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Neglected clubfoot deformity in a 4 year old Mongolian boy
Soo-Sung Park M.D
Department of Orthop. Surgery
AMC Children’s hospital
Seoul KOREA
IntroductionIntroduction
Late-presenting clubfoot deformity is rarely found, but
still common in developing countries
Non-op tx. usually fails and is no longer an option
Surgery is necessary but can lead to problems of poor
wound healing and infection
Variety of skin incision & rotation flaps
Staged surgery – tissue expanders, partial wound closure with healing
by secondary intention, casting with suboptimal correction after surgery
followed by serial manipulation
Ilizarov technique w/ or w/o preliminary surgery
Case Case (4Y/M)(4Y/M)
C.C: nelected clubfoot deformities P/E: Rigid Talipes equinocavovarus deformity (Lt>Rt)
OperationOperation
Rt : SSTR(achilles tenotomy, TPAL, PF, AHR) + Ilizarov inst.
Lt (Staged Op): SSTR(achilles tenotomy, TPAL, PF, AHR)
Ilizarov instrumentation 1wk later
6 weeks after deformity correction 6 weeks after deformity correction
Removal of EF & CAST Removal of EF & CAST (DC 6w)(DC 6w)
Cast for 3 weeks AFO (day & night)
Post Op 3M before leaving to Mongolia Post Op 3M before leaving to Mongolia
Discussion Discussion (recent papers)(recent papers)
Ponseti Method (JBJS-B 2007)
17 children (24 feet), mean age 3.9 yrs. cast for 3.9 mos.
Painless plantigrade foot in 16 feet ; effective method
But 7/16 recurred, 8 feet failed
Circumferential release & fasciocut. flap (JPO-B 2007)
Case report
Single staged tech. w/ double zigzag incision Age 6M~4Y, very safe and cost-effective method
(J of Foot & Ankle Surg. 2006)
Discussion Discussion
Ilizarov External Fixator Role of soft tissue release before or after correction of the
deformity ?
Ilizarov inst. alone w/o preliminary surgery
• ischemic necrosis after preliminary extensive dissection
(Tachdjian’s Pediatric orthop. 4th Ed.)
Ilizarov External Fixator Ilizarov inst. w/ minimal release
• recurrent arthrogrypotic clubfoot after prev. PMR
Medial TN joint release ± TP tenotomy, PC
(Choi el al. JBJS-B 2001)
• Neglected clubfoot in pts. with mean age of 19 (5~39) yrs.
Limited soft tiss. dissection achilles tenot., plantar fasciotomy
; high recurrence(50%) and ankylosis(74%)
; reduce risk of NV Cx. & avoid excessive shortening of foot
(Foot & Ankle international 2006)
DiscussionDiscussion
ConclusionConclusion STAGED Operation; SSTR followed by Ilizarov inst. is thought to be
a useful method in a 4 yrs old boy
Based on literature review, Ponseti method also seems to be a
effective and low-cost strategy in older children
Thank you for your attention
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