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CONGENITAL TALIPES EQUINOVARUS
(CLUBFOOT)ALFONSO MEZA VERNIS M.D.
International Casting SymposiumMiami, March 2013
MIAMI. FLORIDA
MEXICO CITY
History
Hypocrates (460 -337 B. C ) AZTECS
Incidence
Is probably the most common (1 to 2 in 1000 live births)
Male/ Femele ratio 2:1
Bilateral 50%
Right side is most afeccted
Etiology
Embrionyc development arrest (6-8 weeks old)Myofibroblastic retractile tissue in medial ligementsPrimary germ plasm defect in the cartilaginous talar.Neuromyogenic imbalance
Conclusion
Etiology of idiopathic club foot is multifactorial and significantly modulated by developmental aberrations
Anatomical pathologyBones
Joints
Muscular & tendon .
ligaments
Neurovascular
Multiplane defects
Talus neck oblique
Calcaneus and talus relation will be lost
Navicular displacement
Conditions with associatedclubfoot
Arthrogryposis, Diastrophic dysplasia, Streeter's dysplasia Freeman-SheldonMöbius syndrome, Chromosomal deletions
Diagnosis
Clinical findings.
RX.
Physical exploration
MILD
SEVERE
Clasification
DIMEGLIO
DIMEGLIO
GRADE TYPE PTSI MILD <5II MODERATE 5 A 9III SEVERE 10 A 14IV VERY SEVERE 15 A 20
RX
Mesuarements
Talus / calcaneus angle
Gold standardin treatment
1.- Plantigrade foot with complete movement
2.- Allows normal gait and useful for better adult life
3.- Estetically acceptable, but never will be a normal foot
Treatment
No surgical
Surgical
Ignacio Ponseti. M. D.
Ponseti management.
Application
IMPORTANT
Quiet environment Lunch time.Appropriate temperature
PLASTER
NEW MATERIAL
Delta cast softEasy to useClean Flexible adaptable.Easy to remove
Comparison
Plaster castCheaper.HeavierMore difficult to manipulate (application and removal)Takes long time to dry
Soft castMore expensiveLighterEasier to manipulateFaster to dryMore comfortable
CAST SOFT
Easy to
Without cutter
Remove
Flexible
Intistuto Nacional de Pediatria
All patients are managed with this cast to correct deformitiesAfter 6 cast, we check again and take decisions
PIRANI CLUBFOOT SCORE
SCORENormal 0Mildly abnormal 0.5Severely 1
PARAMETER
Forefoot <1Curvature of the outerMedial foldCalcaneal tuberosity
Hindfoot >1Talar headPosterior foldRigidity of equinus
PIRANI
PIRANI
PIRANI
Tenotomy
Indicated to correct equinusAdequate abductionPercutaneous heel cord tenotomyPrepare the familyOpen lengthening
Surgical
Release of the postero medial CincinnatiTurco Caroll Dobel approach
One month
Four months
Example
Serial cast
Operation room
Post op.
15 days after
Six weeks
Long term follow
Braces
Maintain theabduction and dorsiflexion
There are a diferentstypes of braces
IMPORTANT
A.F.O
Rehabilitation
I.-Improvement of the arch of movementII.-Imporovement of the flexibility of the muscles III.- Increasing the strengthIV.- Maintain alignment with orthosesV.-Management of scarsVI.-keep watching development of the foot
Remind
Multiple operations should be avoidedIncreasing stiffnessDeepening of scarsHardening of tissueAtrophy by immovilization
Pearls
Ponseti´s technic is a good way to treat in clubfoot.The soft cast is a good material to do this technic
Pearls
The surgicalmanagment must be individualYou have to release , all that you need.
(Soft tissue or bone)Physiotherapy is veryimportant
ANY QUESTION?
ALFONSO MEZA VERNIS MDPEDIATRIC ORTHOPEDIC SURGEON
@traumapediawww.ortopedia-pediatrica.com
GRACIAS