An MRI volumetric study for leg muscles in congenital clubfoot

Ippolito, Ernesto; Dragoni, Massimiliano; Antonicoli, Marco; Farsetti, Pasquale; Simonetti, Giovanni; Masala, Salvatore

doi:10.1007/s11832-012-0444-9

Cited by 17 publications

(10 citation statements)

References 16 publications

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“…The included articles [ 3 , 4 , 12 , 17 – 62 ] mainly focus on genetic research [ 17 , 21 – 23 , 25 , 27 , 29 – 31 , 37 – 50 , 52 , 54 – 56 , 58 , 60 , 61 ], epidemiological studies [ 12 , 19 , 20 , 24 , 32 , 33 , 35 , 36 , 53 ], MRI analysis [ 26 , 51 , 59 ], and histological histochemical analysis [ 18 , 24 , 28 , 57 ] in ICTEV patients. Two previous reviews [ 3 , 4 , 62 ] reporting a significant analysis of the current evidence and research prospective were also included since they are part of the present evidence of the topic.…”

Section: Resultsmentioning

confidence: 99%

The etiology of idiopathic congenital talipes equinovarus: a systematic review

et al. 2018

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BackgroundAlso known as clubfoot, idiopathic congenital talipes equinovarus (ICTEV) is the most common pediatric deformity and occurs in 1 in every 1000 live births. Even though it has been widely researched, the etiology of ICTEV remains poorly understood and is often described as being based on a multifactorial genesis. Genetic and environmental factors seem to have a major role in the development of this disease. Thus, the aim of this review is to analyze the available literature to document the current evidence on ICTEV etiology.MethodsThe literature on ICTEV etiology was systematically reviewed using the following inclusion criteria: studies of any level of evidence, reporting clinical or preclinical results, published in the last 20 years (1998–2018), and dealing with the etiology of ICTEV.ResultsA total of 48 articles were included. ICTEV etiology is still controversial. Several hypotheses have been researched, but none of them are decisive. Emerging evidence suggests a role of several pathways and gene families associated with limb development (HOX family; PITX1-TBX4), the apoptotic pathway (caspases), and muscle contractile protein (troponin and tropomyosin), but a major candidate gene has still not been identified. Strong recent evidence emerging from twin studies confirmed major roles of genetics and the environment in the disease pathogenesis.ConclusionsThe available literature on the etiology of ICTEV presents major limitations in terms of great heterogeneity and a lack of high-profile studies. Although many studies focus on the genetic background of the disease, there is lack of consensus on one or multiple targets. Genetics and smoking seem to be strongly associated with ICTEV etiology, but more studies are needed to understand the complex and multifactorial genesis of this common congenital lower-limb disease.

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Section: Resultsmentioning

confidence: 99%

The etiology of idiopathic congenital talipes equinovarus: a systematic review

et al. 2018

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“…The detailed description of the virgin and early pathology of both soft tissues and skeletal components of the congenital deformity has allowed us to make new pathogenetic considerations. In addition, MRI studies carried out on newborns and patients with ICCF before and after early treatment by the Ponseti technique (25) have confirmed the pathologic findings observed in fetus, thereby contributing to better highlight its pathogenesis (26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Introductionmentioning

confidence: 82%

“…In order to observe the post-natal aspect of muscle-tendon units, MRI studies were also carried out on the leg muscles of unilateral ICCF of untreated newborns and children and adults treated by Ponseti manipulation and casting (34,35). Muscles were measured on transverse MRI scans of both legs taken midway between the articular surface of the knee and the articular surface of the ankle (34).…”

Section: Muscles and Tendonsmentioning

confidence: 99%

Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

Ippolito¹,

Gorgolini²

2021

Ann Transl Med

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Several studies have described the pathology of idiopathic congenital clubfoot (ICCF) in fetus.Numerous pathogenetic theories have been postulated on ICCF, but many of them lack any objective evidence. Pathologic studies in fetus together with MRI studies in patients with ICCF seem to favor the theory of a muscular imbalance of the foot activators during fetal growth as the main pathogenetic factor of ICCF. Our objectives were: (I) To support the theory of muscular imbalance as the primary pathogenetic factor of ICCF; (II) To clarify why atrophy and shortening affect the activator muscles of the foot unevenly, as reported by literature. A literature search based on MEDLINE and the COCHRANE database was performed to identify all published studies from 1929 to 2020 which report ICCF pathology in fetus, its etiopathogenesis, and imaging and biomechanical studies showing how the basic pathology may be addressed by Ponseti treatment. A manual search was also performed of the references cited in studies, reviews, and university libraries. Altered size, shape and articular relationships of the tarsal bones, and uneven atrophy and shortening of the leg muscles together with capsule and ligament abnormalities were the main pathologic findings reported in fetus with ICCF. Regarding ICCF pathogenesis, the main debate is between the advocators of a primitive blastemal defect of the tarsal bones leading to the skeletal abnormalities and those who hold that the latter are secondary to a deforming force generated by the soft tissues. Imaging studies have shown that the Ponseti method is able to address the skeletal abnormalities, the correction of which is maintained until adulthood, whereas leg muscle atrophy is not improved but tends to worsen with growth.Preliminary histochemical studies of the soleus-Achilles tendon junction have shown a decrease of the growth factors and the presence of myostatin, both down-regulators of muscle growth in patients with ICCF.The authors postulate that a defect of both the radial and the longitudinal growth unevenly affecting the leg muscles with a consequent imbalance of the foot activators might be the main pathogenetic factor of ICCF.Further studies are needed to confirm this theory.

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“…Recurrent congenital clubfoot is caused by the same pathology that initiated the deformity. Stiff clubfeet with a severe atrophy of the leg muscles have a greater tendency to recur, in comparison to more flexible deformities (1,(41)(42)(43)(44)(45). The incidence of recurrence of congenital clubfoot is considerably decreased in the last 20 years for two main reasons, the greater widespread of the Ponseti method instead of surgical procedures and the better parent's compliance with bracing after casting.…”

Section: Discussionmentioning

confidence: 99%

Anterior Tibial Tendon Transfer for Treatment of Recurrent Congenital Clubfoot Initially Treated According to Ponseti Method. Update and Systematic Review Of Literature

Luna

Caterini

Gorgolini

et al. 2021

Muscle Ligaments and Tendons J

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Background. Congenital clubfoot has a tendency to recur regardless the type of treatment; recurrences generally occur after a complete correction of the deformity. Anterior tibial tendon transfer (TATT) is commonly used for treatment of recurrent clubfeet in deformities initially treated according to Ponseti method, since extensive surgery has a high rate of poor results. The aim of our study was to analyze a series of papers, recently published, to evaluate the effectiveness of TATT for treatment of recurrent congenital clubfoot initially treated according to Ponseti method. Methods. A literature search on the topic was performed by searching the databases Medline (Pubmed) and Cochrane Library, to select only articles from the recent literature (January 2000 to January 2021). The articles were screened for the presence of the following inclusion criteria: patients affected by recurrent congenital clubfoot originally managed by Ponseti method and treated by anterior tibial tendon transfer. All the patients affected by non-idiopathic congenital clubfoot and by residual deformities or neglected deformities were excluded. Results. The initial search produced 123 studies from Medline database and 22 studies from Cochrane library database. After detailed evaluation based on inclusion and exclusion criteria, articles were screened and only 11 studies fulfilled the eligibility criteria of our study. All the selected articles were published from 2006 to 2020 and they included overall 331 patients (481 clubfeet). Conclusions. We believe that TATT is an effective surgical procedure to treat recurrent clubfeet initially treated by Ponseti method, independent of the type of surgical technique. A second recurrence is absolutely not common, however it is more frequent when TATT is performed in younger patients. TATT seems to be effective also in late relapse, although in some cases an associated surgical procedure is necessary.

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An MRI volumetric study for leg muscles in congenital clubfoot

Cited by 17 publications

References 16 publications

The etiology of idiopathic congenital talipes equinovarus: a systematic review

The etiology of idiopathic congenital talipes equinovarus: a systematic review

Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics—a narrative review

Anterior Tibial Tendon Transfer for Treatment of Recurrent Congenital Clubfoot Initially Treated According to Ponseti Method. Update and Systematic Review Of Literature

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