The appropriate procedures and combination of procedures depend on; |
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The age of the child.
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The severity of the deformity.
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The pathological processes involved.
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Common components of resistant clubfoot deformity are:
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Adduction or supination, or both, of the forefoot.
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A short medial column or long lateral column of the foot.
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Internal rotation and varus of the calcaneus.
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Equinus.
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Forefoot deformities: |
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Dynamic deformities – tendon balancing procedure (split or complete transfer of tibialis anterior to lateral cuneiform or cuboid).
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2. Rigid deformity (<5years): Multiple MTPJ capsulotomies. |
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3. Rigid deformity (>5years): – Bony procedures like dome osteotomies of metatarsal bases and cuneiform-cuboid osteotomy.
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Rigid Deformity
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Cunieform Cuboid Osteotomy for correcting forefoot adduction deformity
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Hindfoot Deformities
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<2-3 years: - modified McKay procedure
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Picture showing Cincinnati incision for pantalar release
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Its important to find out if hindfoot deformity is because of isolated heel varus, short medial column or long lateral column.
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Isolated Heel Varus
Dwyer osteotomy is the treatment.
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Short lateral column
Dillwyn-Evans procedure is the treatment
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Long lateral Column
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Lichtblau procedure is the treatment
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10-12 years: triple arthrodesis |
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Heel Equinus |
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Achilles tendon lengthening plus posterior capsulotomy of subtalar joint, ankle joint (mild-to-moderate deformity)
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Lambrinudi procedure (severe deformity, skeletal immaturity)
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All Three Deformities |
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Triple Arthrodesis is done children more than 12 years. Upto 12 years one should try Ponseti treatment first. |
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External Fixator
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Has been used successfully in relapsed and resistant clubfoot |
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Case 1
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Relapsed club foot after posteromedial release in a five year old child.
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Treatment with JESS External Fixator.
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Result – Maintenance of correction 8 years later at the age of 13 years
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Result at the age of 13 years
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Internal Tibial Torsion
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De-rotational Osteotomy of tibia is rarely required. Foot deformities should be excluded before undertaking tibial osteotomy.
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