Complex iatrogenic clubfoot: is it a real entity?

Dragoni, Massimiliano; Gabrielli, Armando; Farsetti, Pasquale; Bellini, D.; Maglione, Pierluigi; Ippolito, Ernesto

doi:10.1097/bpb.0000000000000510

Cited by 16 publications

(37 citation statements)

References 3 publications

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“…In their international study at five centres, Ponseti et al 3 identified 50 children, half who were bilaterally affected, from the pool of 762 children with clubfeet, for an incidence of 6.5%. A total of 17% of the children referred to Dragoni et al 47 after failed cast treatment elsewhere had complex clubfeet. In the Bangladesh Clubfoot Project, the incidence was calculated as 13% of 1040 patients in one study, and 21% of 400 randomly selected patients from their ten largest clinics in a follow-up series.…”

Section: Complex or Atypical Clubfootmentioning

confidence: 99%

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Bosse

2019

Journal of Children's Orthopaedics

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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

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Section: Complex or Atypical Clubfootmentioning

confidence: 99%

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Bosse

2019

Journal of Children's Orthopaedics

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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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“…In chubby infants there are high chances of cast slippage due to thick soft tissue between the skin and bone and even minor slippage within the cast can result in iatrogenic atypical (complex) clubfoot. 13,14 The foot Fig. 6.…”

Section: Discussionmentioning

confidence: 99%

Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Agarwal

Gupta

Sud

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Introduction: Serial Ponseti casting achieves deformity correction in early presenting idiopathic clubfoot cases normally in around 7 casts. However, there are resistant patients where correction requires more casts than usual. In such patients a modification in standard technique might be required right from the beginning. Such patients were collectively called as difficult clubfoot. The aim of this study was to assess the outcome of our modification to Ponseti technique in difficult clubfoot. Methods: All idiopathic clubfoot cases who were 75th percentile or more in WHO age for weight chart (chubby infants) or untreated clubfoot patients presenting for first time to our clinic at more than 5 months age (late presenters and neglected cases) were included in the study. Patients who had been previously surgically intervened elsewhere, patients over 7 years of age, patients with syndromic clubfoot or clubfoot associated with neurological conditions were excluded from the study. The patients were treated by early tenotomy of tendoachillis and a plantar fascia release before starting serial casting by Ponseti technique. Post correction, strict bracing protocol was followed with regular follow up. Pirani scoring was done at each stage. Measurement of Talocalcaneal angle on AP radiograph, maximum degree of abduction and dorsiflexion was noted once every year. Results: There were total 28 patients in our study. In all, 47 feet were subjected to modified Ponseti protocol. There were 21 male patients. Median age at presentation was 4 months. Mean centile of weight for age as per WHO growth chart was 64. Mean Pirani score at presentation was 5.86 (S.D. ± 0.34). Mean number of casts required for correction was 3.75 ± 1.10. Maximum followup period was 25 months. Conclusion: This modification of Ponseti casting for difficult clubfoot patients achieves correction in shorter duration with less number of casts.

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Complex iatrogenic clubfoot: is it a real entity?

Cited by 16 publications

References 3 publications

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

Challenging clubfeet: The arthrogrypotic clubfoot and the complex clubfoot

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

Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

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