[Talectomy for the clubfeet treatment in children with myelomeningocoele].
Talectomy, despite its palliative character, seems to be a treatment of choice in many cases of severe neurogenic clubfeet. The aim of our study was to determine the value of talectomy in the treatment of equinovarus deformity in children with myelomeningocoele.


METHODS
The material consists of 12 children with myelomeningocele (21 neurogenic clubfeet), treated by talectomy. The results of two post-operative follow-up examinations were included--first after 15 months (follow-up I, second after 30 months (follow-up II). The material was divided into two groups: I--consist of feet after talectomy combined with wedge resection of calcaneo-cuboid joint, and II--the feet which underwent "only" talectomy. The calcaneo-cuboid wedge osteotomy was performed to improve the forefoot position for the correction of the more severe deformity. The clinical and X-ray records concerning preoperative period were reviewed. At the follow-up the clinical, radiological and functional evaluation were performed with the special affiliation on modified Magone scale.


RESULTS
Satisfactory clinical results were achieved in all feet except one which required reoperation. Walking ability in orthopaedic fit was present in 5 cases before surgery, and increased to 9 at follow-up. There were no radiological signs of the tibio-calcaneal fusion at the time of observation. During follow-up, on the basis of radiograms made in lateral position, gradual limitation of ROM in so called "tibio-calcaneal" joint was observed. At follow-up I according to modified Magone scale good clinical result was observed in 3 feet, satisfactory in 10, and unsatisfactory in the remaining 3 feet. At follow-up II 3 were defined as good, 4 were defined as satisfactory and the remaining 8 as pour results (only patients who underwent two postoperative examinations). The clinical deterioration does not correlate with the lost of feet shape correction--but mainly with the lost of the ROM in the new "tibio-calcaneal" joint. There were no statistically significant differences between the clinical outcome of feet from group I and II. The authors concluded that the additional wedge resection of calcaneo-cuboid joint improved the forefoot position and, by this way, makes the surgery correction easier.
Jóźwiak
Marek
M
Katedra Ortopediii TraumatologiiDzieciecej, Pracownia Biomechaniki Ruchu, Akademia Medyczna im. Karola Marcinkowskiego w Poznaniu.
Idzior
Maciej
M
Kowalski
Ireneusz
I
D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003025:Clubfoot / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods; D010027:Osteotomy / Q000379:methods; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013628:Talus / Q000601:surgery*; D016896:Treatment Outcome; D016138:Walking