side of the foot. To our knowledge, only one brief published report of necrosis following clubfoot surgery exists in the literature, and that report contains little clinical information. Although we know of several additional cases of necrosis following clubfoot surgery, the details of these cases remain unavailable to us for publication. The clubfoot deformity is almost always associated with vascular deficiencies involving the anterior tibial and dorsalis pedis arteries, as well as their derivatives. Since the area of necrosis in this case report coincided with the anatomic distribution of the derivatives of the congenitally reduced or absent dorsalis pedis artery, we suggest that insufficient blood flow to the dorsal and medial sides of the foot, and to the hallux contributed to the necrosis. In our opinion, the surgeon should assume that an abnormal vascular pattern, as described here, is present unless proven otherwise.
Amputation, Surgical↗
Antenatal sonographic diagnosis of congenital clubfoot: a possible indication for amniocentesis.
Eighteen cases of congenital clubfoot were diagnosed sonographically between 16 and 38 weeks. The method of diagnosis, associated anomalies, karyotypes, and obstetric outcomes are described. Fifteen of the 18 fetuses had other major congenital anomalies, and of these, four had abnormal karyotypes. Only three had uncomplicated clubfoot as the only abnormality. Because of the significant incidence of abnormal karyotypes in our series, confirmed in other reported cases, identification of a clubfoot on prenatal sonography may be considered an indication for amniocentesis, particularly when other anomalies are present.
Adult↗
On the pathogenesis of clubfoot.
Empirical testing has not revealed an indisputable cause of clubfoot. Evidence put forward for intrauterine moulding as a cause of idiopathic clubfoot does not stand up to scrutiny. The hypothesis that a regional growth disturbance is the cause of clubfoot would explain clinical and existing research data.
Amniotic Fluid↗
Tibial torsion in untreated congenital clubfoot.
Current methods of measurement were reassessed by the study of tibial torsion in 1000 normal legs using the tropometer, the caliper and X-rays. No significant difference in the reproducibility of results was found and the simpler clinical methods appeared to be satisfactory for practical purposes. The spontaneous evolution of leg torsion in clubfoot was studied in forty-two neglected and previously untreated cases, who were seen for the first time after they had begun walking. Comparison with the torsion observed in the legs of healthy children of a corresponding age proved that untreated clubfoot is not associated with pathological torsion. The place of rotation osteotomy in the treatment of clubfoot is discussed.
Adolescent↗
Incidence of congenital clubfoot in Sweden. 128 cases in 138,000 infants 1946-1990 in Malmö.
The incidence of congenital clubfoot, neurological disorders excluded, was studied over a period of 45 years (1946-1990). The number of children, born alive with clubfoot, and detailed census data for the period were available. Altogether 137,614 living infants were born and of these 128 had congenital clubfoot. 56 (44 percent) were bilateral and 101 (79 percent) were boys. The overall incidence was 0.93 per thousand children. The annual incidence rose during the 45-year-period. This was, however, fully explained by the higher incidence among children of non-Nordic extraction.
Clubfoot↗
Results of ultrastructural analysis of the calf muscles in clubfoot.
Open biopsies were carried out on the muscles of 23 clubfoot patients, ages 9 months to 4 years. Electron microscopic analyses of the so-called "clubfoot muscles" and the peroneal muscles were performed. The changes found were not present in every area of the muscles, but were surrounded by fields of normal structure. Fatty degeneration with fibrosis was observed as the consequence of immobilization. More marked loss was found in the contractile elements. The authors believe that neuromuscular atrophy is a primary cause of congenital clubfoot. The most seriously affected muscles in this study were the tibialis posterior and peroneal muscles. The material failed to prove correlation with age. Based on their observations, the authors suggest finishing all types of immobilization before 1 year of age, when children begin to walk.
Actin Cytoskeleton↗
Sonographic diagnosis of clubfoot in utero.
The in utero sonographic diagnoses of 13 clubbed feet in eight fetuses are reported, and five representative cases are described in detail. The sonographic findings and clinical features of fetal clubfoot are discussed. The prenatal sonographic detection of clubfoot should alert the sonographer to search for other congenital anomalies associated with syndromes involving clubfoot.
Abnormalities, Multiple↗
Practical applications in idiopathic clubfoot: a retrospective multicentric study in EPOS.
We report a European study of idiopathic clubfoot that was compiled with the aid of a detailed questionnaire. The retrospective study was presented at the seventh meeting of the European Paediatric Orthopaedic Society (EPOS). Most EPOS members treat idiopathic clubfoot at birth with plaster cast, but a few use physiotherapy and splints. The results of this conservative treatment vary. Operation is usually indicated at an age ranging from 4 to 15 months. Some physicians perform extensive procedures, and others limit operation to the medial and posterior parts of the foot. We propose a classification system for idiopathic clubfoot in an attempt to standardize procedures.
Casts, Surgical↗
The role of major gene in clubfoot.
The roles of major gene and multifactorial inheritance in the etiology of clubfoot (talipes equinovarus) were studied using Caucasian clubfoot families ascertained in Indiana. The method of analysis used was complex segregation analysis under the mixed model, in which five genetic parameters were examined to test hypotheses on major gene by displacement (t), degree of dominance (d), gene frequency (q), transmission probability (tau2), and multifactorial inheritance by heritability (H). The analysis showed that the segregation pattern of clubfoot in these families is best explained by assuming the action of a major gene with additional contribution of multifactorial inheritance. The estimates of the parameters under the best-fitting model were d = .82, t = 4.69, q = .030, tau2 = .50, and H = .17.
Clubfoot↗
Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot.
The histochemical composition of the triceps surae muscle was investigated in 13 previously unoperated children (age 9-24 months) with unilateral idiopathic clubfoot. On both the normal and the affected side, the percentage of type I fibers was significantly higher than that of the other fiber types. The muscle biopsies from the clubfoot side showed an increase in their connective tissue content. The affected side showed a nonsignificant higher percentage of type I fibers, whereas the average capillary density and capillary to fiber ratio were significantly lower.
Clubfoot↗
Clubfoot with supernumerary soleus muscle. Report of 2 cases.
In 2 cases of clubfoot with severe and rigid varus deformity, an accessory soleus muscle with attachment on the medial side of the calcaneus was found. After cutting the distal attachment of this muscle, the deformity diminished. The accessory soleus muscle is not interpreted as the primary cause of the clubfoot, but as a highly contributing cause to the rigid varus deformity.
Abnormalities, Multiple↗
A method of assessment of the clubfoot deformity.
The literature on clubfeet is inadequate because a common method language for assessing the deformity is lacking. Different severities of clubfoot deformity will give different results for a standard procedure: a less severe deformity can be corrected by limited releases, whereas a severe deformity requires radical procedures. This paper presents a language of assessment that has been used for a number of years. The importance of developing a language of assessment to be able to identify the various types of clubfoot deformity is important if the treatment of this condition is to develop within the field of pediatric orthopedics.
Clubfoot↗
The technique of dynamic adhesive strapping for congenital clubfoot.
The use of dynamic adhesive strapping to correct congenital clubfoot in the immediate neonatal period is an effective method of treatment. The technique is described in detail, the steps are illustrated, and precautions and limitations are given. This type of treatment should shorten the amount of time required to correct congenital clubfoot. If the holding phase is sufficiently prolonged, a reduction in the number and complexity of operative procedures needed for recurrent and recalcitrant cases can be expected.
Bandages↗
Experience in the conservative treatment of congenital clubfoot in newborns and infants.
We studied 323 children with congenital clubfoot from 1970 to 1987. The principles of conservative treatment of congenital clubfoot in newborns have completely changed since 1973. The present principles we follow are to begin treatment immediately after birth; and adduction and varus removal by manipulation. In each case, we use a plaster cast, which is changed after a few days as long as the foot is limp and well corrigible. The knee is immobilized at 60 to 70 degrees in a plaster cast. During the manipulations, the surgeon's hand presses only the plantar side of the foot. The results can be described as good, since in each child we have removed adduction and varus as operation by posterior release and Achilles lengthening was necessary in only 50% of the children.
Casts, Surgical↗
The four quadrant approach to clubfoot surgery.
In the last 20 years, the approach to clubfoot surgery has changed. When surgery is performed, a comprehensive posterior, medial, and lateral release is indicated. The concept of derotation of the os calcis has proved beneficial in resolving the residual pigeon-toed gait. This constitutes the fourth quadrant of correction in clubfoot surgery. The ultimate goal is to achieve a supple functioning, plantargrade foot in one sitting.
Child, Preschool↗
The pathoanatomy of congenital clubfoot.
Patients with resistant clubfeet were reviewed in their second and third decades. For comparison, normal embryological and fetal feet, untreated clubfeet, a recurrent clubfoot, and an amputated foot were dissected. In no child with a resistant clubfoot was the bone architecture normal. In untreated and recurrent clubfeet we found the lateral malleolus to be directed posteriorly, the head of the talus pointed laterally, and the navicular subluxated medially toward the medial malleolus. An operative technique to restore normal alignment of the talus in the ankle mortice, of the navicular and talus, and of the talus and os calcis is described.
Adult↗