Treatment of Foot Deformities in Arthrogryposis Multiplex Congenita

Kowalczyk, Bartłomiej; Feluś, Jarosław

doi:10.2106/jbjs.rvw.n.00103

Cited by 9 publications

(8 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three feet required repeat Achilles tenotomies at an average of 12 months post-treatment and six feet required more invasive surgical correction for recurrence, also performed on average 12 months after initial treatment. The second study 45 evaluated nine children (18 feet) with an average 7.3-year follow-up. At an average of 27 months after correction, 16 feet required further corrective but non-ablative surgeries.…”

Section: Arthrogryposis Multiplex Congenitamentioning

confidence: 99%

See 1 more Smart Citation

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Bosse

2019

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Within the realm of clubfoot deformities, teratologic and complex (or atypical) clubfeet stand out as the most difficult. Exemplarities of the teratologic types of clubfoot are those associated with arthrogryposis multiplex congenita. Treatment of arthrogrypotic clubfoot deformities has been controversial; many different procedures have been advocated, with variable success rates. These clubfeet have a high recurrence rate, regardless of treatment type. Often, the high recurrence rate has led to a high repeat surgery rate, and poor outcomes. Treatment strategies should highlight care that avoids the development of a stiffened foot and allows for a variety of options to regain correction when a relapse occurs. Modifications of the Ponseti method for idiopathic clubfeet have been successful in managing the deformity. The equinocavus variant of the arthrogrypotic clubfoot should be distinguished from the classic clubfoot, as it requires a different treatment method. The equinocavus clubfoot is very similar to the complex or atypical clubfoot. The complex, or atypical, clubfoot also requires a different treatment strategy compared with the typical idiopathic congenital clubfoot. The complex clubfoot appears to be idiopathic in some cases and iatrogenic (due to slipping stretching casts) in others. Dr. Ponseti’s modification of his protocol has been effective in treating the deformity. The high recurrence rate suggests the difficulty in maintaining the deformity after correction. The author’s preferred treatment for each deformity is included, with an emphasis on minimally invasive methods. Level of Evidence Level V, expert opinion

show abstract

Section: Arthrogryposis Multiplex Congenitamentioning

confidence: 99%

Section: Serial Castingmentioning

confidence: 99%

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Bosse

2019

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Evaluation of the severity of the clubfoot deformity can be done using the systems of Dimeglio and colleagues (Dimeglio, Bensahel, Souchet, Mazeau, & Bonnet, ) or Pirani and colleagues (Pirani, Outerbridge, Sawatzky, & Stothers, ). Using these systems allows proper monitoring of the correction process (Kowalczyk & Felus, ).…”

Section: Ankle and Foot Deformities In Arthrogryposismentioning

confidence: 99%

“…The overall goal in the management of patients with arthrogryposis is optimization of quality of life by rendering these patients as independent as possible in their activities of daily living and by attaining independent ambulation and ultimately independent living (Kowalczyk & Felus, ). In order to attain this goal, a comprehensive, multidisciplinary, very early, and aggressive approach is warranted.…”

Section: Introductionmentioning

confidence: 99%

Treatment and outcomes of arthrogryposis in the lower extremity

Hamdy

Bosse

Altıok

et al. 2019

American J of Med Genetics Pt C

View full text Add to dashboard Cite

In this multiauthored article, the management of lower limb deformities in children with arthrogryposis (specifically Amyoplasia) is discussed. Separate sections address various hip, knee, foot, and ankle issues as well as orthotic treatment and functional outcomes. The importance of very early and aggressive management of these deformities in the form of intensive physiotherapy (with its various modalities) and bracing is emphasized. Surgical techniques commonly used in the management of these conditions are outlined. The central role of a multidisciplinary approach involving all stakeholders, especially the families, is also discussed. Furthermore, the key role of functional outcome tools, specifically patient reported outcomes, in the continuous monitoring and evaluation of these deformities is addressed. Children with arthrogryposis present multiple problems that necessitate a multidisciplinary approach. Specific guidelines are necessary in order to inform patients, families, and health care givers on the best approach to address these complex conditions

show abstract

“…17 However, the need for further operative treatment has been reported in up to 67% of patients in long-term follow-up studies. 5,15,16,20 In our analysis, patients who had recurring deformities or required subsequent surgery were less satisfied and had lower AOFAS scores. We observed deformity recurrence in 21.2% of patients, and 17.3% required further surgeries.…”

Section: Discussionmentioning

confidence: 69%

Functional Outcomes of Talectomy in Pediatric Feet

2021

View full text Add to dashboard Cite

Background: Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients’ and their caregivers’ satisfaction. Methods: We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. Results: Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children’s functional status posttalectomy. Conclusion: The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. Level of Evidence: Level III; retrospective cohort study.

show abstract

Treatment of Foot Deformities in Arthrogryposis Multiplex Congenita

Cited by 9 publications

References 51 publications

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Treatment and outcomes of arthrogryposis in the lower extremity

Functional Outcomes of Talectomy in Pediatric Feet

Contact Info

Product

Resources

About