Clubfoot

 

 

New-Born Clubfoot:

Clubfoot is a congenital deformity that occurs in 1/10.000 birth. It is more common in boys. The deformity includes four components: metatarsus adductus, cavus, hindfoot  varus and equinus.

Treatment of clubfoot has evolved from minimal surgery to casting technique then to extensive surgery.

The old serial casting technique, known as Kite technique, has been the standard one for almost half century. However, the excellent results of Dr Kite could not be reproduced by most of the Orthopedic Surgeon. This failure has lead to the misconception of 2 clubfoot types: positional clubfoot that would respond to the casting;  and the true clubfoot that would need surgical release.

In the last 2 decades, and with the increase of surgical expertise of the Pediatric Orthopedic Surgeons, posteromedial release at the age of 1 year became the standard treatment; casting was used to distract the soft tissue and skin to decrease the rate of wound dehiscence.

Ignatio Ponseti, one of the Pionner of pediatric Orthopaedics in North America has developed a new casting technique, based on 2 concepts:

1-     the basic deformity in the clubfoot is fibrosis of the soft tissue

2-     Abduction of the forefoot with a countertraction applied on the head of talus is capable to allow the calcaneus to freely derotate to its normal position.

Since the fifties, Ponseti has managed to treat hundreds of clubfoot deformity in his arena ‘Iowa University Hospital’. He had little time to spend on advertising his technique; thus the world had to wait till the nineties when one of his fellows and his successor published the results of Ponseti technique with 20 years follow up. Since then, it became evident that Ponseti casting technique will result in more than 90% of excellent correction without the need of extensive surgical release. The real advantage is the preservation of the foot and ankle mobility so the functional score is much better than in kids treated with surgery.

Ponseti technique has gained popularity worldwide and it is the treatment of choice for clubfoot in North America.

 

 

 

Clinical Cases:

Case 1.

 

Relapsed Clubfoot:

Clubfoot deformity may persist or reccur after surgical treatment. After the age of seven, soft tissue releases are not helpful.

The only surgical treatment is multiple osteotomies of the hinfoot, midfoot and the forefoot with a stiff, small foot as the end result.

We have adopted a different technique performed worlwide by Dr Ilizarov disciples. It consists in gradual distraction of the soft tissue contractures by an external fixator.

The advantage is that we are able not only to correct the shape of the foot, but also we are increasing its size to match the controlateral foot and preserving its mobility.

The external fixator will be applied to the foot and leg of the child under general anesthesia. The parents will start the correction by adjusting the different nuts following the surgeon instructors.

The child should be seen regularly in the clinic to make sure that everything is running smoothly.

 

Clinical Cases:

Case 1.

 

 

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