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