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Zioupos S, Westacott D. Flat-top talus after clubfoot treatment: a literature review. J Pediatr Orthop B 2024; 33:44-47. [PMID: 36728872 DOI: 10.1097/bpb.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Flat-top talus (FTT) is a complication well-known to those treating clubfoot. Despite this, it receives little attention in textbooks, so our knowledge and understanding can be limited to anecdote and hearsay. In particular, its association with different treatments, especially the Ponseti method, is not well understood. This review provides some clarity on the possible pathoanatomical, radiological and iatrogenic causes of FTT. It summarises its prevalence following different treatments. It is seen after surgery, 'pre-Ponseti' casting and the Ponseti method, and seems least common following Ponseti. Potential surgical management strategies are also discussed.
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Katz A, Dumas É, Hamdy R. Anterior Hemiepiphysiodesis of the Distal Tibia: A Step-by-step Surgical Technique Guide. Strategies Trauma Limb Reconstr 2023; 18:174-180. [PMID: 38404566 PMCID: PMC10891351 DOI: 10.5005/jp-journals-10080-1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/04/2023] [Indexed: 02/27/2024] Open
Abstract
Aim This paper aims to serve as a guide for surgeons to prepare, execute, and perfect anterior hemiepiphysiodesis of the distal tibia (AHDT). Background Treatment of persistent or recurrent equinus deformity following multiple conservative and surgical interventions in patients with idiopathic clubfoot or neuromuscular conditions can be challenging, and multiple surgical options are presented in the existing literature. Anterior hemiepiphysiodesis of the distal tibia is an option that seems to be safe and efficient in treating this entity. To the best of our knowledge, there is not yet any detailed description of this surgical technique in the English literature. Technique The AHDT detailed surgical technique includes patient positioning, careful distal anterior tibial approach, placement of guided growth plates, fixation with epiphyseal and metaphyseal screws under fluoroscopic guidance, meticulous closure, and postoperative measures. Conclusion This guide can be used pre-operatively to plan the surgery, intra-operatively to aid in smooth and safe step progression, and post-operatively to assist in critical critiquing. Clinical significance By understanding the various stages of the surgery as well as the anatomy, pitfalls can be avoided and AHDT can be performed efficiently. How to cite this article Katz A, Dumas É, Hamdy R. Anterior Hemiepiphysiodesis of the Distal Tibia: A Step-by-step Surgical Technique Guide. Strategies Trauma Limb Reconstr 2023;18(3):174-180.
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Affiliation(s)
- Alan Katz
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Évelyne Dumas
- Department of Orthopaedic Surgery, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Reggie Hamdy
- Department of Pediatric Orthopedic Surgery, Limb Deformity Unit, Shriners Hospital for Children; Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Mishra AS, Shrestha J, Rajan RA. Anterior Distal Tibial Guided Growth for recurrent equinus deformity in idiopathic Congenital Talipes Equinovarus treated with the Ponseti method. Foot Ankle Surg 2023; 29:355-360. [PMID: 37031009 DOI: 10.1016/j.fas.2023.03.006] [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: 10/04/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION Distal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment. METHODS Patients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles' tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity. RESULTS We identified 22 feet in 16 patients, with an average follow-up was 25 (8.8-47.3) months. The mean aDTA changed from 88.9 (82.3-94.5) to 77.0 (65.0-83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot. CONCLUSION This procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment. LEVEL OF EVIDENCE Therapeutic Level IV.
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Li S, Myerson MS. Surgical Management of the Undercorrected and Overcorrected Severe Club Foot Deformity. Foot Ankle Clin 2022; 27:491-512. [PMID: 35680301 DOI: 10.1016/j.fcl.2021.11.029] [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
Managing complications of clubfoot deformities can be very challenging. Some patients present with recurrent clubfoot and residual symptoms, and some present with overcorrection leading to a severe complex flatfoot deformity. Both can lead to long-term degenerative changes of the foot and ankle joints owing to deformity caused by unbalanced loading. This article only focuses on severe complications caused by recurrence and overcorrection in both children and adult patients.
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Affiliation(s)
- Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado School of Medicine; Steps2Walk.
| | - Mark S Myerson
- Department of Orthopaedic Surgery, University of Colorado School of Medicine; Steps2Walk
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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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Gaber K, Mir B, Shehab M, Kishta W. Updates in the Surgical Management of Recurrent Clubfoot Deformity: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:75-81. [PMID: 35118632 DOI: 10.1007/s12178-022-09739-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This article focuses on the current advances in surgical management for clubfoot deformity, supported by up-to-date longitudinal studies on each approach. RECENT FINDINGS Long-term analysis following primary and repeated soft tissue releases has demonstrated good results in young patients with low relapse rates. Tibialis anterior transfer following the Ponseti method shows no difference in long-term pedographic analysis in comparison to the Ponseti method alone. Furthermore, tibialis anterior transfer following surgical relapses provides good long-term results with improved correction in talus-first metatarsal angle. Bony osteotomies may also play a role in addressing surgical relapses in older children. However, talar neck osteotomy may result in avascular necrosis of the talar dome. Hexapod external fixation may be considered by experienced surgeons to correct rigid clubfoot deformities in older patients with good long-term results and drastic improvements in pain perception. Long-term analysis of anterior distal tibial epiphysiodesis (ADTE) for recurrent equinus deformity following surgical correction has demonstrated statistical improvements in the anterior distal tibial angle (ADTA) and ankle dorsiflexion. Talectomy and naviculectomy are rarely used in today's practice as long-term studies have demonstrated high relapse rates and residual pain impeding patient mobility. Surgical correction following failure of the conservative approaches can be implemented to achieve full correction in clubfoot deformity. It is difficult to achieve a plantigrade feet with pain-free gait with repeated surgical interventions. Therefore, proper choice of the initial surgical technique is essential for achieving satisfactory long-term outcomes.
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Affiliation(s)
- Karim Gaber
- Department of Orthopaedic Surgery, Mansoura International Hospital, Mansoura, Egypt
| | - Basit Mir
- Faculty of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Manama, Bahrain
| | - Mohammed Shehab
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Waleed Kishta
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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The Pediatric Foot in Neurologic Disorders. Foot Ankle Clin 2021; 26:655-683. [PMID: 34752233 DOI: 10.1016/j.fcl.2021.08.003] [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
Every child with a neuromotor disorder is at risk for the development or a deterioration of foot deformities. This relates to central and peripheral diseases. Almost any kind of deformity may occur. As the basic problems mostly remain, a multidisciplinary team care program is necessary in addition to surgical management of the feet. Surgery must respect any muscle imbalance as well as joint deformities and instabilities. Postoperative orthotic support supplements most treatments. Long-term follow-ups are strongly advised to detect any recurrences or overcorrections.
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Myerson MS, Haje DP. An Approach to the Management of Severe Clubfoot Deformities on Global Humanitarian Programs: The Role of Talectomy. Foot Ankle Clin 2021; 26:727-745. [PMID: 34752236 DOI: 10.1016/j.fcl.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The approach to treatment of severe untreated or recurrent congenital talipes equinovarus deformities is very different in the world where patients are mobile, have access to repeated return visits for follow-up treatment, and where more sophisticated options for gradual correction with external fixation are available. For treatment, talectomy may be the only option to treat certain neglected clubfoot deformities during humanitarian programs and it may still have to be used as a salvage procedure used in modern foot surgery. Our extensive experience with these deformities has been on global humanitarian programs.
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Affiliation(s)
| | - Davi P Haje
- Centro Clinico Orthopectus e IGESDF, SMHN Bloco A Ed. Clínicas, Sala 804-806, Brasília, DF 70710-904, Brazil
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Masrouha K, Chu A, Lehman W. Narrative review of the management of a relapsed clubfoot. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1102. [PMID: 34423014 PMCID: PMC8339836 DOI: 10.21037/atm-20-7730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators). These are discussed from the least to the most invasive. Available evidence, and limitations of the literature, for the management of relapses following both the Ponseti method and initial surgical release is reviewed along with along with the reported outcomes. Future efforts should be geared towards standardizing the definition of a relapse with objective criteria for its management.
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Affiliation(s)
- Karim Masrouha
- Division of Pediatric Orthopedics, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Alice Chu
- Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Wallace Lehman
- Division of Pediatric Orthopedics, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Murphy D, Raza M, Khan H, Eastwood DM, Gelfer Y. What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review. EFORT Open Rev 2021; 6:354-363. [PMID: 34150329 PMCID: PMC8183149 DOI: 10.1302/2058-5241.6.200110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood.A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age.Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction.All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat.Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group.This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: EFORT Open Rev 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110.
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Affiliation(s)
- Daniel Murphy
- St George's University Hospitals NHS Foundation Trust, London, UK.,St George's, University of London, London, UK
| | - Mohsen Raza
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Hiba Khan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Deborah M Eastwood
- Great Ormond Street Hospital, London, UK.,University College London (UCL), London, UK
| | - Yael Gelfer
- St George's University Hospitals NHS Foundation Trust, London, UK.,St George's, University of London, London, UK
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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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