Interventions for congenital talipes equinovarus (clubfoot).

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Abstract

[Indexed for MEDLINE] 11. Gait Posture. 2020 Mar;77:308-314. doi: 10.1016/j.gaitpost.2020.02.012. Epub 2020 Feb 19. Does an overcorrected clubfoot caused by surgery or by the Ponseti method behave differently? Dussa CU(1), Böhm H(2), Döderlein L(3), Forst R(4), Fujak A(4). Author information: (1)Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany. Electronic address: dussacu1@web.de. (2)Gait Laboratory, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany. (3)Peadiatric Orthopaedic Surgeon, Bismarckstrasse 60, 69198 Schriesheim, Germany. (4)Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, D-91054 Erlangen, Bavaria, Germany. BACKGROUND: Overcorrection is a recognized problem following surgical treatment of congenital clubfoot. Recently this complication has also been mentioned following Ponseti treatment. RESEARCH QUESTION: Do overcorrected clubfeet (OCCF) caused by surgery behave differently from those caused by Ponseti treatment in terms of segmental motion of the feet and show differences in the severity of deformity on X-rays? METHODS: Children between 7 and 12 years with OCCF were included in this study. Depending on the aetiology causing them, the feet were divided into 2 groups (Ponseti and peritalar release surgery). 25 typically developing children served as controls. All subjects were subjected to clinical and radiological examination and 3-Dimensional gait analysis using the Oxford Foot Model. RESULTS: Thirty-two children with OCCF, of these 18 feet in the surgical and 14 feet in the Ponseti group, were included in the study. No radiological differences were seen in the flatfoot parameters between OCCF groups except in the calcaneal inclination angle that was more pathological in the Ponseti group. The clinical ankle plantar flexion was significantly reduced in the surgical group. During walking the range motion of the hindfoot in the frontal plane was significantly reduced in surgically treated feet compared to the Ponseti group. The other parameters did not show any significant difference between groups. SIGNIFICANCE: The overcorrected clubfeet following surgery and Ponseti showed similar appearance and showed no significant differences in 11/12 radiological parameters. The segmental motion of the feet showed no significant differences between groups except the in the range of motion of the subtalar eversion. A considerable subtalar joint motion was present even in the surgical group. These findings might help plan the treatment of these feet. Copyright © 2020 Elsevier B.V. All rights reserved. DOI: 10.1016/j.gaitpost.2020.02.012