Correction of the Neglected Clubfoot in the Adolescent and Adult Patient

Peterson, Nicholas; Prior, Christopher P.

doi:10.1016/j.fcl.2020.02.008

Cited by 13 publications

(13 citation statements)

References 31 publications

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“…Painful callosities develop on the unsuitable dorsal skin of the foot, which then breaks down and becomes infected. Prolonging the neglected clubfoot will make the foot progressively becomes more difficult to shod and to treat [ 8 ]. In our case, the patient had deformity on her right foot since birth and came to the clinic at the age of 18.…”

Section: Discussionmentioning

confidence: 99%

“…Incremental changes in foot form and joint alignment, such as the Ponseti and Ilizarov, are favoured by less invasive approaches. Open surgery with or without osteotomy can then be limited to certain moderately stiff club feet in patients who are not appropriate for Ilizarov care or who are unlikely to be completely corrected by the Ponseti technique [ 8 ]. Up to our knowledge, no similar case report using this technique was published before, hence we couldn't compare our outcome with other published studies.…”

Section: Discussionmentioning

confidence: 99%

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Neglected neurogenic clubfoot treated with Achilles tendon lengthening using Z-plasty, total talectomy, and tibiocalcaneal arthrodesis

Oesman

Sari

2021

International Journal of Surgery Case Reports

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Introduction The most common foot and ankle deformity from injury to the nervous system is equinocavovarus. This deformity comprises of equinus, cavus, varus, and adduction of the forefoot which leads to pain and poor stability in stance phase of gait. Treatment for this condition is difficult regarding literature limitation of the neurogenic clubfoot management. We reported a 18-year-old female with neglected right neurogenic clubfoot treated with 2 stage deformity correction. Case report A 18-year-old female presented with crooked right foot since birth. It caused pain, especially during walking and standing for a long time and resulted in occasional skin infection on the bottom of the foot. However, currently she could walk in limping gait without walking aid. The patient was born aterm 39 weeks through caesarean delivery due to severe preeclampsia. There was delayed development of walking at 2 years and 9 months. Previously, she had history of spina bifida and undergone surgery in 2001. Afterward, she underwent VP shunt surgery. Physical examination demonstrated cavus varus, tenderness of the right foot, and limited ankle motion. The patient was diagnosed with neglected right neurogenic clubfoot and underwent two stage deformity correction consisting of Achilles tendon lengthening using Z-plasty, total talectomy, and tibiocalcaneal arthrodesis followed by posteromedial release, tendon lengthening (Tibialis posterior, FDL, FDB) and plantar fascia release. Conclusions Two stage deformity correction can be successful in patients with neglected neurogenic clubfoot. Further studies are required to investigate the safety and efficacy of such procedure in neurogenic clubfoot.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neglected neurogenic clubfoot treated with Achilles tendon lengthening using Z-plasty, total talectomy, and tibiocalcaneal arthrodesis

Oesman

Sari

2021

International Journal of Surgery Case Reports

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“…Time is the fourth dimension to the condition, as flexible deformities become fixed and more difficult to manage, as patients get older. Time changes the nature of the deformity and eventual prognosis (1).…”

Section: Introductionmentioning

confidence: 99%

Neglected clubfoot treated by serial casting: a narrative review on how possibility takes over disability

Alves¹,

Batlle²,

Rodríguez

2021

Ann Transl Med

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The Ponseti Method is recognized as the best treatment for congenital idiopathic clubfoot in newborns and its principles became also adopted for treating older children with neglected deformity. This review aims to evaluate the role and effectiveness of serial casting in the treatment of neglected clubfoot, worldwide. Clubfoot is a complex tridimensional congenital foot deformity that can be easily treated after birth by correct manipulation of the foot and serial casting, with a great majority of cases requiring a percutaneous Achilles tenotomy, which can be organized as an ambulatory day procedure, without need for general anesthesia. However, in many low-income countries, treatment is not readily available, and many children grow up with disabling foot deformities. When compared to a newborn's clubfoot, a neglected clubfoot is different and more challenging to treat, as bones become ossified while malaligned and exposed to abnormal forces. Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The upper age limit for the use of Ponseti Method in clubfoot treatment is yet to be established. Success of clubfoot treatment is mostly defined as a pain-free, aesthetically acceptable plantigrade foot, with no need for extensive surgical tissue release after casting and tenotomy. The results of the Ponseti method for the treatment of clubfoot in children after the walking age are encouraging, with more than 80% of success in achieving initial correction and 18-62.5% of relapses. If Ponseti casting is not successful, any further interventions should be carefully selected and planned, in order to maintain the length of the foot and avoid intracapsular scarring or bony fusions.

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Section: Introductionmentioning

confidence: 99%

“…Clubfoot, or congenital talipes equinovarus, is the most frequently encountered congenital deformity involving the foot (1)(2)(3). It is a complex tridimensional deformity concerning hindfoot, midfoot and forefoot (1,2,4). This deformity consists of four components: equinus, hindfoot varus, forefoot adductus, and midfoot cavus (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

Clubfoot management in the Middle East: a survey-based review

Ghanem¹,

Rizkallah²

2021

Ann Transl Med

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Clubfoot is the most frequent congenital deformity involving the foot. Little is known about the management of this disease in the Middle East as sparse data is available in the literature. Through the last 5 decades, congenital clubfoot management in the Middle East went from manipulation through Kite's technique in the late seventies, to early primary surgical intervention in the late eighties and early nineties of the previous century, and then back to manipulation with Ponseti's technique and the French functional technique in the late nineties, with the latter falling out of favor with time. This is comparable to the evolution of management witnessed in the United States and in Europe, with 10 to 15 years of delay.The delay is getting shorter with time due to the easier access to published scientific data and the increasing number of fellows from Middle East travelling to referral centers in Europe and the USA. A survey was performed among pediatric orthopedic surgeons in the Middle East to assess their approach to clubfoot management. This is the first survey of its kind in the region. It showed a wide adoption (97.1%) of the Ponseti's technique with serial manipulation and casting, Achilles tenotomy followed by abduction bracing. Divergent practices were found concerning the upper age limit for Ponseti treatment and the setting of the Achilles tenotomy. Nevertheless, these subjects are still a matter of debate in the literature and international conferences. All in all, pediatric orthopedic surgeons in the Middle East are offering their patients the gold standard of care. However, lot of work is to be done in raising awareness for this disease in the community, and among our colleagues as prenatal screening for clubfoot in the Middle East is practically nonexistent.

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Correction of the Neglected Clubfoot in the Adolescent and Adult Patient

Cited by 13 publications

References 31 publications

Neglected neurogenic clubfoot treated with Achilles tendon lengthening using Z-plasty, total talectomy, and tibiocalcaneal arthrodesis

Neglected neurogenic clubfoot treated with Achilles tendon lengthening using Z-plasty, total talectomy, and tibiocalcaneal arthrodesis

Neglected clubfoot treated by serial casting: a narrative review on how possibility takes over disability

Clubfoot management in the Middle East: a survey-based review

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