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Moreira A, Benjamin Ravetti L, Carrapeiro Prina D, Paschoal Nogueira M. Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations - a systematic review. BMC Musculoskelet Disord 2024; 25:638. [PMID: 39134994 PMCID: PMC11318294 DOI: 10.1186/s12891-024-07621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/23/2024] [Indexed: 08/16/2024] Open
Abstract
PURPOSE Review the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described. METHODS A systematic review of the literature was performed with the keywords ''clubfoot'', ''Ponseti'' and ''anterior tibial''. Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included. RESULTS Six studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small. CONCLUSION Several options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle.
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Affiliation(s)
- Andreia Moreira
- Hospital Pedro Hispano, ULS Matosinhos, Portugal, Matosinhos, Portugal
| | | | | | - Monica Paschoal Nogueira
- Hospital do Servidor Publico Estadual de São Paulo, Sao Paulo, SP, Brazil.
- Núcleo de Apoio à Pesquisa Ortopédica Avançada (NAPOA), Sao Paulo, SP, Brazil.
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Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
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Butt MN, Perveen W, Ciongradi CI, Alexe DI, Marryam M, Khalid L, Dobreci DL, Sârbu I. Outcomes of the Ponseti Technique in Different Types of Clubfoot-A Single Center Retrospective Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1340. [PMID: 37628341 PMCID: PMC10453163 DOI: 10.3390/children10081340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Background: Clubfoot is a congenital deformity that can affect one or both of a newborn's lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.
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Affiliation(s)
- Maryum Naseer Butt
- Muzaffarabad Physical Rehabilitation Centre, Muzaffarabad 13100, Pakistan;
| | - Wajida Perveen
- School of Allied Health Sciences, CMH Lahore Medical College & IOD (NUMS Rawalpindi), Lahore 54810, Pakistan
| | - Carmen-Iulia Ciongradi
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania; (D.I.A.); (D.L.D.)
| | | | - Laique Khalid
- Combined Military Hospital, Muzaffarabad 13100, Pakistan;
| | - Daniel Lucian Dobreci
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania; (D.I.A.); (D.L.D.)
| | - Ioan Sârbu
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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Grin L, van Oorschot L, Vanwanseele B, Wijnands SDN, Kars HJJC, Besselaar AT, van der Steen MCM. Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050785. [PMID: 37238333 DOI: 10.3390/children10050785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). METHODS A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. RESULTS Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. CONCLUSIONS Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems.
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Affiliation(s)
- Lianne Grin
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Lisa van Oorschot
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Benedicte Vanwanseele
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Saskia D N Wijnands
- Department of Movement Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - H J J Cojanne Kars
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, The Netherlands
| | - Arnold T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
| | - M C Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, 5600 PD Eindhoven, The Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
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Grin L, Wijnands S, Besselaar A, van Oorschot L, Vanwanseele B, van der Steen M. The relation between clinical and objective gait scores in clubfoot patients with and without a relapse. Gait Posture 2022; 97:210-215. [PMID: 35995000 DOI: 10.1016/j.gaitpost.2022.07.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective gait analysis that fully captures the multi-segmental foot movement of a clubfoot may help in early identification of a relapse clubfoot. Unfortunately, this type of objective measure is still lacking in a clinical setting and it is unknown how it relates to clinical assessment. RESEARCH QUESTION The aim of this study was to identify differences in total gait and foot deviations between clubfoot patients with and without a relapse clubfoot and to evaluate their relationship with clinical status. METHODS In this study, Ponseti-treated idiopathic clubfoot patients were included and divided into clubfoot patients with and without a relapse. Objective gait analysis was done resulting in total gait and foot scores and clinical assessment was performed using the Clubfoot Assessment Protocol (CAP). Additionally, a new clubfoot specific foot score, the clubFoot Deviation Index (cFDI*), was calculated to better capture foot kinematics of clubfoot patients. RESULTS Clubfoot patients with a relapse show lower total gait quality (GDI*) and lower clinical status defined by the CAP than clubfoot patients without a relapse. Abnormal cFDI* was found in relapse patients, reflected by differences in corresponding variable scores. Moderate relationships were found for the subdomains of the CAP and total gait and foot quality in all clubfoot patients. SIGNIFICANCE A new total foot score was introduced in this study, which was more relevant for the clubfoot population. The use of this new foot score (cFDI*) besides the GDI*, is recommended to identify gait and foot motion deviations. Along with clinical assessment, this will give an overview of the overall status of the complex, multi-segmental aspects of a (relapsed) clubfoot. The relationships found in this study suggest that clinical assessment might be indicative of a deviation in total gait and foot pattern, therefore hinting towards personalised screening for better treatment decision making.
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Affiliation(s)
- Lianne Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands.
| | - Saskia Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands
| | - Arnold Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
| | - Lisa van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Benedicte Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001 Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN Eindhoven, the Netherlands
| | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, the Netherlands
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Kinematic differences in the presentation of recurrent congenital talipes equinovarus (clubfoot). Gait Posture 2022; 96:195-202. [PMID: 35696825 DOI: 10.1016/j.gaitpost.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The tibialis anterior tendon transfer (TATT) is the suggested surgical intervention in the Ponseti method for treatment of dynamic recurrent congenital talipes equinovarus (clubfoot) presenting as hindfoot varus and forefoot supination during the swing phase of gait. The indication for surgery, however, is typically based on visual assessment, which does not sufficiently examine the variability of foot motion in this cohort. RESEARCH QUESTION The aim of this research was to determine whether subgroups, based on foot model kinematics, existed within a clubfoot cohort being considered for TATT surgery. METHODS Sixteen children with recurrent clubfoot that had been previously treated with the Ponseti method and were being considered for tendon transfer surgery were prospectively recruited for this study and were required to attend a pre-surgery data collection session at the Queensland Children's Motion Analysis Service (QCMAS). Data collected included standard Plug-in-Gait (PiG) kinematics and kinetics, Oxford Foot Model (OFM) foot kinematics, and regional plantar loads based on anatomical masking using the integrated kinematic-pressure method. RESULTS Results of this study identified two clear subgroups within the cohort. One group presented with increased hindfoot inversion across 91 % of the gait cycle. The second group presented with increased hindfoot adduction across 100 % of the gait cycle. Hindfoot adduction was statistically significantly different between the two groups. SIGNIFICANCE The identification of these two groups propose a need for further classification of deformity within this cohort and query the appropriateness of this surgical intervention for both presentations.
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Dynamic Supination in Congenital Clubfoot: A Modified Delphi Panel Approach to Standardizing Definitions and Indications for Treatment. J Pediatr Orthop 2022; 42:e459-e465. [PMID: 35180725 DOI: 10.1097/bpo.0000000000002119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dynamic supination is a well-recognized cause of congenital clubfoot deformity relapse. However, there is no consensus on how to diagnose it and there are varied approaches in its management. This study aims to define dynamic supination and indications for treatment by presenting consensus from an international panel of experts using a modified Delphi panel approach. METHODS An international panel of 15 pediatric orthopaedic surgeons with clinical and research expertise in childhood foot disorders participated in a modified Delphi panel on dynamic supination in congenital clubfoot. Panelists voted on 51 statements using a 4-point Likert scale on dynamic supination, clinical indications for treatment, operative techniques, and postoperative casting and bracing. All panelists participated in 2 voting rounds with an interim meeting for discussion. Responses were classified as unanimous consensus (100%), consensus (80% or above), near-consensus (70% to 79%), and indeterminate (69% or less). RESULTS Consensus was achieved for 34 of 51 statements. Panelists agreed dynamic supination is present when the forefoot is supinated during swing phase of gait with initial contact on the lateral border of the foot. There was also agreement that dynamic supination results from muscle imbalance between the tibialis anterior and the peroneus longus and brevis. There was no consensus on observation of hindfoot varus in dynamic supination, operative indications for posterior release of the ankle joint, or incisional approach for tibialis anterior tendon transfer. Reference to the calcaneopedal unit concept, planes of movement, and phases of gait were deemed important factors for consideration when evaluating dynamic supination. CONCLUSIONS Consensus statements from the Delphi panel can guide diagnosis and treatment of dynamic supination in clubfoot deformity relapse, including clinical decision making regarding preoperative casting, surgical approach, and postoperative immobilization. Near-consensus and indeterminate statements may be used to direct future areas of investigation. LEVEL OF EVIDENCE Level V.
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Abstract
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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Affiliation(s)
- Kali Tileston
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Meyer ZI, Polk JL, Zide JR, Kanaan Y, Riccio AI. Lateral Cuneiform Ossification and Tibialis Anterior Tendon Width in Children Ages 3 to 6: Implications for Interference Screw Fixation of Tibialis Anterior Tendon Transfers in Children. J Pediatr Orthop 2022; 42:229-232. [PMID: 35125415 DOI: 10.1097/bpo.0000000000002077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND While the transfer of the tibialis anterior tendon (TAT) to the lateral cuneiform (LC) following serial casting has been used for nearly 60 years to treat relapsed clubfoot deformity, modern methods of tendon fixation remain largely unstudied. Interference screw fixation represents an alternative strategy that obviates concerns of plantar foot skin pressure-induced necrosis and proper tendon tensioning associated with button suspensory fixation. A better understanding of LC morphology in young children is a necessary first step in assessing the viability of this fixation technique. Therefore, the purpose of this investigation is to define LC morphology and TAT width in children aged 3 to 6 years. METHODS A retrospective radiographic review of 40 healthy pediatric feet aged 3 to 6 years who had either magnetic resonance imaging or computed tomography scans was performed at a single pediatric hospital. The length, width, and height of only the ossified portion of the LC were measured digitally using sagittal, coronal, and axial imaging. In addition, the maximal cross-sectional diameter of the TAT was measured at the level of the tibiotalar joint. RESULTS The average ossified LC width ranged from 8.5 mm in the 3-year-old cohort to 10.3 mm in 6-year-old children. Analysis of variance testing revealed no statistically significant difference in width between age groups. Average ossified LC length ranged from 13.5 mm in the 3-year-old cohort to 18.3 mm in 6-year-old children with statistically significant increases in age groups separated by 2 or more years. Significant differences in LC height, volume, and TAT diameter were demonstrated after analysis of variance testing. The TAT to ossified LC width ratio ranged from 44% to 53% across age groups. CONCLUSIONS The dimensions of the LC ossification center are large enough to allow interference screw fixation in children 3 to 6 years of age. Further studies are needed to investigate interference screw fixation performance in the pediatric clubfoot population. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | | | - Anthony I Riccio
- Scottish Rite for Children
- University of Texas Southwestern School of Medicine, Dallas, TX
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10
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Abstract
Clubfoot or talipes equinovarus deformity is one of the most common anomalies affecting the lower extremities. This review provides an update on the outcomes of various treatment options used to correct clubfoot. The ultimate goal in the treatment of clubfoot is to obtain a fully functional and pain-free foot and maintain a long-term correction. The Ponseti method is now considered the gold standard of treatment for primary clubfoot. Relapse is common after primary treatment with the Ponseti method, and other interventions are discussed that are used to provide for long-term successful outcomes.
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Radler C. The Treatment of Recurrent Congenital Clubfoot. Foot Ankle Clin 2021; 26:619-637. [PMID: 34752231 DOI: 10.1016/j.fcl.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Ponseti method for treatment of congenital clubfoot is well established and has been introduced in most pediatric orthopedic centers worldwide. However, reported rates of recurrence are largely variable and open joint surgery is still performed frequently, even in the age group younger than 6 years of age. Preventing recurrence and residual deformity can be achieved by strict adherence to the Ponseti method, ensuring and enforcing brace compliance, frequent follow-up, and early treatment of recurrence. This review discusses reasons for clubfoot recurrence, prevention of clubfoot recurrence, and the treatment of recurrent congenital clubfoot within the realm of the Ponseti method.
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Affiliation(s)
- Christof Radler
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising GmbH, Speisinger Strasse 109, Vienna A-1130, Austria.
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Grin L, van der Steen MC, Wijnands SDN, van Oorschot L, Besselaar AT, Vanwanseele B. Forefoot adduction and forefoot supination as kinematic indicators of relapse clubfoot. Gait Posture 2021; 90:415-421. [PMID: 34583148 DOI: 10.1016/j.gaitpost.2021.09.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding the kinematic characteristics of relapse clubfoot compared to successfully treated clubfoot could aid early identification of a relapse and improve treatment planning. The usage of a multi segment foot model is essential in order to grasp the full complexity of the multi-planar and multi-joint deformity of the clubfoot. RESEARCH QUESTION The purpose of this study was to identify differences in foot kinematics, using a multi-segment foot model, during gait between patients with Ponseti treated clubfoot with and without a relapse and age-matched healthy controls. METHODS A cross-sectional study was carried out including 11 patients with relapse clubfoot, 11 patients with clubfoot and 15 controls. Gait analysis was performed using an extended Helen Hayes model combined with the Oxford Foot Model. Statistical analysis included statistical parametric mapping and discrete analysis of kinematic gait parameters of the pelvis, hip, knee, ankle, hindfoot and forefoot in the sagittal, frontal and transversal plane. RESULTS The relapse group showed significantly increased forefoot adduction in relation with the hindfoot and the tibia. Furthermore, this group showed increased forefoot supination in relation with the tibia during stance, whereas during swing increased forefoot supination in relation with the hindfoot was found in patients with relapse clubfoot compared with non-relapse clubfoot. SIGNIFICANCE Forefoot adduction and forefoot supination could be kinematic indicators of relapse clubfoot, which might be useful in early identification of a relapse clubfoot. Subsequently, this could aid the optimization of clinical decision making and treatment planning for children with clubfoot.
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Affiliation(s)
- L Grin
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands.
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - S D N Wijnands
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands
| | - L van Oorschot
- Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
| | - A T Besselaar
- Department of Orthopaedic Surgery & Trauma, Máxima Medical Center, Postbus 90052, 5600 PD, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands
| | - B Vanwanseele
- KU Leuven, Department of Movement Sciences, Tervuursevest 101, 3001, Heverlee, Belgium; Fontys University of Applied Sciences, Dominee Theodoor Fliednerstraat 2, 5361 BN, Eindhoven, the Netherlands
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13
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Zionts LE, Ebramzadeh E, Sangiorgio SN. Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1101. [PMID: 34423013 PMCID: PMC8339808 DOI: 10.21037/atm-20-7774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/12/2021] [Indexed: 12/04/2022]
Abstract
The Ponseti method of manipulative treatment for clubfoot deformity became widely adopted by pediatric orthopaedic surgeons beginning in the mid-1990s. The technique allows correction of most idiopathic clubfeet using gentle manipulation and cast application. The treatment represents a marked advance over past efforts to gain correction of the foot through extensive release surgery. In 2006, we began a Clubfoot Clinic at the Orthopaedic Institute for Children in Los Angeles, California dedicated to managing clubfoot patients using Ponseti’s method. An IRB-approved database of patient-related, treatment related, and demographic variables was assembled and used to ascertain the outcome of treatment as well as to address parental questions regarding certain aspects of treatment. Here, we present a review of our body of work, which has improved clinical decision making as well as our ability to better inform our patients’ parents regarding the treatment and prognosis of the Ponseti method. Studies from our institution showed that while relapses and the need for extra-articular tibialis anterior tendon transfer (TATT) surgery remain common to the Ponseti method, these events do not adversely affect overall patient function or satisfaction. These findings were not unlike those of classic studies reported from Ponseti’s institution. We conclude that the Ponseti method is not only a technique to achieve initial correction of an idiopathic clubfoot, but also how to manage relapses that will inevitably occur in many patients. While relapses and tendon transfer surgery are likely to remain common with this treatment method, these events do not adversely affect overall patient function or satisfaction. The parents of infants whose clubfeet are managed using the Ponseti method should be counselled accordingly.
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Affiliation(s)
- Lewis E Zionts
- The J. Vernon Luck, Sr., MD Orthopedic Research Center, Orthopaedic Institute for Children and the Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., MD Orthopedic Research Center, Orthopaedic Institute for Children and the Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., MD Orthopedic Research Center, Orthopaedic Institute for Children and the Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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14
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Abstract
Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.
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Andras LM, Abousamra O. What's New in Pediatric Orthopaedics. J Bone Joint Surg Am 2021; 103:287-294. [PMID: 33369978 DOI: 10.2106/jbjs.20.01953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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