Bilateral congenital idiopathic talipes equinovarus in twins

A case of twins with bilateral congenital idiopathic talipes equinovarus is reported. This specific presentation is rare, and no specific measures of incidence are presently registered. Both patients are currently undergoing serial follow-up. The cases discussed here support a genetic basis for the condition and suggest that chromosomal/genetic studies may prove informative in such incidences.     

Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

Background

We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up.

Materials and methods

Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet).

Results

The average follow-up was 5 years (1–6 years). In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. In ambulating children, the results were excellent in 5 feet, good in 16, and poor in 3. No major complications were reported. No overcorrections were observed. The need for open surgery was higher in cases of delayed treatment. In cases of relapse, re-casting and/or more extensive surgery was considered.

Conclusions

Early treatment enables a high rate of good correction to be obtained with serial casting and limited surgery. Conversely, if the deformity is observed after walking age surgery should be considered. Serial casting in cases of late observation and relapse have demonstrated encouraging results.

Level of evidence

IV.

     

Seasonal distribution of idiopathic congenital talipes equinovarus in Scotland

Idiopathic congenital talipes equinovarus has a reported prevalence of between 0.64 and 2.5 per thousand live births in the Scottish population. A retrospective study of neonates (n=162), who presented with idiopathic congenital talipes equinovarus in Scotland over a 3 year period (1994-1996) revealed a seasonal increased incidence of the condition in neonates born in March and April. The probable aetiological factors for congenital talipes equinovarus are discussed.     

Muscular strength after extensive operative treatment of congenital talipes equinovarus

Maximum isometric voluntary contraction (MIVC) strength of muscles (extensors, plantar flexors, pronators and supinators of the foot) in children with congenital talipes equinovarus who underwent extensive operative treatment was evaluated. The first group consisted of 28 children (50 clubfeet) operated on with posteromedial-lateral release aged 7 months to 76 months (mean, 22 months), with mean follow-up period of 85 months. The second group consisted of 32 children (39 clubfeet) operated on with complete subtalar release from Cincinnati incision aged from 3 months to 50 months (mean, 11 months), with mean follow-up period of 51 months. In both groups, the muscles moving the foot in the sagittal and coronal plane showed a decreased MIVC. The greatest deficit was observed in the supinators and extensors, less in the pronators and plantar flexors. Better results were accompanied by greater MIVC, but significant relations existed in the first group between the strength of the extensors and the quality of results (better results correlated with better MIVC of the extensors). No significant differences between both patient groups were noted. For the plantar flexors, the difference of the MIVC strength between the normal and affected feet is stable; instead, for the extensors, supinators and pronators, it increases in the analyzed age interval.     

Leg-length discrepancy and bone age in unilateral idiopathic talipes equinovarus

The goals of this retrospective review were to evaluate leg-length discrepancy in patients with a unilateral clubfoot and to determine the relationship between bone age and chronologic age in the same population. Thirty-two of 47 patients referred for scanograms had a discrepancy more than 0.5 cm. Shortening was predominantly in the tibia, and four patients had radiographic evidence of growth disturbance. Five had been treated surgically at the time of review. If clinically indicated, a scanogram and standing radiographs of the ankle are necessary to determine the location and magnitude of discrepancy. Although the literature supports a neurologic etiology in some patients, and bone age may be delayed in certain neuromuscular conditions associated with limb shortening (hemiplegia), the authors' results suggest that bone age is statistically equivalent to chronologic age in the unilateral clubfoot population. These findings do not provide indirect support for a neurologic etiology.     

先天性多发关节挛缩症致马蹄内翻足的治疗

目的 研究先天性多发关节挛缩症患者的马蹄内翻足畸形治疗。方法 回顾性分析先天性多发关节挛缩症的马蹄内翻足畸形32例（64足）的临床资料,根据Sodergard评定方法进行综合评价。结果 保守治疗满意4足,手术治疗60足中,14足1次手术获得满意结果,467足初次术后畸形复发,占77.7%,有些足需3次手术。结论 手术治疗应在1岁前行彻底的软组织松解,对于复发性、顽固性的马蹄内翻足距骨切除术是一种值得考虑的手术。     

Peritalar release in the treatment of congenital talipes equinovarus clubfoot

It is the purpose of this retrospective study to evaluate the results of the surgical treatment of congenital talipes equinovarus clubfoot. Seven patients affected with congenital talipes equinovarus clubfoot, 2 of which bilateral, treated surgically using peritalar release according to Simons were re-examined. The long-term follow-up results obtained after an average of 4 years were evaluated from clinical, morphofunctional, and radiographic points of view, and with the help of a photopodogram and computed baropodometry. The subjective satisfaction of the patients was also evaluated. Results were considered to be good in all of the cases. In conclusion, surgery involving peritalar release allows for correction of abduction of the forefoot, and restores physiological calcaneal valgus, re-balancing standing on the plantar surface; the persistence of an area of hypostanding in the forefoot operated on and of mild, residual cavus of the plantar arch do not, thus, seem to influence the good results obtained.     

改良双"8"字石膏固定治疗先天性马蹄内翻足

目的 :介绍早期采用手法矫正及改良序列连续双“8”字石膏固定治疗先天性马蹄内翻足的方法并评价其效果。方法 :本院自 1994～ 2 0 0 2年采用手法矫正和连续双“8”字序列石膏固定 ,治疗先天性马蹄内翻足 2 1例共3 2足。结果 :本组平均随访 18个月 ,按优、良、可、差评价。优 2 6足 ,良 4足 ,可 2足 ,差 1足 ,优良率93 75 %。结论 :手法矫正和连续双“8”字序列石膏固定 ,可使不同程度的先天性马蹄内翻足获得较好的矫正。     

Lack of seasonal variation in idiopathic talipes equinovarus

BACKGROUND: One proposed etiology of idiopathic talipes equinovarus is an in utero enterovirus infection. Enterovirus infections demonstrate seasonal variation in temperate climates. METHODS: We collected data on 1202 children with idiopathic talipes equinovarus born in the Northeastern United States, Midwestern United States, and the United Kingdom to investigate a seasonal variation in this congenital deformity. Birth date, gestational age at the time of delivery, gender, race, and laterality were tabulated and subjected to univariate and bivariate analyses. RESULTS: There were 774 boys and 428 girls with idiopathic talipes equinovarus. The birth location was the United Kingdom (458 children), the Midwestern United States (426 children), and the Northeastern United States (318 children). No significant differences were detected among the geographic groups with respect to gender, race, or laterality, and no variation in month of birth or month of conception was noted. CONCLUSIONS: This study does not support an in utero enterovirus infection as an etiology of idiopathic talipes equinovarus in industrialized populations.     

Ilizarov external fixator in treatment of severe recurrent congenital talipes equinovarus

Aim  

Severe recurrent congenital talipes equinovarus deformity remains a significant problem in orthopedic surgery particularly in the developing countries with limited facilities. Surgical treatment of patients with severe recurrent congenital talipes equinovarus is difficult and has many complications. This study discusses the results of using Ilizarov external fixator in treatment of severe recurrent congenital talipes equinovarus deformity.     

Primary treatment of talipes equinovarus

Our primary club foot therapy consists of a combination of plaster cast manipulation, physiotherapy and surgical correction. The initial plaster cast method of 4 to 6 weeks is followed by a functional mobilisation of the foot. The main aim being the reduction of the malpositioned talus in the ankle mortise. If there is residual deformity surgery is planned after six month. We use the Cincinnati approach with the possibility of the dorsal, medial and lateral release, enabling a correction of the hind-, mid- and forefoot. The main part of postoperative care is seen in the functional rehabilitation of the foot by physiotherapy, in order to achieve a cosmetic foot with good functions. Physiotherapy is advised until the child enters school in order to preserve function and form into adult life. A high frequency of satisfactory results can be expected using this protocol.     

Relapse in staged surgery for congenital talipes equinovarus

Between 1988 and 1995, we studied 91 club feet from a series of 120 recalcitrant feet in 86 patients requiring surgical treatment. There were 48 boys and 20 girls. The mean age at operation was 8.9 months. Surgery consisted of an initial plantar medial release followed two weeks later by a posterolateral release. This strategy was adopted specifically to address the problems of wound healing associated with single-stage surgery and to ascertain the rate of relapse after a two-stage procedure. Immobilisation in plaster was used for three months followed by night splintage. The feet were classified preoperatively and prospectively into four grades according to the system suggested by Dimeglio et al. Grade-1 feet were postural and did not require surgery. All wounds were closed primarily. One superficial wound infection occurred in a grade-4 foot and there were no cases of wound breakdown. The rate of relapse was 20.4% in grade-3 and 65.4% in grade-4 feet. Two-stage surgery for the treatment of club foot seems to be effective in the reduction of wound problems but does not appear to give significantly better results in terms of relapse when performed for more severe deformities.