TOTBİD Dergisi

TOTBİD Dergisi

2015, Cilt 14, Sayı, 3     (Sayfalar: 214-219)

Congenital clubfoot; relapsing of deformities

Cemil Yıldız 1, İsmail Demirkale 2

1 GATA Ortopedi ve Travmatoloji Anabilim Dalı, Ankara
2 S.B. Keçiören Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara

DOI: 10.14292/totbid.dergisi.2015.35
Görüntüleme: 458
İndirme : 392

The Ponseti method is accepted as gold standard in the treatment of congenital clubfoot. The method consists of correction, protection and normal shoe wearing, and an error made in any of these stages may result in relapse of the deformities especially in the first 1 to 3 years of age. Equinus and hind-foot varus deformities may relapse mostly at correction phase of the treatment due to improper orthosis wearing. Deformities can recur in children with severe and stiff clubfeet, and premature infants with thin calfs, despite proper treatment and follow-up. The most critical step of Ponseti method is Achilles tenotomy necessary in 70–80% of cases to obtain at least 15º of dorsiflexion. Hind-foot varus deformity can be corrected by subtalar release and/ or lateral closing wedge calcaneal osteotomy. Deformities can also relapse after previous surgical management due to persistant muscle fibrosis and scar tissue retraction. If tibalis anterior leads the foot to forceful supination, it can be transferred to the lateral cuneiform after 2.5 years of age. Regardless of the cause, conservative treatment should be initiated, if possible. Parents should be alerted for the protection of the correction by orthosis and they should be informed that manipulation and plaster casting constitute only a stage of the treatment.

Anahtar Kelimeler : clubfoot; congenital defects; Ponseti; relapsing