Recurrent club-foot deformity following previous soft-tissue release

Mehrafshan, M.; Rampal, Virginie; Seringe, R.; Wicart, Philippe

doi:10.1302/0301-620x.91b7.22474

Cited by 33 publications

(9 citation statements)

References 24 publications

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“…The Ponseti method of clubfoot correction has considerably decreased the need for radical surgery and its attending complications 1617181920. Relapses following clubfoot surgery are complicated by skin problems, foot stiffness, bony deformities and soft tissue scarring 19.…”

Section: Discussionmentioning

confidence: 99%

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Classification of relapse pattern in clubfoot treated with Ponseti technique

Bhaskar

Patni

2013

IJOO

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Background:Relapse of clubfoot deformity following correction by Ponseti technique is not uncommon. The relapsed feet progress from flexible to rigid if left untreated and can become as severe as the initial deformity. No definitive classification exists to assess a relapsed clubfoot. Some authors have used the Pirani score to rate the relapse while others have used descriptive terms. The purpose of this study is to analyze the relapse pattern in clubfeet that have undergone treatment with the Ponseti method and propose a simple classification for relapsed clubfeet.Materials and Methods:Ninety-one children (164 feet) with idiopathic clubfeet who underwent treatment with Ponseti technique presented with relapse of the deformity. There were 68 boys and 23 girls. Mean age at presentation for casting was 10.71 days (range 7-22 days). Seventy three children (146 feet, 80%) had bilateral involvement and 18 (20%) had unilateral clubfeet. The mean Pirani Score was 5.6 and 5.5 in bilateral and unilateral groups respectively. Percutaneous heel cord tenotomy was done in 65 children (130 feet, 89%) in the bilateral group and in 12 children (66%) with unilateral clubfoot.Results:Five relapse patterns were identified at a mean followup of 4.5 years (range 3-5 years) which forms the basis of this study. These relapse patterns were classified as: Grade IA: decrease in ankle dorsiflexion from15 degrees to neutral, Grade IB: dynamic forefoot adduction or supination, Grade IIA – rigid equinus, Grade IIB – rigid adduction of forefoot/midfoot complex and Grade III: combination of two or more deformities: Fixed equinus, varus and forefoot adduction.In the bilateral group, 21 children (38 feet, 28%) had Grade IA relapse. Twenty four children (46 feet, 34%) had dynamic intoeing (Grade IB) on walking. Thirteen children (22 feet, 16%) had true ankle equinus of varying degress (Grade IIA); eight children (13 feet, 9.7%) had fixed adduction deformity of the forefoot (Grade IIB) and seven children (14 feet, 10.7%) had two or more fixed deformities. In the unilateral group seven cases (38%) had reduced dorsiflexion (Grade IA), six (33%) had dynamic adduction (Grade IB), two (11%) had fixed equinus and adduction respectively (Grade IIA and IIB) and one (5%) child had fixed equinus and adduction deformity (Grade III). The relapses were treated by full time splint application, re-casting, tibialis anterior transfer, posterior release, corrective lateral closing wedge osteotomy and a comprehensive subtalar release. Splint compliance was compromised in both groups.Conclusion:Relapse pattern in clubfeet can be broadly classified into three distinct subsets. Early identification of relapses and early intervention will prevent major soft tissue surgery. A universal language of relapse pattern will allow comparison of results of intervention.

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Section: Discussionmentioning

confidence: 99%

“…Relapses following clubfoot surgery are complicated by skin problems, foot stiffness, bony deformities and soft tissue scarring 19. Relapses following the Ponseti method are more subtle and the foot stays supple due to minimum surgical intervention 21…”

Section: Discussionmentioning

confidence: 99%

Classification of relapse pattern in clubfoot treated with Ponseti technique

Bhaskar

Patni

2013

IJOO

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“…However, in such cases, surgery is complex and often associated with serious complications and difficulty obtaining satisfactory outcomes [ 3 ]. In addition, surgery does not prevent recurrence, the rate of which is approximately 25%, and reoperation is frequently required, with a consequent increase in complications and limitations in functional outcomes [ 4 , 5 ]. Given this scenario and considering its success among younger children, the Ponseti method was indicated as a therapeutic option for older children with CC, i.e., older than 1 year old, being associated with low complication rates and lower cost [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Ferreira¹,

Stéfani²,

Haje

et al. 2018

PLoS ONE

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BackgroundThe prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children.MethodsA metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.ResultsTwelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82–0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14–0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03–0.15, p = 0.19).ConclusionApplication 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 results obtained exhibited considerable heterogeneity.

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“…Relapse may include all four components of the clubfoot deformity and may present at any time following primary correction. 6 , 17 Recurrent deformity in a surgically treated clubfoot presents an even greater challenge due to joint stiffness and tissue scarring 18 but may be improved by use of the Ponseti technique.…”

Section: Introductionmentioning

confidence: 99%

What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

et al. 2021

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Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age. Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction. All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat. Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group. This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: EFORT Open Rev 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110

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Recurrent club-foot deformity following previous soft-tissue release

Cited by 33 publications

References 24 publications

Classification of relapse pattern in clubfoot treated with Ponseti technique

Classification of relapse pattern in clubfoot treated with Ponseti technique

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

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