title: Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases.
abstract: BACKGROUND
  We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up.
  
  
  METHODS
  Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet).
  
  
  RESULTS
  The average follow-up was 5 years (1-6 years). In newborns treated with Ponseti, the results were excellent in 42 feet, good in 6, and poor in 4. In non-ambulating children, the results were excellent in 9 feet, and good in 3. In ambulating children, the results were excellent in 5 feet, good in 16, and poor in 3. No major complications were reported. No overcorrections were observed. The need for open surgery was higher in cases of delayed treatment. In cases of relapse, re-casting and/or more extensive surgery was considered.
  
  
  CONCLUSIONS
  Early treatment enables a high rate of good correction to be obtained with serial casting and limited surgery. Conversely, if the deformity is observed after walking age surgery should be considered. Serial casting in cases of late observation and relapse have demonstrated encouraging results.
  
  
  METHODS
  IV.
authors.affiliation: University of Bologna, Bologna, Italy. lostudio14@gmail.com.|Dipartimento Rizzoli-Sicilia, Istituto Ortopedico Rizzoli, Strada Statale 113 km 246, 90011, Bagheria, PA, Italy. lostudio14@gmail.com.
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.affiliation: Dipartimento Rizzoli-Sicilia, Istituto Ortopedico Rizzoli, Strada Statale 113 km 246, 90011, Bagheria, PA, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Traina
authors.affiliation: Dipartimento Rizzoli-Sicilia, Istituto Ortopedico Rizzoli, Strada Statale 113 km 246, 90011, Bagheria, PA, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Nanni
authors.affiliation: University of Messina, Messina, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sanzarello
authors.affiliation: University of Bologna, Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Borghi
authors.affiliation: University of Bologna, Bologna, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Perna
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D002370:Casts, Surgical; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D012008:Recurrence; D000070558:Talipes / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: Casting; Clubfoot; Re-casting; Surgical treatment; Walking age