Rational selection of treatment methods in recurrent clubfoot
https://doi.org/10.51523/2708-6011.2021-18-3-8
Abstract
Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.
Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).
Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.
Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.
About the Author
G. V. Divovich
Gomel State Medical University
Belarus
Belarus
Gennady V. Divovich, Senior Lecturer at the Department of Traumatology, Orthopedics and Military Field Surgery
Gomel
References
1. Deykalo VP, Divovich GV. Epidemiology of congenital clubfoot among children’s population of Gomel region. Novosti Khirurgii. 2014;22(2):207-212. DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.207 (In Russ.).
2. Dobbs MB, Gurnett CA. Genetics of clubfoot. J Pediatr Orthop. 2012;21(1):7-9. DOI: http://dx.doi.org/10.1097/BPB.0b013e328349927c
3. Mironov SP, ed. Clinical guidelines Traumatology and orthopedics of children and adolescents. [Electronic resource]. Moscow: GEOTAR-Media; 2017. [date of access 2021 June 23]. Available from: https://www.rosmedlib.ru/book/ISBN9785970442449.html (In Russ.).
4. Klychkova IY, Konyukhov MP, Lapkin YA. Congenital clubfoot. Classifcations, etiology, pathogenesis, evolution of treatment methods (Literary review). Pediatric Traumatology, Orthopedics and Reconstructive Surgery. 2014;2(3):53-63. (In Russ.) DOI: http://dx.doi.org/10.17816/PTORS2353-63
5. Ponseti I, Morkuenda X, Mosca V. Clubfoot: treatment according to the Ponseti method. [Electronic resource]. GlobalHELP. [date of access 2021 June 21]. Available at: http://www.global-help.org/publications/books/help_cfponsetirussian.pdf (In Russ.).
6. Malakhov OA, Volkov SE. Congenital clubfoot and other malformations of the feet in children: a guide for doctors. In: Shaposhnikov YuG, ed. Traumatology and Orthopedics. A guide for doctors. Vol 3. Moscow, 1997. p. 309-326. (In Russ.).
7. Bradko VG, Sakalouski OA, Bradko GA. Congenital clubfoot: review of the problem. Med. Novosti. 2014(4):12-15. [date of access 2021 June 28]. Available from: https://cyberleninka.ru/article/n/vrozhdennaya-kosolapostobzor-problemy (In Russ.).
8. Ponseti IV. Congenital clubfoot. Fundamentals of treatment Ponseti. New York: Oxford University Press; 1996.
9. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classifcation of clubfoot. J Pediatr Orthop. 1995;4(2):129-36. DOI: http://dx.doi.org/10.1097/01202412-199504020-00002
10. Derlyatka M, Ignatovsky MI, Lashkovsky VV, Krupich B, Kiselevsky YM, Pauk I, Rogalsky M, Sviridenok AI, Sychevsky LZ. Biomechanics and correction of foot dysfunctions: monograph. Grodno: GrSU, 2009. (In Russ.).
11. Divovich GV, Bronova AA, Romanyuk TI. The results of the treatment of congenital clubfoot and its relapses in children: the results of 8-year surgical practical work. Health and Ecology Problems. 2020;(2):35-42 [date of access 2021 June 21]. Available at: https://journal.gsmu.by/jour/article/view/193 (In Russ.).
12. Divovich GV. Rational choice of a method for surgical treatment of equinovarus deformity of feet of various origins in children and adolescents. Medical news. 2020;(8):42-45. (In Russ.).
13. Congenital clubfoot: diagnosis and treatment, problems and prospects: a rating system for assessing Rumyantsev N, Ezrohi V. In abstracts. mat. edged scientifc-practical conf. St. Petersburg, June 20-21, 2013. [date of access 2021 June 19]. Available from: http://www.kosolapikov.net/index.php/news/13/57/itogi-nauchno-prakticheskoj-konferentsii-vrozhdennaya-kosolapost-diagnostika-i-lechenie-problemy-i-perspektivy (In Russ.).
14. Rebrova OY. Medical statistics. Moscow: “Media Sfera”; 2001. (In Russ.).
15. Yatsyk SP, Zherdev KV, Zubkov PA, Pak LA, Volkova MO, Chel-pachenko OB, Petelguzov AA. The role of neurogenic foot deformities in the structure of lower limb dysfunctions in patients with cerebral palsy. Surgical treatment strategies. Review of literature data. Medical advice. 2018;(11):162-167. (In Russ.). DOI: http://dx.doi.org/10.21518/2079-701X-2018-11-162-167
16. Leonchuk SS, Shchurova EN, Popkov DA, Chibirov GM, Bidyamshin RR, Gatamov OI. Three-joint arthrodesis for correction of foot deformities and its effect on blood supply to soft tissue structures in the area of surgery in patients with cerebral palsy. Traumatology and Orthopedics of Russia. 2018;24(4):32-43. (In Russ.). DOI: http://dx.doi.org/10.21823/2311-2905-2018-24-4-32-43
Review
For citations:
Divovich G.V. Rational selection of treatment methods in recurrent clubfoot. Health and Ecology Issues. 2021;18(3):64-71. (In Russ.) https://doi.org/10.51523/2708-6011.2021-18-3-8
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