Nirav Hasmukh Amin1, Andre Jakoi2, Volpi Ms Alexander3, Martin Joseph Morrison1, Per Trobisch4. 1. Department of Orthopedic Surgery, Loma Linda University School of Medicine, Loma Linda, CA 25455 Barton Rd #102B Loma Linda, CA 92354. 2. Department of Orthopedic Surgery, Drexel University College of Medicine, Resident in Orthopedic Surgery, Philadelphia, PA Broad and Vine Street Philadelphia, PA 19103. 3. Drexel University College of Medicine, Philadelphia, PA Broad and Vine Street Philadelphia, PA 19103. 4. Department of Orthopedic Surgery, New York University, New York, NY 301 East 17 Street New York, NY 10003.
Abstract
BACKGROUND: Idiopathic clubfoot is commonly treated with the Ponseti method with the extent of invasive treatment involving tendon-Achilles lengthening. Forefoot adduction is a common complication in surgically treated clubfeet. Yet, no method has been described to measure dynamic (walking) forefoot adduction. The aim of this study was to assess the persistent pes adductus in children whose clubfeet were surgically treated using a dorsomedial soft tissue release and to find out correlations between forefoot adduction and clinical outcome measures. METHODS: We analysed the dynamic adduction angle in 33 clubfeet using a pressure-sensitive foot platform and compared it to the healthy feet of an age- and weight-matched group of children without congenital foot deformities. The clinical outcome was analysed using the McKay score. RESULTS: Mean dynamic adduction angle was 4.1o in the surgically corrected clubfeet, whereas it was 6.4° in unaffected feet of patients with unilateral clubfoot and 7.1o in control group. The McKay score were excellent in 1 patient, good in 5, average in 13, and fair in 4 of the 23 patients. There was no correlation between dynamic adduction angle and McKay score using paired t test (P > 0.05). CONCLUSION: High occurrence of dynamic adduction angle in surgically treated clubfeet was detected. In conclusion, no correlation between forefoot adduction, dynamic forefoot adduction angle and clinical outcome measures within the study was observed.
BACKGROUND:Idiopathic clubfoot is commonly treated with the Ponseti method with the extent of invasive treatment involving tendon-Achilles lengthening. Forefoot adduction is a common complication in surgically treated clubfeet. Yet, no method has been described to measure dynamic (walking) forefoot adduction. The aim of this study was to assess the persistent pes adductus in children whose clubfeet were surgically treated using a dorsomedial soft tissue release and to find out correlations between forefoot adduction and clinical outcome measures. METHODS: We analysed the dynamic adduction angle in 33 clubfeet using a pressure-sensitive foot platform and compared it to the healthy feet of an age- and weight-matched group of children without congenital foot deformities. The clinical outcome was analysed using the McKay score. RESULTS: Mean dynamic adduction angle was 4.1o in the surgically corrected clubfeet, whereas it was 6.4° in unaffected feet of patients with unilateral clubfoot and 7.1o in control group. The McKay score were excellent in 1 patient, good in 5, average in 13, and fair in 4 of the 23 patients. There was no correlation between dynamic adduction angle and McKay score using paired t test (P > 0.05). CONCLUSION: High occurrence of dynamic adduction angle in surgically treated clubfeet was detected. In conclusion, no correlation between forefoot adduction, dynamic forefoot adduction angle and clinical outcome measures within the study was observed.
Authors: Christine M Alvarez; Stephen J Tredwell; Sean P Keenan; Richard D Beauchamp; Rachel L Choit; Bonita J Sawatzky; Mary A De Vera Journal: J Pediatr Orthop Date: 2005 Mar-Apr Impact factor: 2.324
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