MODIFIED ALGORITHM FOR MYELODYSPLASIA CLUBFOOT TREATMENT WITH PONSETI METHOD
Authors: Aysegul BURSALI, Semih AYANOGLU, Timur YILDIRIM
Institution: Metin Sabanci Baltalimani Bone Diseases Training Hospital, Orthopedics and Traumatology Clinic, Istanbul, TURKEY
Purpose: Minimize unnecessary extensive surgical procedures for treatment of neurogenic clubfoot
Introduction: Clubfoot is one of the most common lower extremity deformities in pediatric orthopedics. This is the most troublesome deformity, because of tendency to recur despite apparently adequate initial correction. Muscle imbalance has traditionally been regarded as the major cause of deformity. Regardless of age and etiology, Ponseti’s clubfoot treatment method is suitable for both neurogenic and idiopathic clubfoot.
In literature some authors recommend operative correction of neurogenic clubfoot with posteromedial release or talectomy after walking of age.
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Material and Methods: We have been treating idiopathic & neurogenic clubfeet cases following strict rules of Ponseti’s casting method since 1997. After 2001 we have modified follow-up protocol of Ponseti’s method for neurogenic clubfeet cases.
During follow-up, if we see recurrences, we restart manipulation and casting than we perform percutaneus Achilles tenotomy. If we see second relapse and uncontrollable deformity with casting after 6 months of age we perform Flexor Hallusis Longus, Flexor Digitorum Longus and Tibialis Posterior tendon resections because of fibroblastic activity decreases after 6 months of age.
In cases which we observe second relapse or more after three years of age we perform Plantar Fasciatomy, talus Decancellation / longitudinal osteotomy for unreduced talus, Achilles lengthening, tendon transfer (if it is possible for dynamic correction of deformity) or tendon resection.
We don’t perform extensive posteromedial, soft-tissue release and posterior capsulotomy. Postoperatively feet were placed in well-padded cast. Then we used Ankle
Foot Orthosis or Ponseti’s foot-abduction brace. The goal is normal looking, plantigrade feet and usage of orthosis without problem before the child reach at walking age.
In our
series we treated 39 Spina Bifida [SB] patients with 25 bilateral, 14 unilateral and total 64 feet. Mean age at correction is 2.28yr [1-8yr], M/F ratio: 16/23. Neurosegmental levels of SB cases were 5 Thoracal 24 Lumbar, and 10 Sacral.
Conclusions: Modified Ponseti’s method is very effective and successful method of choice for neurogenic clubfoot treatment.
Corresponding Author : Dr. Aysegul BURSALI