A New Eclectic Open Surgical Management of Recurrent, Residual, or Neglected Clubfoot in Children: An update on old and new in the field
Main Article Content
Abstract
Background context: All patients with clubfoot, regardless of age, are treated by the Ponseti or Bensahel technique as the first conservative therapeutic method. These techniques have greatly increased the success rate, which still remains at a good level even if the recurrence rate has recorded an increase from 5% to 40%. Thus, interventions for medial and dorsal release have also increased in number. When the decision to treat complications is resumed, it is good to start with one of these methods to ensure tissue flexibility and consolidate favorable outcomes.
Purpose: The purpose of the new eclectic procedure is to reduce or eliminate recurrence and obtain a stable and pain-free foot. The article presents a new eclectic technique to analyze the outcomes of medial and dorsal release using this surgical technique for recurrent, residual, or neglected clubfoot in children 6 months to 8 years of age. The study aims to standardize an effective treatment solution for clubfoot after the treatment of choice and non-idiopathic feet in genetic syndromes. The therapeutic orientation focuses on the medial and dorsal approach and establishes the limits between this approach and the use of an external fixator.
Design: This is a project study that analyzes statistical data from three graduation theses. The paper is actually a meta-analysis that compares various published procedures and presents the results obtained from both independent studies conducted by various authors and our own study to illustrate the most relevant data.
Patient sample: All patients included in the study were personally operated on in two periods of time as follows: 2008-2016, in public clinics, and 2018-2022, in private clinics.
Outcome measures: The preoperative evaluation was performed after completion of the Ponseti or Bensahel technique and consisted of an X-ray examination (CT and 3D-CT). After this scan, those who needed CT and MRI were selected.
Methods: Radiologically measured talonavicular-cuneometatarsal 1 alignment was invariably fixed on the splint within the talus range and restored the tibial radius of the foot. The plantar arch was normal, and the talocalcaneal divergence in the coronal and sagittal planes was within normal limits.
Results: The mentioned results showed an excellent correlation between the plantar arch configuration and the three essential clinical elements of the foot: shape, direction, and position. In the support phase, the operated foot moves normally from the contact point on the calcaneus to the digital support phase. The comparison with the normal foot indicated a similarity of 89%, meaning 25 out of 28 feet.
The results of the study can bring improvements to the statics and dynamics of children with severe complications after the initial treatment but especially to non-idiopathic deformities.
Conclusions: The properly aligned and reconfigured tibial (medial) radius of the foot allows the biomechanics of the foot to regain a mobility pattern that is almost similar to that of the normal foot.
Article Details
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References
2. Willis RB, Al-Hunaishel M, Guerra L, Kontio K. What proportion of patients need extensive surgery after failure of the Ponseti technique for clubfoot? Clin Orthop Relat Res. 2009; 467: 1294-1297.
3. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113: 376-380. doi: 10.1542/peds.113.2.376
4. Bergerault F, Fournier J, Bonnard C. Idiopathic congenital clubfoot: Initial treatment. Orthop Traumatol Surg Res. 2013; 99: S150-S159.
5. Van Schelven H, Moerman S, Van Der Steen M, Besselaar AT, Greve C. Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis. Arta Orthopaedica. 2022; doi: 10.1080/17453674.2021.1982576
6. Wenger DR, Rang M. The art and practice of children orthopedics. 1992; New York: Raven Press.
7. Coplan JA, Herzenberg JE. Non-operative treatment of congenital clubfoot. In: McCarthy JJ, Drennam JC. The child’s foot and ankle (2nd edition). Philadelphia: Lippincott Williams & Wilkins. 2010: 64-74.
8. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg [Am]. 1963; 45A: 261-344.
9. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg [Am]. 1992; 74A: 448-454.
10. Eidelman M, Kotlarsky P, Herzenberg JE. Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery. J Child Orthop. 2019; 13: 293-303. DOI: 10.1302/1863-2548.13.190079
11. Azarpira MR, Emami MJ, Vosoughi AR, Rahbari K. Factors associated with recurrence of clubfoot treated by the Ponseti method. World J Clin Cases. 2016; 4(10): 318-322. doi: 10.12998/wjcc.v4.i10.318
12. Dobbs MB, Corley CL, Morcuende JA, Ponseti IV. Late recurrence of clubfoot deformity: a 45-year followup. Clin Orthop Relat Res. 2003; (411): 188-192.
13. Kuo KN, Smith PA. Correcting residual deformity following clubfoot releases. Clin Orthop Relat Res. 2009; 467(5): 1326-1333. doi: 10. 1007/s11999-008-0664
14. Verestiuc L, Spataru MC, Baltatu MS, Butnaru M, Solcan C, Sandu AV, Voiculescu I, Geanta V, Vizureanu P, New Ti–Mo–Si materials for bone prosthesis applications, Journal of the mechanical behavior of biomedical materials. 2021; (113) Art. No. 104198. doi: 10.1016/j.jmbbm.2020.104198
15. Spataru MC, Butnaru M, Sandu AV, Vulpe V, Vlad MD, Baltatu MS, Geanta V, Voiculescu I, Vizureanu P, Solcan C. In-depth Assessment of New Ti-based Biocompatible Materials. Materials Chemistry and Physics. 2021; (258) Art. no:123959. doi: 10.1016/j.matchemphys.2020.123959
16. Baltatu MS, Spataru MC, Verestiuc L, Balan V, Solcan C, Sandu AV, Geanta V, Voiculescu I, Vizureanu P. Design, Synthesis, and Preliminary Evaluation for Ti-Mo-Zr-Ta-Si Alloys for Potential Implant Applications. Materials. 2021; Vol. 14 (22), Art. no. 6806, doi: 10.3390/ma14226806
17. Jeffs WA. Treatise on the Nature of Club-Foot, and Analogous Distortions; Including Their Treatment Both with and without Surgical Operation. Medicine. Published April 1840: 423-445. The Medico-Chirurgical Review.
18. Farill J. Tratamiente Del Pie Varus Equino Congenito En Ninos Menores De Cuarto Anos. Gaceta Medica de Mexico. 1955; LXXXV(1): 31-45.
19. Mosca VS. Principles and management of pediatric foot and ankle deformities and malformations. Philadelphia: Lippincott Williams and Wilkins, 2014.
20. Radler C, Mindler GT. Treatment of severe recurrent clubfoot. Foot Ankle Clin. 2015; 20: 563-586.
21. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003; 85: 1286-1294.
22. Bensahel H, Bienayme B, Jehanno P. History of the functional method for conservative treatment of clubfoot. J Child Orthop. 2007; 1(3): 175-176.
23. Bensahel H, Guillaume A, Czukonyi Z, Desgrippes Y. Results of physical therapy for idiopathic clubfoot. A long-term follow-up study. J Pediatr Orthop. 1990; 10: 189-192.
24. Dimeglio A, Canavese F. The French functional physical therapy method for the treatment of congenital clubfoot. J Pediatr Orthop B. 2012; 21(1): 28-39. doi: 10.1097/BPB.0b013e32834ee5f8
25. Eidelman M, Keren Y, Katzman A. Correction of residual clubfoot deformities in older children using the Taylor spatial butt frame and midfoot Gigli saw osteotomy. J Pediatr Orthop. 2012; 32: 527-533.
26. Li L, Zhang L, Wang E. [Comparison of long-term results between muscle-strength balancing procedure and Mckay procedure in treating congenital clubfoot]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007; 21(10): 1108-1112. Chinese. PMID: 17990780.
27. McKay DW. New concept of and approach to clubfoot treatment: section ll - correction of the clubfoot. J Pediatr Orthop. 1983; 3:10-16.
28. Simons GW. Complete subtalar release in club feet. Part I - A preliminary report. J Bone Joint Surg Am. 1985; 67(7): 1044-1055. PMID: 4030824
29. Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfoot treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006; 88: 986-996. doi: 10.2106/JBJS.E.00114
30. Licthblau S. A medial and lateral release operation for club foot. A preliminary report. J Bone Joint Surg Am. 1973; 55: 1377.
31. Turco VJ. Surgical correction of the resistant club foot. One-stage posteromedial release with internal fixation: a preliminary report. J Bone Joint Surg Am. 1971; 53(3): 477-497. PMID: 5580007
32. Turra S, Pavanini G, Volpe A. Surgical treatment of congenital club foot. (Comparison of the results of Codivilla's operation with those of Turco's modification). Ital J Orthop Traumatol. 1978; 4(2): 155-169. PMID: 753816
33. Lejman T, Kowalczyk B. Leczenie wrodzonych stóp końsko-szpotawych metoda Goldnera [Treatment of congenital clubfeet by the Goldner method]. Chir Narzadow Ruchu Ortop Pol. 2001; 66(3): 293-296. Polish. PMID: 11732259
34. Goldner JL. Congenital talipes equinovarus - fifteen years of surgical treatment. Cure Pract Orthop Surg. 1969; 4: 61-123.
35. Burnei G, Ciobanu C, Neagoe P. Carroll Surgical Procedure - an alternative surgical treatment for varus equine congenital club foot in children. Journal of Orthopaedic and Traumatology. 2002; 12: 233-234.
36. Porat S, Kaplan L. Critical analysis of results in club feet treated surgically along the Norris Carroll approach: seven years of experience. J Pediatr Orthop. 1989; 9: 137-143.
37. Pesamosca A, Burnei G, Ciobanu C, Neagoe P. Carroll operation – alternative in the treatment of the varus equine club foot. World Congress of Pediatric Surgery, Zagreb, Croația. 2004: 22-27.
38. Carroll NC, McMurtry R, Leete SF. The pathoanatomy of congenital clubfoot. Orthop Clin North Am. 1978; 9(1): 225-232. PMID: 643263.
39. Herring JA. Tachdjian’s Pediatric Orthopaedics from the Texas Scottish Rite Hospital for Children: Sixth Edition. En: Riccio Al, Professor, Disorders of the Foot. Philadelphia: Elsevier. 2022: 721-741.
40. Goldner J.L. Congenital talipes equinovarus. Guest Editorial. Foot & Ankle. 2016; 2(3): 123-125 https://doi.org/10.1177/107110078100200301
41. Goldner J.L. Congenital talipes equinovarus-classification, operative treatment and management of lateral impingement syndromes. J. Bone Joint Surg. Orthopaedic Transactions. 1979; 3: 295.
42. Carroll NC. Congenital clubfoot: pathoanatomy and treatment. Instr Course Lect. 1987; 36: 117-121. PMID: 3437121.
43. Goldner JL. Congenital talipes equinovarus-changing concepts during the past twenty-five years. J. Bone Joint Surg., Orthopaedic Transactions. 1979; 3: 306.
44. Goldner JL, Ruderman RJ, Somers WA. Management of true congenital talipes equinovarus in myelodysplasia. Surg. Infancy Childhood. 1980; 31: 413-421.