Magnetic Resonance Angiography in Clubfoot and Vertical Talus: A Feasibility Study

Abstract

Congenital

Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

“…At that time, the foot is likely to have become rigid, and typically the child walks with weightbearing on the dorsolateral aspect of the affected foot [5,16]. Although much of the current literature reports the clinical results of treatment for congenital clubfoot in the early years, few reports discuss the results of surgical techniques required to treat the more rigid deformities found in older children [12,24,25]. We perform shortening of the lateral column consisting of a single cuboid osteotomy associated with a selected soft tissue release to correct the residual deformities.…”

“…STR can be used to correct some cases of neglected clubfoot [20,46,48], but in patients with more severe deformities as a result of the lateral column being longer than the medial one, STR allows for only partial correction of the deformity. In addition, extensive STRs are known to predispose the clubfoot to vascular complications related to its congenitally reduced vascular supply, leading to local tissue necrosis [24]. For this reason, some authors advocate a combined procedure of bony osteotomies with shortening of the lateral column and lengthening of the medial column as the most logical approach to address the forefoot deformities seen in more rigid neglected clubfeet [31].…”

“…Moreover, the excised cuboid bone is sometimes soft or the wedge is too small to support the needed lengthening of the medial cuneiform. Finally, graft wedge extrusion after the medial cuneiform elongation osteotomy can complicate this approach and require revision surgery [24,30]. To overcome such problems in children older than 5 years with neglected clubfoot, we describe an approach consisting of a single-step combination of a modified STR with the addition of a cuboid subtraction wedge osteotomy.…”

Pé torto congênito

“…14 The most frequent anomaly is absence or hypoplasia of the anterior tibial artery, which is present proximally in the leg, but ends abruptly in the ankle or in the calf, with deficient or absent anastomotic network. 14,[68][69][70][71][72][73] The absence of pedis pulse is more frequent in CC of greater severity and in older children. 74 In rarer situations, there can be more accentuated vascular insufficiencies, which also compromise the perfusion provided by the posterior tibial artery.…”

“…74 In rarer situations, there can be more accentuated vascular insufficiencies, which also compromise the perfusion provided by the posterior tibial artery. 71,[75][76][77][78] In these cases, the blood supply occurs separately through the fibular artery. 73 …”