Rigidity of foot deformity in congenital clubfoot: foot stiffness index
- Authors: Vlasov M.V.1
-
Affiliations:
- Privolzhsky Research Medical University
- Issue: Vol 14, No 2 (2024)
- Pages: 173-182
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/263093
- DOI: https://doi.org/10.17816/psaic1797
- ID: 263093
Cite item
Abstract
BACKGROUND: A unified system for assessing the severity of congenital clubfoot in newborns and young children worldwide remains to be established. “Rigidity” of foot deformity refers to the degree of “resistance” of foot tissues during manual correction of elements of the deformity and is often used in subjective severity of foot deformity assessment. However, there is no objective quantitative assessment for the degree of foot rigidity.
AIM: The study aimed to introduce a novel clinical sign — ”rigidity of foot deformation”, which enables objective assessment of the severity of foot deformity in congenital clubfoot.
MATERIALS AND METHODS: Before applying the first plaster cast, a clinical dynamometric examination was performed on 350 feet of 229 children, followed by a mathematical calculation of the foot rigidity index. Statistical analysis was performed using the nonparametric Mann–Whitney U-test and Spearman’s rank correlation coefficient. Differences were considered significant at p < 0.05.
RESULTS: Significant differences were found in all clinical and dynamometric parameters between congenital clubfoot of I–II, III, and IV degrees (p ≤ 0.05). Generally, the higher the degree of deformity, the more effort required to eliminate it, the smaller angle of simultaneous correction, and the higher index of foot rigidity. The results of Spearman’s correlation analysis of clinical dynamometric examination indicators in children with congenital clubfoot of I–II degree may indicate the mobile nature of the foot deformity; III degree, a rigid version of the deformity; and IV degree, an extremely rigid degree of deformity.
CONCLUSIONS: Rigidity of the foot deformity is a crucial clinical sign that characterizes the severity of the foot deformity, which has a quantitative characteristic — the rigidity index. Initial data on foot rigidity enables objective assessment of the severity of the deformity and selecting an individual approach to its elimination when applying staged plaster casts using the Ponseti method.
Full Text
##article.viewOnOriginalSite##About the authors
Maksim V. Vlasov
Privolzhsky Research Medical University
Author for correspondence.
Email: footdoc@mail.ru
ORCID iD: 0009-0009-4381-8340
SPIN-code: 2721-5113
MD, Cand. Sci. (Medicine)
Russian Federation, Nizhny NovgorodReferences
- Alexandrov VV, Kochenov AG. Bloodless treatment of severe forms of congenital clubfoot in children up to 3 years old with the Ilizarov apparatus. In: VII congress of traumatologists and orthopedists of Russia. Vol. 2; 2002 Sept 18–20; Novosibirsk. Novosibirsk; 2002. 176 p. (In Russ.)
- Kenis VM, Klychkova IY, Stepanova YA. Treatment of children with congenital clubfoot using the Ponseti method. Clinical recommendations. Saint Petersburg: All-Russian Public Association of Traumatologists and Orthopaedists of Russia (ATOR); 2013. 30 p. (In Russ.)
- Baindurashvili AG, Solov’yova KS, Zaletina AV, Lapkin YA. Congenital abnormalities (developmental defects) and musculoskeletal system deformities in children. N.N. Priorov Journal of Traumatology and Orthopedics. 2014;21(3):15–20. EDN: STTRPB doi: 10.17816/vto20140315-20
- Klychkova IY, Lapkin YA, Konyukhov MP, et al. Modern concepts of conservative treatment methods of clubfoot. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2014;2(4):20–31. EDN: TGIVYV doi: 10.17816/PTORS2420-31
- Bina S, Pacey V, Barnes EH, et al. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev. 2020;5(5):CD008602. doi: 10.1002/14651858.CD008602.pub4
- Garcia LC, de Jesus LR, Trindade MO, et al. Evaluation of kite and Ponseti methods in the treatment of idiopathic congenital clubfoot. Acta Ortop Bras. 2018;26(6):366–369. doi: 10.1590/1413-785220182606183925
- Rieger MA, Dobbs MB. Clubfoot. Clin Podiatr Med Surg. 2022;39(1):1–14. doi: 10.1016/j.cpm.2021.08.006
- Hopwood S, Khan F, Kemp J, et al. Clubfoot: an overview and the latest UK guidelines. Br J Hosp Med (Lond). 2023;84(1):1–7. doi: 10.12968/hmed.2022.0380
- Silvani S. The evolution of the treatment of clubfoot from posterior medial release to the Ponseti technique: my 42-year journey at the permanente medical group. Clin Podiatr Med Surg. 2024;41(1):1–16. doi: 10.1016/j.cpm.2023.06.001
- Blandinsky VPh, Vavilov MA, Torno ТЕ, Skladneva AL. The treatment of clubfoot by I. Ponseti method. Traumatology and orthopedics of Russia. 2008;(2):32–36. EDN: KKOYIN
- Cady R, Hennessey TA, Schwend RM. Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics. 2022;149(2):e2021055555. doi: 10.1542/peds.2021-055555
- Nielsen MF, Moller-Madsen B, Engell V. Treatment of clubfoot in children. Ugeskr Laeger. 2022;184(40):V04220238.
- Dibello D, Colin G, Galimberti AMC, et al. How to cope with the Ponseti method for clubfoot: the families’ standpoint. Children (Basel). 2022;9(8):1134. doi: 10.3390/children9081134
- Scanlan E, Grima-Farrell K, IIhan E, et al. Initiating Ponseti management in preterm infants with clubfoot at term age. J Child Orthop. 2022;16(2):141–146. doi: 10.1177/18632521221080476
- Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74(3):448–454. doi: 10.2106/00004623-199274030-00021
- Maranho DA, Volpon JB. Congenital clubfoot. Acta Ortop Bras. 2011;19(3):163–169. doi: 10.1590/S1413-78522011000300010
- Rumyantsev NJ, Kruglov IJ. Clubfoot severity changes during primary treatment using Ponseti technique. Children’s medicine of the North-West. 2011;2(1):52–56. EDN: OZNJVH
- Dimeglio A, Bensahel H, Souchet P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129–136. doi: 10.1097/01202412-199504020-00002
- Pirani S, Outerbridge HK, Sawatzky B, Stothers K. A relianle method of clinically evaluating a virgin clubfoot evaluation. In: 21st SICOT congress. Vol. 29. Sydney; 1999. P. 2–30.
- Ponseti V, Smoley EN. The classic: congenital club foot: the results of treatment. Clin Orthop Relat Res. 2009;467(5):1133–1145. doi: 10.1007/s11999-009-0720-2
- Blandinsky VF, Vavilov MA, Torno TE, Donskoy AV. Management of atypical clubfoot by Ponseti method. Traumatology and Orthopedics of Russia. 2010;16(1):75–79. EDN: LJLVPR doi: 10.21823/2311-2905-2010-0-1-75-79
- Pogosyan IA, Chelchushev DA, Sosnin EB. Application of the method I. Ponseti in the treatment of different types of equinocavovarus deformities of foot in children. System integration in health care. 2011;(3):30–37. EDN: OEEGHJ
- Zhang G, Zhang Y, Li M. A modified Ponseti method for the treatment of rigid idiopathic congenital clubfoot. J Foot Ankle Surg. 2019;58(6):1192–1196. doi: 10.1053/j.jfas.2019.04.003
- Sahoo PK, Sahu MM. Neglected clubfoot — a community health challenge in rural Odisha, India. Indian J Orthop. 2023;57(11):1757–1764. doi: 10.1007/s43465-023-00923-5
- Kenis VM, Stepanova YA. Causes of non-optimal conservative treatment of congenital clubfoot in children. Traumatology and Orthopedics of Russia. 2017;23(3):80–85. EDN: ZRXJRX doi: 10.21823/2311-2905-2017-23-3-80-85
- Hu W, Ke B, Niansu X, et al. Factors associated with the relapse in Ponseti treated congenital clubfoot. BMC Musculoskelet Disord. 2022;23(1):88. doi: 10.1186/s12891-022-05039-9
- Barik S, Agarwal A. Non-zero Pirani score in corrected clubfoot due to empty heel: a prognostic dilemma. J Clin Orthop Trauma. 2023;47:102295. doi: 10.1016/j.jcot.2023.102295
- Alsayed MA, Hussein MA, Althaqafi RM II, Alyami A. Conventional versus accelerated Ponseti in the management of cases of idiopathic clubfoot: a systematic review and meta-analysis. Cureus. 2023;15(9):e45041. doi: 10.7759/cureus.45041
- Kruglov IY, Rumyantsev NY, Omarov GG, Rumiantceva NN. Change in the severity of congenital clubfoot in the first week of life. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(4):49–56. EDN: KTAIVD doi: 10.17816/PTORS7449-56
- Zhao A, Bai R, Yao J, Liu R. The “Hand as foot” teaching model in Dimeglio classification of children clubfoot. Asian J Surg. 2022;45(1):646–648. doi: 10.1016/j.asjsur.2021.11.007
- Ghanem I, Ghanem D, Rassi J, Saliba I. Achilles tenotomy during Ponseti‘s clubfoot treatment: better early than late. J Pediatr Orthop B. 2024;33(3):251–257. doi: 10.1097/BPB.0000000000001106
- Zeaiter Z, Alzein H, Daher Y. An insight on current clubfoot management: a reported data from Lebanon. Cureus. 2023;15(6):e40194. doi: 10.7759/cureus.40194