Atypical and complex congenital clubfoot. Current Concepts
DOI:
https://doi.org/10.1016/j.rccot.2020.12.001Keywords:
clubfoot, congenital talipes equinovarus, etiology, risk factors, anatomical pathological conditionAbstract
Atypical and complex congenital clubfoot have particular characteristics in their pathophysiology, clinical presentation, and management. The omission in its diagnosis prevents from opting for the modified Ponseti method described for these conditions, which results in poor results due to skin complications, deterioration of some deformities and even instability in the Lisfranc joint. Regarding the modification of the Ponseti method, the way in which the forefoot is manipulated stands out: all metatarsal heads are extended simultaneously with both thumbs while avoiding excessive abduction, not only during manipulation and casting, but also with the position of the foot in the postoperative splint. The characteristics of these feet make manipulations and plastering a demanding task, so it is recommended for this treatment to be carried out by personnel properly trained in the Ponseti method and its modifications for complex feet. Characteristics and treatment of these varieties of clubfoot are described in detail in this review. After correction, strict and prolonged follow-up is necessary, since the probability of recurrence and the need for reoperations is greater than that described for typical idiopathic clubfoot. The good results obtained with the Ponseti method in various clinical situations apply to cases of recurrence of atypical and complex feet which means, the modified Ponseti method allows the deformities to be corrected without extensive surgeries.
Evidence Level: IV
Downloads
References
Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA. Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res. 2006;451:171-6, https://doi.org/10.1097/01.blo.0000224062.39990.48
Ponseti International Association, The University of Iowa, Iowa City, IA U. Clinical Practice Guidelines for the Management of Clubfoot Deformity Using the Ponseti Method. http://www.ponseti.info/publications-resources.html.
Turco V. Recognition and management at the atypical idiopathic clubfoot. In: The Clubfoot. The Present and View of the Future. Simons G, editor. New York:Springer- Verlag. 1994. 76-77. https://doi.org/10.1007/978-1-4613-9269-9_13
Mandlecha P, Kanojia RK, Champawat VS, Kumar A. Evaluation of modified Ponseti technique in treatment of complex clubfeet. J Clin Orthop Trauma. 2019;10:599-608, https://doi.org/10.1016/j.jcot.2018.05.017
Allende V, Paz M, Sanchez S, Lanfranchi L, Torres-Gomez A, Arana E, Nogueira M, Masquijo J. Complex clubfoot treatment with ponseti method: A Latin American multicentric study. J Pediatr Orthop. 2020;40:241-5, https://doi.org/10.1097/BPO.0000000000001469
Dragoni M, Gabrielli A, Farsetti P, Bellini D, Maglione P, Ippolito E. Complex iatrogenic clubfoot: ¿Is it a real entity? J Pediatr Orthop B. 2018;27:428-34, https://doi.org/10.1097/BPB.0000000000000510
Atypical Club Foot. POSNA [Internet]. https://posna.org/Physician-Education/Study-Guide/AtypicalClub-Foot.
van Praag VM, Lysenko M, Harvey B, Yankanah R, Wright JG. Casting is effective for recurrence following Ponseti treatment of clubfoot. J Bone Joint Surg Am. 2018;100:1001-8, https://doi.org/10.2106/JBJS.17.01049
Agarwal A, Gupta S, Rastogi P. Hallux length and deep medial crease in complex clubfeet: Do they recover? J Clin Orthop Trauma. 2020;11:453-6, https://doi.org/10.1016/j.jcot.2020.03.004
Ponseti I. Congenital Clubfoot. Fundamentals of treatment. 2nd ed. New York: Oxford; 1996.
Hicks J. The mechanics of the foot II. The plantar aponeurosis and the arch. J Anat. 1954;88:25-30.
Moon DK, Gurnett CA, Aferol H, Siegel MJ, Commean PK, Dobbs MB. Soft-tissue abnormalities associated with treatment-resistant and treatment-responsive clubfoot: Findings of MRI análisis. J Bone Joint Surg Am. 2014;96:1249-56, https://doi.org/10.2106/JBJS.M.01257
Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet. J Bone Joint Surg Am. 2004;86:22-7, https://doi.org/10.2106/00004623-200401000-00005
Dobbs MB, Walton T, Gordon JE, Schoenecker PL, Gurnett CA. Flexor digitorum accessorius longus muscle is associated with familial idiopathic clubfoot. J Pediatr Orthop. 2005;25:357-9, https://doi.org/10.1097/01.bpo.0000152908.08422.95
Jose Jerome JT. Aberrant Tendo-Achilles Tendon in Club Foot: A case report. The Foot & Ankle Journal. 2009;2:2, https://doi.org/10.3827/faoj.2009.0202.0002
Shaheen S, Mursal H, Rabih M, Johari A. Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence. J Pediatr Orthop B. 2015;24:143-6, https://doi.org/10.1097/BPB.0000000000000129
Matar HE, Beirne P, Bruce CE, Garg NK. Treatment of complex idiopathic clubfoot using the modified Ponseti method: Up to 11 years follow-up. J Pediatr Orthop B. 2017;26:137-42, https://doi.org/10.1097/BPB.0000000000000321
Agarwal A, Gupta S, Sud A, Agarwal S. Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature. J Clin Orthop Trauma. 2020;11:222-31, https://doi.org/10.1016/j.jcot.2019.05.003
Göksan SB, Bursali A, Bilgili F, Sivacio-lu S, Ayano-lu S. Ponseti technique for the correction of idiopathic clubfeet presenting up to 1 year of age. A preliminary study in children with untreated or complex deformities. Arch Orthop Trauma Surg. 2006;126:15-21, https://doi.org/10.1007/s00402-005-0070-9
Simons GW. A Standardized Method for the Radiographic Evaluation of Clubfeet. Clin Orthop Relat Res. 1978;135: 107-18. https://doi.org/10.1097/00003086-197809000-00025
Pirani, S., Dietz F., Morcuende J., Mosca V., Herzenberg J., Weinstein S., Norgrove P., Steenbeek M. Pie Zambo: El método de Ponseti. Global-HELP Publication. http://www.ponseti.info/publications-resources.html.
Desai S, Aroojis A, Mehta R. Ultrasound Evaluation of Clubfoot Correction During Ponseti Treatment A Preliminary Report. J Pediatr Orthop. 2008;28:53-9, https://doi.org/10.1097/bpo.0b013e31815a60a6
Bhargava S, Tandon A, Prakash M, Arora S, Bhatt S, Bhargava S. Radiography and sonography of clubfoot: A comparative study. Indian J Orthop. 2012;46:229-35, https://doi.org/10.4103/0019-5413.93675
Rampal V, Rohan PY, Pillet H, Bonnet-Lebrun A, Fonseca M, Desailly E. Combined 3D analysis of lower-limb morphology and function in children with idiopathic equinovarus clubfoot: A preliminary study. Orthop Traumatol Surg Res. 2020;106:1333-7, https://doi.org/10.1016/j.otsr.2019.11.013
Ko KR, Shim JS, Kim JH, Cha YT. Difficulties During Ponseti Casting for the Treatment of Idiopathic Clubfoot. J Foot Ankle Surg. 2020;59:100-4, https://doi.org/10.1053/j.jfas.2019.07.022
Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br. 2002;84:1020-4, https://doi.org/10.1302/0301-620X.84B7.12909
Eidelman M, Kotlarsky P, Herzenberg JE. Treatment of relapsed, residual and neglected clubfoot: Adjunctive surgery. J Child Orthop. 2019;13:293-303, https://doi.org/10.1302/1863-2548.13.190079
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;113:376-80, https://doi.org/10.1542/peds.113.2.376
Sangiorgio SN, Ebramzadeh E, Morgan RD, Zionts LE. The Timing and Relevance of Relapsed Deformity in Patients with Idiopathic Clubfoot. J Am Acad Orthop Surg. 2017;25:536-45, https://doi.org/10.5435/JAAOS-D-16-00522
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Derechos de autor
Los autores aceptar transferir a la Revista Colombiana de Ortopedia y Traumatología los derechos edición, publicación y reproducción de los artículos publicados. La editorial tiene el derecho del uso, reproducción, transmisión, distribución y publicación en cualquier forma o medio. Los autores no podrán permitir o autorizar el uso de la contribución sin el consentimiento escrito de la revista. Una vez firmada por todos los autores, la carta de Cesión de derechos debe ser cargada en el paso dos del envío.
Aquellos autores que tengan publicaciones en esta revista aceptan los siguientes términos:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web), lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
