Congenital Clubfoot. Classification, Etiology, Pathogenesis, the Evolution of Treatments (Literature Review)

Klychkova, Irina Yurievna; Юрьевна, Клычкова Ирина; Konyukhov, Mikhail Pavlovich; Павлович, Конюхов Михаил; Lapkin, Yuri Alexeevich; Алексеевич, Лапкин Юрий

doi:10.17816/ptors2353-63

Cited by 2 publications

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“…Стандарт лечения этого заболевания базируется на консервативных методах коррекции с применением малоинвазивных операций -метод Игнасио Понсети, основанный на постепенном исправлении деформации стоп этапными корригирующими гипсовыми повязками с применением подкожной ахиллотомии (малоинвазивная релизная тенотомия), небольшим сроком гипсовой иммобилизации и длительной ортезной поддержкой стоп в брейсах [3,4,5].…”

Section: Introductionunclassified

“…Частота рецидивов при лечении эквино-варусной деформации стоп остается высокой. По данным литературных источников, в процессе лечения рецидивы косолапости встречаются до 40-50 % случаев, а при использовании метода И. Понсети -от 6 до 20 % [4,6].…”

Section: Introductionunclassified

“…При этом до конца не изучен процесс формирования фиброзных нарушений при косолапости и способы воздействия на него, не решены проблемы ранней прогностической диагностики рецидивов косолапости, требуют исследований хирургические вмешательства, использующие для коррекции заболевания потенциал роста ребенка [4,8,10].…”

Section: Introductionunclassified

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Rational selection of treatment methods in recurrent clubfoot

Дивович

2021

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Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumﬂex joints and without damage to the ﬂexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

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Rational selection of treatment methods in recurrent clubfoot

Дивович

2021

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Scale of severity of congenital clubfoot by the degree of rigidity of foot deformity

Vlasov

2024

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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BACKGROUND: To date, the development of scales and classification systems for congenital clubfoot mainly involves determining the severity of clinical symptoms of foot pathology. However, it does not provide a quantitative assessment of the degree of rigidity of the foot deformity. The use of a scale that determines the foot stiffness index allows individualized long-term treatment plan for each patient. AIM: This study aimed to develop a severity scale for congenital clubfoot based on the determination of the foot rigidity index. MATERIALS AND METHODS: Before treatment, 229 children (350 feet) with typical congenital clubfoot who were treated with the Ponseti method underwent a clinical dynamometric examination. Then, the foot rigidity index was calculated. The number of plaster casts required to eliminate foot deformities in patients with congenital clubfoot of I–II, III, and IV degrees was determined. The Spearman rank method was used to establish correlations between clinical and dynamometric indicators for congenital clubfoot. P 0.05 indicated significant differences. RESULTS: A retrospective analysis of the treatment of children with congenital clubfoot using the Ponseti method revealed that fewer plaster casts are required in correcting a mild deformity than in correcting a severe deformity, and a lower index of foot rigidity is noted in mild than in severe congenital clubfoot. The Spearman correlation analysis was used to identify the criterion “foot stiffness index,” which had the most number of strong correlations between the studied signs with a high statistical significance (p = 0.001). Considering the initial index of foot rigidity, three forms of congenital clubfoot were identified: mobile, rigid, and extremely rigid. The mobile form included a deformity with a rigidity index ≤0.2. The rigid form included a deformity with a foot rigidity index of 0.21–0.3. In an extremely rigid deformity, the foot rigidity index exceeds 0.31. CONCLUSIONS: The foot rigidity index is a criterion that provides a qualitative characteristic of the condition of the foot in patients with congenital clubfoot. Based on the initial foot rigidity index, congenital clubfoot can be classified as mobile, rigid, or extremely rigid.

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Congenital Clubfoot. Classification, Etiology, Pathogenesis, the Evolution of Treatments (Literature Review)

Cited by 2 publications

References 3 publications

Rational selection of treatment methods in recurrent clubfoot

Rational selection of treatment methods in recurrent clubfoot

Scale of severity of congenital clubfoot by the degree of rigidity of foot deformity

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