Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults:A case report

BACKGROUND Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described,and the evidence for treatment is limited.The purpose of this case study was to report the new application of the Ilizarov technique,which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma.CASE SUMMARY A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery.The equinus deformity was roughly corrected after 2 years of follow-up,without significant secondary sequelae.CONCLUSION Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique.The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.

Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study

BACKGROUND Clubfoot,or congenital talipes equinovarus,is a widely recognized cause of disability and congenital deformity worldwide,which significantly impacts the quality of life.Effective management of clubfoot requires long-term,multidiscip-linary intervention.It is important to understand how common this condition is in order to assess its impact on the population.Unfortunately,few studies have investigated the prevalence of clubfoot in Saudi Arabia.AIM To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital(KFUH).METHODS This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions.RESULTS Of the 7792 births between 2015 to 2023 that were included in the analysis,42 patients were diagnosed with clubfoot,resulting in a prevalence of 5.3 per 1000 live births at KFUH.CONCLUSION The observed prevalence of clubfoot was significantly higher than both global and local estimates,indicating a substantial burden in the study population.

Ponseti method compared with soft-tissue release for the management of clubfoot:A meta-analysis study

AIM: To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic measurements.METHODS: A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubM ed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each study.RESULTS: Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery(0.76 and 0.62, respectively), but not quite to the point of statistical significance(Q = 3.73, P = 0.053). Age at surgery wasnot correlated with the functional outcome for the surgically treated patients(r =-0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes(r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic outcomes.CONCLUSION: The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

Factors associated with recurrence of clubfoot treated by the Ponseti method

AIM To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method. METHODS A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in firstdegree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were recorded.RESULTS There were 83 boys(72.2%) and 32 girls(27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d(range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities(P = 0.001), noncompliance to wear braces(P < 0.001), low educational level of mother(P = 0.033), increased number of casts(P < 0.001), and more follow-up periods(P < 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method(P = 0.091). Also, no significant correlation was found for variables of age(P = 0.763), Dimeglio grade(P = 0.875), and Pirani score(P = 0.624) obtaining at the beginning of the serial casting. CONCLUSION Using the Ponseti method, non-idiopathic clubfoot, noncompliance to wear braces, low educational level of mother, increased number of casts and more followup periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.

Lateral Intra-Articular Transposition of the Anterior Tibialis Tendon for the Treatment of Relapsed Clubfoot in Toddlers: A Previously Unreported Surgical Technique

Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.

Rare case of tibial hemimelia,preaxial polydactyly,and club foot

A seven-month old female presented with left tibial hemimelia(or congenital tibial aplasia; Weber type VIIb, Jones et al type 1a), seven-toed preaxial polydactyly, and severe club foot(congenital talipes equinovarus). Definitive amputation surgery disarticulated the lower limb at the knee. This case report describes the anatomical findings of a systematic post-amputation examination of the lower limb's superficial dissection, X-ray s, and computed to mography (CT) scans. From the X-rays and CT scans, we found curved and overlapping preaxial supernumerary toes, hypoplastic first metatarsal, lack of middle and distal phalanges in one supernumerary toe, three tarsal bones, hypoplastic middle phalanx and no distal phalanx for fourth toe, andno middle or distal phalanges for fifth toe. The fibula articulated with the anteromedial calcaneus and the tibia was completely absent. We identified numerous muscles and nerves in the superficial dissection that are described in the results section of the case report. Due to the rarity of this combination of anatomical findings, descriptions of such cases are very infrequent in the literature.

Functional physiotherapy method results for the treatment of idiopathic clubfoot

BACKGROUND Idiopathic clubfoot is a congenital deformity of multifactorial etiology.The initial treatment is eminently conservative;one of the methods applied is the Functional physiotherapy method(FPM),which includes different approaches:Robert Debré(RD)and Saint-Vincent-de-Paul(SVP)among them.This method is based on manipulations of the foot,bandages,splints and exercises adapted to the motor development of the child aimed to achieve a plantigrade and functional foot.Our hypothesis was that the SVP method could be more efficient than the RD method in correcting deformities,and would decrease the rate of surgeries.AIM To compare the RD and SVP methods,specifically regarding the improvement accomplished and the frequency of surgery needed to achieve a plantigrade foot.METHODS Retrospective study of 71 idiopathic clubfeet of 46 children born between February 2004 and January 2012,who were evaluated and classified in our hospital according to severity by the Dimeglio-Bensahel scale.We included moderate,severe and very severe feet.Thirty-four feet were treated with the RD method and 37 feet with the SVP method.The outcomes at a minimum of two years were considered as very good(by physiotherapy),good(by percutaneous heel-cord tenotomy),fair(by limited surgery),and poor(by complete surgery).RESULTS Complete release was not required in any case;limited posterior release was done in 23 cases(74%)with the RD method and 9(25%)with the SVP method(P<0.001).The percutaneous heel-cord tenotomy was done in 2 feet treated with the RD method(7%)and 6 feet(17%)treated with the SVP method(P<0.001).Six feet in the RD group(19%)and twenty-one feet(58%)in the SVP group did not require any surgery(P<0.001).CONCLUSION Our study provides evidence of the superiority of the SVP method over the RD method,as a variation of the FPM,for the treatment of idiopathic clubfoot.

Term Pregnancy in a Patient with Septate Uterus: Incidental Finding at Caesarean Section

Mullerian duct anomalies are the most common congenital anomalies of the reproductive system and septate uterus is the most frequently diagnosed Müllerian anomaly. The true incidence of Mullerian duct anomalies is difficult to state because some cases may be asymptomatic and there are pitfalls associated with various diagnostic methods. This is a case report of a 17-year-old primigravida with septate uterus diagnosed at caesarean section performed at term for cephalo-pelvic disproportion. Baby was delivered with bilateral talipes equinovarus.