Evidence-Based Treatment for Clubfoot
The management of clubfoot has been the subject of active research interest for some time and there is a large body of evidence supporting its treatment strategy. The spectrum of evidence includes randomised controlled trials (RCT), long term prospective
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Munier Hossain and Naomi Davis
Abstract
The management of clubfoot has been the subject of active research interest for some time and there is a large body of evidence supporting its treatment strategy. The spectrum of evidence includes randomised controlled trials (RCT), long term prospective follow up as well as systematic reviews including a recent Cochrane review. The actual quality of evidence does vary and there are no real level I studies. Besides, evidence was not always available for the most pertinent clinical questions. However, most published evidence consistently supported the superiority of the Ponseti technique for treating idiopathic clubfoot. Evidence was less clear for management of the complex idiopathic type or the non-idiopathic type clubfoot. Since the publication of results from Ponseti’s team this technique has been adopted widely and results published from numerous centres from as far afield as Brazil to Bangladesh. On the basis of available publications it is estimated that the Ponseti technique is in use in at least 113 countries around the world Shabtai et al. (World J Orthop 5:585–590, 2014). The basic principle of the Ponseti technique is well established although minor variations have been attempted by different researchers. In the ensuing paragraphs we have reviewed the evidence base for management of clubfoot recommendations. Keywords
Clubfoot • Congenital talipes equinovarus • Pirani score • Ponseti method • Kite method • French method • Tendoachilles tenotomy • Foot abduction brace • Boots and bar • Tibialis anterior tendon transfer
Background Clubfoot, also known congenital talipes equinovarus (CTEV), is a common congenital limb deformity with an incidence of 1/1000. It involves both feet in 50 % of patients
M. Hossain (*) Department of Trauma and Orthopaedics, Royal Manchester Children’s Hospital, Manchester, UK e-mail: [email protected] N. Davis Department of Paediatric Orthopaedic Surgery, Royal Manchester Children’s Hospital, Manchester, UK e-mail: [email protected]
and boys are more affected than girls (3/2). It is characterised by a tight tendoachilles (equinus), an excessively turned in foot (varus) and high medial longitudinal arch (cavus) (Fig. 16.1), which if left untreated leads to long-term functional disability, deformity and pain [2]. Clubfoot can be: • Idiopathic clubfoot which presents as an isolated anomaly in a normal child. • Non-idiopathic clubfoot which is associated with other neuromuscular or congenital anomalies • Complex or atypical idiopathic clubfoot which is defined as having rigid equinus, severe plantar flexion of all metatarsals, a deep crease above the heel, a transverse crease in the sole of the foot, and a short and hyperextended first toe.
© Springer International Publishing Switzerland 2017 S. Alshryda et al. (eds.), Paediatric Orthopaedics, DOI 10.1007/978-3-319-41142-2_16
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Fig. 16.1 Clinical photographs showing classical deformity of a clubfoot
Idiopathic clubfoot responds well to tre
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