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Journal of Orthopaedics and Traumatology
Published in: Journal of Orthopaedics and Traumatology 1/2016

Open Access 01-03-2016 | Original Article

Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

Authors: Cesare Faldini, Francesco Traina, Matteo Nanni, Ilaria Sanzarello, Raffaele Borghi, Fabrizio Perna

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2016

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Abstract

Background

We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up.

Materials and methods

Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet).

Results

The average follow-up was 5 years (1–6 years). In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. In ambulating children, the results were excellent in 5 feet, good in 16, and poor in 3. No major complications were reported. No overcorrections were observed. The need for open surgery was higher in cases of delayed treatment. In cases of relapse, re-casting and/or more extensive surgery was considered.

Conclusions

Early treatment enables a high rate of good correction to be obtained with serial casting and limited surgery. Conversely, if the deformity is observed after walking age surgery should be considered. Serial casting in cases of late observation and relapse have demonstrated encouraging results.

Level of evidence

IV.
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Metadata
Title
Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases
Authors
Cesare Faldini
Francesco Traina
Matteo Nanni
Ilaria Sanzarello
Raffaele Borghi
Fabrizio Perna
Publication date
01-03-2016
Publisher
Springer International Publishing
Published in
Journal of Orthopaedics and Traumatology / Issue 1/2016
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI
https://doi.org/10.1007/s10195-015-0377-4

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