Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet

Alkar, Fanny; Louahem, Djamel; Bonnet, F.; Patte, Karine; Delpont, Marion; Cottalorda, J.

doi:10.1097/bpo.0000000000000703

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…alleviate the need for additional and extensive surgeries [15][16][17][18][19][20]. On the other hand the use of extensive surgical soft tissue releases in children with club foot is fraught with impaired foot function, quality of life pain and bone deformations on the long term [20,21]. Similar controversies were echoed in literature on management of CVT children [1,2,[5][6][7]10].…”

Section: Discussionmentioning

confidence: 99%

Naviculectomy as a Third Way Beyond Minimally Invasive and Extensive Soft Tissue Releases for Ambulatory Children with Complex Congenital Vertical Talus: A Technical Note

A¹,

Mahmoud²,

Samir³

et al. 2021

Preprint

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We investigated the radioclinical outcomes of naviculectomy and limited/tailored soft-tissue releases in a short series of ambulatory children with complex/intractable congenital vertical talus subsets namely neglected, multiple operated and recurrent patients. We postulated that this technique will yield satisfactory radioclinical outcomes and minimal complications because it avoids extensive surgical release/trauma that is otherwise classically recommended for complex congenital vertical talus (CVT). The cohort consisted of five -four boys, one girl- complex CVT children with neglected, multiple operated and/or recurrent subsets. Patients were included if manipulative casting techniques were deemed unlikely to produce a plantigrade foot. Patients underwent naviculectomy with variable on-demand limited soft tissue releases. Two patients had bilateral affection and two had a non-idiopathic aetiology. The mean age was 5.2 years (4 to 6.25) and mean follow-up was 2.3 years (1 to 3). We reported satisfactory outcomes as per foot posture, function, overall parent satisfaction including pain and radiography per lateral views of talar-axis-first metatarsal base angle on the short/intermediate term. Whereas manipulative casting is unlikely to yield lasting outcomes in ambulatory children with complex subsets of CVT, extensive surgical soft-tissue releases have unfavourable long-term complications. As a substitute, naviculectomy as a form of resection arthroplasty created a practical and affordable third way between manipulative casting with minimally invasive surgery and the extensive surgical soft tissue releases on the short/intermediate term.

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Section: Discussionmentioning

confidence: 99%

Naviculectomy as a Third Way Beyond Minimally Invasive and Extensive Soft Tissue Releases for Ambulatory Children with Complex Congenital Vertical Talus: A Technical Note

A¹,

Mahmoud²,

Samir³

et al. 2021

Preprint

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“…[42][43][44] Furthermore, patients who underwent Ponseti casting have less pain and less talar flattening than those who underwent surgical release. 42,45…”

Section: Clubfootmentioning

confidence: 99%

What is New in Pediatric Orthopaedic Foot and Ankle

Tileston

Baskar

Frick

2022

Journal of Pediatric Orthopaedics

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Background: This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Methods: The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021. Results: A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies. Conclusions: Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices. Level of Evidence: Level III.

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“…Additionally, it is unknown whether severe tarsal bone deformities, often observed after primary surgical therapy of clubfeet, occur or persist after the Ponseti treatment [11][12][13][14]. Clinical experience with residual clubfoot deformities in adult patients shows that in many cases the condition of the ankle will determine the long-term clinical outcome [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

Hämel

Hörterer

Harrasser

2021

BMC Musculoskelet Disord

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Background Major abnormalities of tarsal bone shape after surgical clubfoot treatment are well known from the literature. The Ponseti method has gained widespread acceptance in primary treatment of congenital clubfeet. Despite the longtime experience, data regarding the development of tarsal bones after this treatment are still rare. The aim of the study was therefore to evaluate radiographic parameters describing tarsal bone shape of clubfeet after Ponseti treatment and compare them to age-matched healthy feet. Methods Twenty two consecutive severe clubfeet in 14 patients were investigated by repeated diagnostic ultrasound during the corrective process. Extent and temporal course of correction were documented with standardized X-rays after a mean follow-up of 12 years (between the ages of 10–14 years) and compared to a group of age-matched normal feet. Results Reliability testing for all X-ray parameters showed good to excellent results. In comparison to the control group, all parameters except the radius of the trochlea (RT) were significantly altered in clubfeet with highest differences shown for the anterior talar motion segment (ATM), talonavicular coverage (TNC) and the talometatarsal index (TMT-Index). Differentiation between minor and major deformities showed significant differences only for the front tarsal index (FTI). Conclusions Tarsal bone shape of clubfeet treated by the Ponseti method differs significantly from normal feet. One of the most pronounced and clinically relevant difference of the clubfoot talus compared to the normal talus is the markedly reduced anterior talar motion segment.

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Long-term Results After Extensive Soft Tissue Release in Very Severe Congenital Clubfeet

Abstract: Level IV.

Cited by 12 publications

References 16 publications

Naviculectomy as a Third Way Beyond Minimally Invasive and Extensive Soft Tissue Releases for Ambulatory Children with Complex Congenital Vertical Talus: A Technical Note

Naviculectomy as a Third Way Beyond Minimally Invasive and Extensive Soft Tissue Releases for Ambulatory Children with Complex Congenital Vertical Talus: A Technical Note

What is New in Pediatric Orthopaedic Foot and Ankle

Radiological tarsal bone morphology in adolescent age of congenital clubfeet treated with the Ponseti method

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