Congenital talipes equinovarus in spina bifida: treatment and results.
The results of the surgical treatment of clubfoot deformity in spina bifida by radical posteromedial-lateral release (PMLR) are presented. In all cases, the Cincinnati incision was used and the tendons excised, including the anterior tibial tendon. In 21 feet, a special K-wire was used to derotate the talus in the ankle mortise. The minimum follow-up was 2 years. The average age at surgery was 14 months. The overall results showed 63% good, 14% fair, and 23% poor results. In the 21 feet in which the talus K-wire was used, 76% had a good result, 14% fair, and 10% poor. The results were also analyzed based on the motor level. In the thoracic/high lumbar level, 50% had a poor result. In the low lumbar and sacral level groups together, of 45 feet, five had a poor result. This study shows that a radical PMLR can produce an overall good and fair result in 77% of the cases. The use of the K-wire to derotate the talus led to an improvement in the result. The tendon excision leading to a flail foot corrects any residual muscle imbalance. The poor results seen in the thoracic/high lumbar patients are likely to be related to the lack of weight bearing in view of their motor paralysis.
Children's Memorial Medical Center, Chicago, Illinois, USA.
J
J
de Carvalho Neto
L S
LS
Dias
A P
AP
Gabrieli
D001864:Bone Wires; D002370:Casts, Surgical; D002675:Child, Preschool; D003025:Clubfoot / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008124:Locomotion; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D011182:Postoperative Care; D013165:Splints; D013514:Surgical Procedures, Operative / Q000379:methods; D013710:Tendons / Q000601:surgery*; D016474:Weight-Bearing