Congenital Talipes Equinovarus in Spina Bifida: Treatment and Results

Abstract

The results of the surgical treatment of clubfoot deformity in spina bifida by radical posteromedial-lateral release (PMLR) are presented. In all cases, the Cincinnati incision was used and the tendons excised, including the anterior tibial tendon. In 21 feet, a special K-wire was used to derotate the talus in the ankle mortise. The minimum follow-up was 2 years. The average age at surgery was 14 months. The overall results showed 63% good, 14% fair, and 23% poor results. In the 21 feet in which the talus K-wire was used, 76% had a good result, 14% fair, and 10% poor. The results were also analyzed based on the motor level. In the thoracic/high lumbar level, 50% had a poor result. In the low lumbar and sacral level groups together, of 45 feet, five had a poor result. This study shows that a radical PMLR can produce an overall good and fair result in 77% of the cases. The use of the K-wire to derotate the talus led to an improvement in the result. The tendon excision leading to a flail foot corrects any residual muscle imbalance. The poor results seen in the thoracic/high lumbar patients are likely to be related to the lack of weight bearing in view of their motor paralysis.

Surgical treatment for myelodysplastic clubfoot

“…Another point cited in the literature is correction of the rotation of the talus. 12 In our study, there was an increase in the Kite angle in all the radiographically documented feet that evolved satisfactorily and which did not undergo talectomy, which indicates the importance of this technical detail.…”

“…Some authors have emphasized the importance of using an appropriate surgical technique, with the use of tendon resection rather than simple stretching, and this was also our preference. 1 , 4 , 12 Through doing this, we rebalanced the forces acting on the foot and avoided recurrence.…”

“…1 , 7 , 8 , 9 In the literature, there are reports on procedures going from soft-tissue release with tendon stretching to bone surgery of a more aggressive nature, such as talectomy. 3 , 10 , 11 , 12 , 13 …”

Tratamento cirúrgico do pé equinovaro mielodisplásico

“…2,3 Outro ponto citado na literatura é a correção da rotação do tálus. 12 Em nosso estudo houve incremento no ângulo de Kite em todos os pés documentados radiograficamente que evoluíram satisfatoriamente e que não sofreram talectomia, o que sugere a importância desse detalhe técnico.…”

“…1,7-9 Na literatura há relatos desde procedimentos que envolvem liberaç ões de partes moles com alongamentos tendíneos até cirurgias ósseas mais agressivas, como a talectomia. 3,[10][11][12][13] O objetivo do presente estudo foi avaliar os resultados do tratamento cirúrgico do pé equinovaro mielodisplásico na nossa instituição de outubro de 1984 a outubro de 2004 e relacionar as deformidades, a técnica cirúrgica e os resultados obtidos.…”