Trends in Clinical and Medical Sciences
Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 20 – 35
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv004
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv004
A prospective study to evaluate outcomes of serial corrective cast followed by surgery in Congenital Talipes Equinovarus (CTEV)
Agam Kant\(^{1}\), Hemendra Chauhan\(^{1}\), Jitendra Kumar Tripathi\(^{1}\), Rajendra Kumar Thakur\(^{1,*}\) and Ashok Vidyarthi\(^{1}\)
\(^{1}\) Department of Orthopaedics, NetajiSubhash Chandra Bose Medical College, Jabalpur (M.P), India.
Correspondence should be addressed to Rajendra Kumar Thakur at kumar.thakur@gmail.com
Copyright © 2023 Agam Kant, Hemendra Chauhan, Jitendra Kumar Tripathi, Rajendra Kumar Thakur and Ashok Vidyarthi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: January 16, 2023 – Accepted: May 10, 2023 – Published: May 14, 2023
Abstract
Introduction: Congenital Talipes EquinoVarus/Clubfoot is a common structural congenital deformity affecting approximately 1 in 1000 live births. The choice of operative procedures for clubfoot management depends on factors such as patient age, rigidity of deformity, and severity. However, there is a lack of consensus regarding the optimal surgical approach, whether comprehensive release or minimal staged surgery. This study aims to evaluate the outcomes of percutaneous tendon release and posteromedial soft tissue release for the treatment of relapsed, neglected, syndromic, and postural clubfoot. The corrective casts applied are assessed using the Pirani scoring system, podography, radiological imaging, and functional evaluation based on Laaveg Ponseti and Cummings scores.
Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics at Netaji Subhash Chandra Bose Medical College, Jabalpur, over an 18-month period. A total of 27 clubfoot patients with 33 affected feet, ranging from 6 months to 7 years old, were included after meeting the inclusion and exclusion criteria. Detailed history, examination, and required investigations were performed and recorded. Patients were treated accordingly and followed up at regular intervals. Data was collected, compiled, and analyzed using SPSS 22.0.
Results: The majority of participants (37%) were in the age group of 6-11 months, with males constituting the majority (66.7%). The study included patients with relapsed clubfeet (n=18) and neglected clubfeet (n=9). Right foot involvement was more prevalent than left foot involvement. Pre- and post-operative measurements showed significant associations between Pirani scores, talocalcaneal angles, tibiocalcaneal angles, and talocalcaneal indices. The mean change in Pirani score was 4.04, and podographic measurements demonstrated increased foot bimalleolar angles. Functional assessment using Laaveg Ponseti and Cumming’s Functional Score indicated good to excellent outcomes in the majority of participants.
Conclusion: Percutaneous tendon release surgery with corrective cast application is a safe, effective, and low-risk method for correcting relapsed clubfoot. Posteromedial soft tissue release, along with corrective cast application, remains the best option for neglected clubfoot, despite the potential risks of neurovascular and wound complications. These preliminary results, with an average follow-up of 1 year, suggest that soft tissue release surgery for neglected clubfoot and percutaneous tendon release for relapsed clubfoot, along with corrective casting in both methods, yield good to excellent outcomes.
Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics at Netaji Subhash Chandra Bose Medical College, Jabalpur, over an 18-month period. A total of 27 clubfoot patients with 33 affected feet, ranging from 6 months to 7 years old, were included after meeting the inclusion and exclusion criteria. Detailed history, examination, and required investigations were performed and recorded. Patients were treated accordingly and followed up at regular intervals. Data was collected, compiled, and analyzed using SPSS 22.0.
Results: The majority of participants (37%) were in the age group of 6-11 months, with males constituting the majority (66.7%). The study included patients with relapsed clubfeet (n=18) and neglected clubfeet (n=9). Right foot involvement was more prevalent than left foot involvement. Pre- and post-operative measurements showed significant associations between Pirani scores, talocalcaneal angles, tibiocalcaneal angles, and talocalcaneal indices. The mean change in Pirani score was 4.04, and podographic measurements demonstrated increased foot bimalleolar angles. Functional assessment using Laaveg Ponseti and Cumming’s Functional Score indicated good to excellent outcomes in the majority of participants.
Conclusion: Percutaneous tendon release surgery with corrective cast application is a safe, effective, and low-risk method for correcting relapsed clubfoot. Posteromedial soft tissue release, along with corrective cast application, remains the best option for neglected clubfoot, despite the potential risks of neurovascular and wound complications. These preliminary results, with an average follow-up of 1 year, suggest that soft tissue release surgery for neglected clubfoot and percutaneous tendon release for relapsed clubfoot, along with corrective casting in both methods, yield good to excellent outcomes.
Keywords:
CTEV; Clubfoot; Podography; Percutaneous tendon release; Posteromedial soft tissue release.