A Preliminary Study On The Predictive Factors For Residual Equinovarus Deformity Following Ponseti Treatment And Percutaneous Achilles Tenotomy For Congenital Talipes Equinovarus

Congenital clubfoot is a common childhood foot deformity, which belongs to thechildren’s bone joint and trauma category, also known as idiopathic clubfoot.Only theclubfoot deformity and not associated with other malformations, not including thoseknown as the syndrome pathogenesis and part of the clubfoot deformity.Clubfoot deformity in the performance of the foot and ankle are varied, but the realturning congenital club foot deformity must contain the following elements:(1) the ankleand subtalar joint in plantar flexion deformity;(2) the root bone varus;(3) the forefootadduction deformity.So far, the etiology, pathology and pathogenesis of congenital talipes equinovarus isnot fully understood.The principle of consensus on the clubfoot: early proper treatment ofclubfoot, mostly can obtain better deformity correction;If not treated, the children will bethe face of lifelong disability, caused a great burden to the family and psychological, affectthe life and work.The treatment goal of Congenital clubfoot is expected to get as much aspossible and keep the normal structure and function of the foot and ankle.But the patients and their family members must understand, on the current status oftreatment methods and research point of view,in any case,,after the treatment ofclubfoot,which are still some residual deformity requiring further surgery.If treatment isnot timely, with the growth of age,foot deformities in children with weight will graduallyincrease, by the soft type into rigid type.Therefore, the main factors influencing theresidual clubfoot deformity, early effective treatment for residual clubfoot deformity, toprevent further development is particularly important.On the application of the Ponsetimethod for the treatment of congenital club foot after the turn of residual clubfootdeformity factors did not reach a consensus. The Ponseti method based on the in-depth study of anatomy and PAT术hology ofnormal feet and equinus, make CTEV treatment achieved the soft, painless, goodfunction.The Ponseti method was used to correct the fixation combined with plaster, by4~6times continuous correction (replaced1times a week), and gradually restore the normalanatomical relationship between the distance and talonavicular joint, properly maintain legmild external rotation, to correct the calcaneus varus, forefoot adductiondeformity.Through the above treatment, some scholars believe that the MRI confirmedfrom the bones gradually achieve reduction, calcaneus, talus and cuboid have obviousrecovery improvement, foot shape recovery.The method reported in the literature Ponsetiinitial correction success rate is93%~100%. But what kind of parameters can be usedas the affecting factors of residual clubfoot deformity, has been plagued by the problem ofthe clinician. A retrospective analysis of35cases of children with clinical data within50clubfoot, mean follow-up time was2years. Found that Pirani score, lateral tibiocalcanealangle and lateral talocalcaneal angle may be the factors affecting residual clubfootdeformityMethodsCollected from May2006to June2010turned in Tai’an Central Hospital PediatricSurgery35cases of hospitalized children with congenital clubfoot50(26male and9female, left22and right28; unilateral20bilateral15),children under general anesthesiaPAT as Ponsti part of the treatment.ObjectivesThrough the clinical scoring system of the congenital clubfoot and radiographicparameters after percutaneous Achilles transection measured to prove that the influencefactors of residual clubfoot deformity.Results1.There is no significant statistically difference between the gender and age in twogroups(P>0.05).2.The initial Dimeglio and Pirani score difference was not statistically significant (P>0.05).3.In the PAT and last follow-up examination, Pirani score in Group2was significantlyhigher than in group1, the difference was statistically significant (P <0.05).4.The lateral tibial angle and lateral talocalcaneal angle between the two groups weresignificant statistically differences (P <0.05). 5.There was a positive correlation between the Pilani score and lateral tibia andmandible angle(r＝0.61，P＜0.05).6.Pilani scores and lateral talocalcaneal angle was negatively correlated(r＝-0.42，P＜0.05).7.Pilani scores and anteriorl talocalcaneal angle is no siginificant correlation(r＝-0.021，P＞0.05).ConclusionsThe Ponsti method and PAT for the treatment of congenital talipes equinovarus,clinical score Pilani, lateral tibia and mandible angle and lateral talocalcaneal angle may bethe factors affecting residual clubfoot deformity.