The Overcorrected Clubfoot in Children
Clubfoot overcorrection can develop gradually over years and is characterized in school age by hindfoot valgus position due to excessive rigid peritalar eversion, sometimes accompanied by supramalleolar valgus malalignment. Surgical treatment is recommended in severe cases and consists of bony realignment at the peritalar complex by osteotomy or fusion, correction of the supramalleolar valgus deformity in younger children by hemiepiphyseodesis, or osteotomy in adolescents. In addition, dorsal bunion requires stabilization of the medial tarsometatarsal ray and transfer of the tendons of Mm. tibialis anterior and flexor hall...
Source: Foot and Ankle Clinics - October 13, 2021 Category: Orthopaedics Authors: Johannes Hamel Source Type: research
Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity
This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 13, 2021 Category: Orthopaedics Authors: Maryse Bouchard, Tayler Declan Ross Source Type: research
An Approach to the Management of Severe Clubfoot Deformities on Global Humanitarian Programs
The approach to treatment of severe untreated or recurrent congenital talipes equinovarus deformities is very different in the world where patients are mobile, have access to repeated return visits for follow-up treatment, and where more sophisticated options for gradual correction with external fixation are available. For treatment, talectomy may be the only option to treat certain neglected clubfoot deformities during humanitarian programs and it may still have to be used as a salvage procedure used in modern foot surgery. Our extensive experience with these deformities has been on global humanitarian programs. (Source: ...
Source: Foot and Ankle Clinics - October 7, 2021 Category: Orthopaedics Authors: Mark S. Myerson, Davi P. Haje Source Type: research
Preface
When Mark Myerson offered me to guest edit an issue dedicated to the child ’s foot, I felt honored, and I accepted with pleasure and enthusiasm. As a member of many Pediatric Orthopedic and Foot societies, I thought of keeping abreast of the hot topics and of the less discussed pathologic conditions but with an important clinical relevance. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 7, 2021 Category: Orthopaedics Authors: Maurizio De Pellegrin Source Type: research
Congenital Vertical Talus
Congenital vertical talus represents a congenital structural foot deformity characterized by the classical rocker bottom deformity. The main feature is dislocation of the talonavicular joint along with contractures of the dorsolateral tendons of the foot and tendo Achilles. In the past treatment consisted of 2- or single-stage more or less extensive soft tissue releases including reduction of the talonavicular joint following casting in the first phase. Nowadays all feet are treated by serial casting, closed or miniopen talonavicular joint reduction, and percutaneous achillotenotomy. Functional results of the miniinvasive ...
Source: Foot and Ankle Clinics - October 7, 2021 Category: Orthopaedics Authors: Thomas Wirth Source Type: research
The Treatment of Neglected Clubfoot
The adolescent neglected clubfoot is mostly treated in humanitarian programs by those with a great deal of surgical experience. This deformity needs a major correction, which can compromise the blood circulation and wound healing. A bony correction is preferable over an isolated soft tissue release. The extreme Lambrinudi arthrodesis with a double incision is therefore a preferred tool to correct a neglected clubfoot. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 6, 2021 Category: Orthopaedics Authors: Anja C. Helmers Source Type: research
The Surgical Treatment of Brachymetatarsia
This article describes the 3 main surgical options for correction of congenital brachymetatarsia in childhood. The one-stage lengthening by lengthening osteotomy and lengthening with graft interposition are suitable for defects less than 10 mm. For the greater defects from 10 mm to more than 20 mm, gradual lengthening by callus distraction with an external or internal fixator is appropriate. Over the last years, callus distraction with an internal minifixator became commonly established because of the significantly improved afterca re with early full weight-bearing and high postoperative comfort for the child. All 3 su...
Source: Foot and Ankle Clinics - October 4, 2021 Category: Orthopaedics Authors: Hubert O. Klauser Source Type: research
Subtalar Arthroereisis for Surgical Treatment of Flexible Flatfoot
Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last 10-year period (2010 –2020) show that among the 691 feet undergoing subtalar arthroereisis with endorthesis, average age at surgery was 11.40 years and in the 1856 feet that underwent subtalar arthroereisis with calcaneo-stop 11.69 years, while the complications rate was 9.00% and 6.38%, respectively. These data con firm that subtalar arthroereisis with calcaneo-stop may have an advantage over subtalar arthroereisis with endorthesis as the screw is not pl...
Source: Foot and Ankle Clinics - October 4, 2021 Category: Orthopaedics Authors: Maurizio De Pellegrin, Desiree Moharamzadeh Source Type: research
Ilizarov Technique in Severe Pediatric Foot Disorders
The treatment of foot disorders in pediatric age with Ilizarov method is reserved for complex cases, cases in which it is not possible to perform acute corrections or cases that need bone and soft-tissue lengthening. Ilizarov method permits to correct any deformity. Correction can be achieved progressively with a closed procedure or combining the external fixator with a treatment involving soft or bone tissues. Complications are frequent; however, most of them do not affect the outcome of the treatment. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - October 4, 2021 Category: Orthopaedics Authors: Alexander Kirienko, Emiliano Malagoli Source Type: research
Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions
Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inad equat...
Source: Foot and Ankle Clinics - October 4, 2021 Category: Orthopaedics Authors: D ésirée Moharamzadeh, Maurizio De Pellegrin Source Type: research
Benign and Malignant Tumors in Child Foot
Bone tumors affecting pediatric foot are a rare occurrence. Most lesions are benign, but a thorough diagnostic evaluation must always be performed to rule out malignant tumors. Approach to benign lesions is conservative, from observation follow-up to curettage or mininvasive techniques. In malignant lesions, a wide resection must be performed and same protocols applied as in tumors affecting other skeletal sites. Reconstructive procedures should aim to mechanical stability and long-lasting results; joint motion restoring can be attempted when not negatively affecting stability. Amputation procedures should be considered as...
Source: Foot and Ankle Clinics - September 8, 2021 Category: Orthopaedics Authors: Domenico Andrea Campanacci, Guido Scoccianti Source Type: research
Juvenile Hallux Valgus
Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 1, 2021 Category: Orthopaedics Authors: Susan T. Mahan, Emily O. Cidambi Source Type: research
Management of Complex Tarsal Coalition in Children
Complex tarsal coalition includes extensive talocalcaneal coalition, double or triple coalition, coalition with severe hindfoot deformities, or coalition with a ball-and-socket ankle deformity. Careful preoperative physical examination including diagnostic injection is important in treatment planning. Both radiographic examination and computed tomographic scan that involve not only the foot but also the ankle are necessary to analyze the location and size of the coalitions, determining the presence of arthritis in the involved or adjacent joints, and if there are any deformities including a ball-and-socket ankle, which is ...
Source: Foot and Ankle Clinics - August 30, 2021 Category: Orthopaedics Authors: Shuyuan Li, Mark S. Myerson Source Type: research
The Foot in Cerebral Palsy
Children with cerebral palsy frequently develop foot deformities, most commonly equinus contractures, which can be managed with orthotics up to age 5 to 7 years. Plantar flexor lengthening, typically around this age, should be restricted to the offending muscle only, usually with a fascia release of the gastrocnemius. Equinovarus, mainly a problem in children with unilateral cerebral palsy, often responds to plantar flexor lengthening. If further te ndon transfers are needed, they should be done when the child is older to avoid overcorrection. Planovalgus mostly improves spontaneously up to age 5 years. Surgical correct...
Source: Foot and Ankle Clinics - August 16, 2021 Category: Orthopaedics Authors: Julieanne P. Sees, Freeman Miller Source Type: research
The Treatment of Recurrent Congenital Clubfoot
The Ponseti method for treatment of congenital clubfoot is well established and has been introduced in most pediatric orthopedic centers worldwide. However, reported rates of recurrence are largely variable and open joint surgery is still performed frequently, even in the age group younger than 6 years of age. Preventing recurrence and residual deformity can be achieved by strict adherence to the Ponseti method, ensuring and enforcing brace compliance, frequent follow-up, and early treatment of recurrence. This review discusses reasons for clubfoot recurrence, prevention of clubfoot recurr ence, and the treatment of recu...
Source: Foot and Ankle Clinics - August 7, 2021 Category: Orthopaedics Authors: Christof Radler Source Type: research
