Clubfoot

The high valleys of the Mount Bego region, in the Southern Alps, shelter a very important corpus of rock art from Recent Prehistory (IV-II millennium B.C.). Among these thousands of engravings, at least four anthropomorphic figures, attributed to the Final Neolithic, share a singularity: their feet are turned inward. The anatomical anomaly evokes the pathology of the bilateral clubfoot. If the identification hypothesis is correct, and knowing the context that accompanies these representations – namely the achievement of copper metallurgy in Northern Italy and in the Southern Alps –, maybe we should see there the oldest manifestations of the orthopedic affections from which, by nature, the mythological blacksmiths suffer.

Introduction Open-source, self-replicating rapid prototypers (RepRaps) have radically reduced the costs of three-dimensional (3D) printing while expanding its access. Three-dimensional printing's model of distributed manufacturing can produce medical technologies at significantly reduced costs. We investigate this potential by evaluating the viability of an open-source 3D printable infant clubfoot brace.

Materials and Methods Starting with a list of key features present in currently available clubfoot braces, a 3D-printed clubfoot brace was developed in free and open-source CAD software (FreeCAD) to enable future customization. Polylactic acid, a biodegradable and recyclable bioplastic, was selected among the various commercial 3D printable materials based on strength and cost.

Results The results show that the open-source clubfoot brace matches or surpasses the physical features and mechanical degrees of freedom of all commercial- and nonprofit-developed brace designs while substantially reducing the costs of the braces to hospitals and families.

Conclusions The 3D-printed brace has the features of commercially available braces while significantly reducing the cost, making this clubfoot brace particularly appropriate for use in developing countries. In addition, the results indicated that this model of distributed manufacturing of medical technology is technically and economically appropriate through much of the Global South.

Ponseti’s and Kite’s methods of conservative management in idiopathic congenital clubfoot were compared in a prospective randomised study consisting of 45 infants (67 feet) younger than 3 months, from March 2003 through February 2004. There were 36 and 31 feet that underwent treatment by Ponseti’s and Kite’s methods, respectively. After an average follow-up of 27.24 months in the Ponseti group, correction was achieved in 33 feet (91.7%), with only three patients requiring surgical management. There were seven relapses (21.1%), all of which were corrected conservatively. However, two of these required surgical intervention on showing a relapse again in the second year. In the Kite group, we achieved correction in 21 feet (67.7%) after an average follow-up of 24.8 months, with ten patients requiring surgical intervention. There were eight relapses of which only four could be corrected conservatively. We could also achieve correction in very severe feet (Dimeglio classification) in a significantly higher percentage using Ponseti’s method, in significantly lesser time and with fewer casts. We are of the opinion that Ponseti’s method is superior to Kite’s method in achieving correction in idiopathic clubfeet in a relatively shorter period of time when used to treat young infants. Les méthodes de Ponseti et de Kite dans le traitement conservateur du pied bot congénital sont comparées dans une étude prospective randomisée incluant 45 enfants (67 pieds), traités avant 3 mois, étude réalisée de mars 2003 à février 2004. Trente-six pieds ont été traités selon la méthode de Ponseti et 31 selon la méthode de Kite. Le suivi moyen a été de 27.24 mois dans le groupe de Ponseti. La correction a été réalisée dans 33 pieds (91.7%), seulement 3 patients ont nécessité un traitement chirurgical. Il y a eu 7 récidives (21.1%), tous les pieds ont été traités avec un traitement conservateur. Cependant deux pieds nécessitant un traitement chirurgical ont montré une récidive dans la deuxième année. Dans le groupe Kite, la correction a été réalisée dans 21 pieds (67.7%) avec un suivi moyen de 24.8 mois, 10 patients ont nécessité un traitement chirurgical et 8 récidives dont 4 ont bénéficié d’un traitement conservateur. Nous pouvons traiter les pieds sévères (classification de Dimeglio) avec un bon pourcentage et bon résultat en utilisant la méthode de Ponseti qui permet de diminuer le temps de traitement et le nombre de plâtre. Nous pouvons conclure que la méthode de Ponseti est supérieure à la méthode de Kite, elle permet un temps de traitement plus court dans le traitement des pieds bots varus équins de l’enfant.

Clubfoot (talipes equinovarus) is a three-dimensional deformity of unknown etiology. Treatment aims at correction to obtain a functional, plantigrade pain-free foot. The "French" functional method involves specialized physiotherapists. Daily manipulation is associated to immobilization by adhesive bandages and pads. There are basically three approaches: the Saint-Vincent-de-Paul, the Robert-Debré and the Montpellier method. In the Ponseti method, on the other hand, the reduction phase using weekly casts usually ends with percutaneous tenotomy of the Achilles tendon to correct the equinus. Twenty-four hour then nighttime splinting in abduction is then maintained for a period of 3 to 4 years. Recurrence, mainly due to non-compliance with splinting, is usually managed by cast and/or anterior tibialis transfer. The good long-term results, with tolerance of some anatomical imperfections, in contrast with the poor results of extensive surgical release, have led to a change in cl...

In 2001, Roye et al. developed a disease-specific instrument (DSI) to measure outcomes of treatment for clubfoot. We assessed this instrument using a cohort of 62 patients, ages 5 through 12 years (mean, 8.6 years), with idiopathic clubfoot who were treated as infants by various methods. Treatment groups were defined by whether the patient received joint-invasive surgery (posterior or posteromedial release surgery) or joint-sparing treatment only (manipulation and casting with or without tendo-Achilles lengthening or anterior tibial tendon transfer). The DSI scales demonstrated internal consistency reliability of 0.74 to 0.85 using Cronbach’s alpha. Higher (better) DSI scores were associated with “excellent” general health ratings and better health-related quality of life; lower DSI score were related to special healthcare needs. Patients treated using joint-sparing techniques only (eg, Ponseti technique) had higher DSI scores than those who had received joint-invasive surgery. DSI scores for patients who had received posterior or posterior medial release surgery were very similar to those reported by Roye et al. in New York for a comparable group of patients. Our findings suggest the DSI is sensitive to differences in treatment technique or underlying severity of disease. These data support the use of the Roye DSI as an outcome measure for idiopathic clubfoot in children. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Total homocysteine (tHcy) measured in serum or plasma is a marker of folate status and a risk factor for cardiovascular disease. Our objective was to investigate associations between tHcy and complications and adverse outcomes of pregnancy. Plasma tHcy values measured in 1992-1993 in 5883 women aged 40-42 y were compared with outcomes and complications of 14492 pregnancies in the same women that were reported to the Medical Birth Registry of Norway from 1967 to 1996. When we compared the upper with the lower quartile of plasma tHcy, the adjusted risk for preeclampsia was 32% higher [odds ratio (OR): 1. 32; 95% CI: 0.98, 1.77; P for trend = 0.02], that for prematurity was 38% higher (OR: 1.38; 95% CI: 1.09, 1.75; P for trend = 0.005), and that for very low birth weight was 101% higher (OR: 2.01; 95% CI: 1.23, 3.27; P for trend = 0.003). These associations were stronger during the years closest to the tHcy determination (1980-1996), when there was also a significant relation between t...

The concept of conservative clubfoot treatment beginning in the neonatal period has changed considerably in the last 2 decades. The rate of clubfeet requiring surgery (20%) and the extent of surgical interventions have dropped significantly. The early functional Montpellier method has proved to be highly effective for all degrees of deformity. It is used for patients from birth until the age of 1 year. The treatment during the first 3 months of life is decisive and consists of daily physical therapy, use of a continuous passive motion machine, and taping. This method represents an efficient alternative to the popular treatment of serial casting. Nevertheless, conservative clubfoot treatment reaches its limits as the degree of deformity increases and it should be complemented by a selective minimally invasive surgical concept. The technique is described systematically and its current value is discussed.

Context The New Kingdom in ancient Egypt, comprising the 18th, 19th, and 20th dynasties, spanned the mid-16th to the early 11th centuries BC. The late 18th dynasty, which included the reigns of pharaohs Akhenaten and Tutankhamun, was an extraordinary time. ...

In most clubfoot studies, the outcome instruments used are designed to evaluate classification or long-term cross-sectional results. Variables deal mainly with factors on body function/structure level. Wide scorings intervals and total sum scores increase the risk that important changes and information are not detected. Studies of the reliability, validity and responsiveness of these instruments are sparse. The lack of an instrument for longitudinal follow-up led the investigators to develop the Clubfoot Assessment Protocol (CAP). The aim of this article is to introduce and describe the CAP and evaluate the items inter- and intra reliability in relation to patient age. The CAP was created from 22 items divided between body function/structure (three subgroups) and activity (one subgroup) levels according to the International Classification of Function, Disability and Health (ICF). The focus is on item and subgroup development. Two experienced examiners assessed 69 clubfeet in 48 chil...

The present study describes a 9-month-old infant who presented with congenital lumbar hernia, kyphoscoliosis, atrial septal defect, congenital talipes equinovarus and arthrogryposis. To the best of our knowledge, this is the first case in English literature with this combination of defects. The case could be considered an incomplete form of the lumbocostovertebral syndrome. We also discuss the etiopathogenesis of these malformations.

Background: Clubfoot is a congenital disorder identifiable with the clinical assessment itself, provided the knowledge of key
features is sound. Several disorders affecting the foot and lower limb that present with crooked or bent anatomy may be confused
with it. Knowledge of common disorders that mimic clubfoot in a particular region is thus important to adequately distinguish,
manage or refer the case to specialist opinion. Objectives: The current study attempts to provide an overview and documentation of
the conditions referred and labeled as clubfoot from primary care facilities, the knowledge of which is important so that appropriate
treatment is given to each. The findings will reflect lacunae in the knowledge and perception of primary healthcare workers
regarding the deformity. Materials and Methods: A retrospective assessment of all cases referred to our dedicated clubfoot
clinic with a diagnosis of clubfoot by peripheral health-care facility was done from September 2016 to October 2017. Relevant
demographic details including that of parents, type of deformity, nature, laterality, and treatment received were noted for each
case. Conditions requiring non-operative treatment and those requiring further evaluation were noted separately with a detailed
description. Results: Out of total 97 cases labeled as clubfoot, 32 (33.68%) cases with 64 feet were part of the study after excluding
true clubfoot cases. The common condition noted was calcaneovalgus, postural clubfoot, equinus deformity secondary to cerebral
palsy, metatarsus adductus, in-toeing, and posteromedial bowing of tibia. Conclusion: The knowledge of common foot disorders
in primary care settings should be strengthened by refresher practical training so that these disorders are diagnosed and managed
there an appropriate referral is made thus leading to decrease the burden on higher centers.
Key words: Anomaly, Child, Clubfoot, Congenital, Deformity, Diagnosis, Foot disorders.

Split anterior tibialis transfer is a procedure, frequently performed in combination with triceps surae lengthening, to treat equinovarus foot deformity in adult hemiplegia patients. The authors present their surgical technique, with tendon fixation by an anchor to the base of the fifth metatarsal. Although bone-tendon anchor fixation is widespread in orthopedic surgery, it is original in this type of indication. It is simpler, and less traumatic for the bone than a bone tunnel and less traumatic for the sole than transplantar fixation. The very distal attachment to the base of the 5th metatarsal bone solves the common problem of adjusting the tension of tendon transfer. The authors report their experience of 22 split transfers from 2005 to 2008.