Clinical implications of clubfoot histopathology.
Ipsilateral peroneus brevis muscle histopathology was studied in 64 children with idiopathic rigid equinovarus at the setting of initial posteromedial-lateral release. Fifty percent of biopsies demonstrated abnormal muscle fiber morphology, classified as congenital fiber-type disproportion or fiber-size variation. Forty-one infants (59 feet) underwent initial surgical intervention within the first year of life with a minimum 2-year follow-up. Feet with abnormal muscle histology had a significantly greater incidence of recurrent equinovarus deformity requiring reoperation; the relative risk of clubfoot recurrence in children with fiber abnormalities was 5.6. Male patients with bilateral deformity and abnormal peroneus brevis histology had a particularly high incidence of recurrent equinovarus. Developmental internal tibial torsion requiring surgical intervention was also greater in the abnormal-fiber histology group. The incidence of postoperative metatarsus adductus/varus necessitating surgery was comparable despite histologic findings. Thus muscle-fiber abnormalities are prevalent in idiopathic equinovarus. Such fiber-type anomalies may predict recurrent limb deformities.
Loren
G J
GJ
Children's Hospital and Health Center, San Diego, California, USA.
Karpinski
N C
NC
Mubarak
S J
SJ
D003025:Clubfoot / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome