Current conservative management and classification of club foot: A review

Abstract

Clubfoot, known as congenital talipes equinovarus, is one of the complex paediatric foot deformity with the incidence of 1 in every 1000 live births. It consists of four complex foot abnormalities such as forefoot adductus, midfoot cavus, and hindfoot varus and ankle equinus. There are a number of surgical techniques (soft tissue releases, arthrodesis) used to correct clubfoot. However currently the conservative management (manipulation, serial casting, and braces) of clubfoot is considered as the best choice and it is widely accepted among orthopaedists. Clubfoot treated with surgical techniques might suffer various complications such as soft tissues contractures, neurovascular complications, infections, and shortening of the limbs. Although conservative method is generally considered as an effective method, it is still challenging to cure clubfoot in advance stages. Also, the classification of the initial severity of clubfoot is essential to evaluate the outcome of the treatment. In this review, the aim is to review the different types of conservative method and the assessment of clubfoot severity.

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

“…Although orthopedic surgeons agreed that initial treatment for clubfoot should be a conservative method to correct the clubfoot successfully [17, 22–27], the relapses, partial correction of clubfoot- rocker bottom foot is still not avoidable [28, 29]. Based on the literature search, in the past five decades, a number of studies have reviewed and published which include the history of development of conservative method and its management in the clubfoot [30, 31], controversies in the clubfoot management [32], current updates of clubfoot treatment and effectiveness of Ponseti method [1, 33, 34], different types of conservative methods (Ponseti techniques, Kite’s method, and French physical therapy method) and results of Ponseti methods [35], using sonography for the evaluation of clubfoot treatment outcome [36]. For a period of century, to the best of our knowledge, there were only 5 systematic review articles published on the clubfoot with related Ponseti management [37–41] and one as Cochrane review [42], in which Smythe, Kuper (41).…”

Eficacia del método Ponseti en el tratamiento del pie equinovaro

“…Esta deformidad hace que los pacientes apoyen por el lado externo del pie, generando hiperqueratosis, posibles infecciones en la piel y huesos, artritis y limitaciones significativas en la movilidad. (Dobbs MB, 2009;Radler C, 2013;Ponseti IV, 1996) (8,9). Más de 2.2 millones de niños al año presentan esta deformidad rígida del pie al nacer (Shabtai, Specht & Herzenberg, 2014) (7).…”

“…La prevalencia en varones es mayor a la de las mujeres, con una proporción 2:1; asimismo, es bilateral en el 50% de los casos (Beals RK, 1978;Dobbs MB, 2012, Foster A, 2007Dobbs MB, 2009). Además, se afirma que el pie derecho se ve más afectado que el izquierdo (Wynne-Davies R, 1964) (8).…”

“…El calcáneo estará en adducción y en inversión medialmente girado por debajo del astrágalo. En casos severos de pie zambo, el escafoides se desplazará hacia medial y se articulará con la cara medial de la cabeza del astrágalo (8).…”

“…Existen varios factores de riesgo asociados al pie zambo entre ellos el sexo masculino, madre o padre fumadores durante el embarazo, diabetes gestacional, estado civil de la madre, educación materna, edad materna y paridad (7,8,10).…”