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01.05.2009 | Symposium: Clubfoot: Etiology and Treatment | Ausgabe 5/2009

Clinical Orthopaedics and Related Research® 5/2009

Correction of Arthrogrypotic Clubfoot With a Modified Ponseti Technique

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 5/2009
Autoren:
MD Harold J. P. van Bosse, MD Salih Marangoz, MD Wallace B. Lehman, MS, PT Debra A. Sala
Wichtige Hinweise
Study conducted at NYU Hospital for Joint Diseases, New York, NY.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
The authors certify that their institution (NYU Medical Center) has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Abstract

Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.2 months; range, 3–40 months), with 19 arthrogrypotic clubfeet, underwent an initial percutaneous Achilles tenotomy to unlock the calcaneus from the posterior tibia followed by weekly Ponseti-style casts. A second percutaneous Achilles tenotomy was performed in 53%. Mean number of casts was 7.7 (range, 4–12). From pretreatment to completion of initial series of casts, mean scores of Dimeglio et al. improved from 16 to 5 (ranges, 12–18 and 2–9, respectively), Catterall scores (as modified by Pirani and colleagues) from 4.8 to 0.9 (ranges, 1.5–6.0 and 0.0–2.0), and maximum passive dorsiflexion from −45° (range, −75° to −20°) to 10° (range, 0° to 40°). Ankle-foot orthoses maintained correction. At the minimum followup of 13 months (mean, 38.5 months; range, 13–70 months), the mean maximum dorsiflexion was 5° (range, –20° to 20°), two patients had posterior releases and no patient’s ambulatory ability was compromised by foot shape. Arthrogrypotic clubfeet can be corrected without extensive surgery during infancy or early childhood. Limited surgery may be required as the children age.

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