Morphometric Study of Muscle in Congenital Idiopathic Club Foot (original) (raw)
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An MRI volumetric study for leg muscles in congenital clubfoot
Journal of Children's Orthopaedics, 2012
Purpose To investigate both volume and length of the three muscle compartments of the normal and the affected leg in unilateral congenital clubfoot. Methods Volumetric magnetic resonance imaging (VMRI) of the anterior, lateral and postero-medial muscular compartments of both the normal and the clubfoot leg was obtained in three groups of seven patients each, whose mean age was, respectively, 4.8 months, 11.1 months and 4.7 years. At diagnosis, all the unilateral congenital clubfeet had a Pirani score ranging from 4.5 to 5.5 points, and all of them had been treated according to a strict Ponseti protocol. All the feet had percutaneous lengthening of the Achilles tendon. Results A mean difference in both volume and length was found between the three muscular compartments of the leg, with the muscles of the clubfoot side being thinner and shorter than those of the normal side. The distal tendon of the tibialis anterior, peroneus longus and triceps surae (Achilles tendon) were longer tha...
Mutation screening of muscle development genes in patients with idiopathic clubfoot
Open Journal of Genetics, 2012
Background: Congenital idiopathic clubfoot is a very common musculoskeletal birth defect, but with no known etiology. Dietz et al. have shown possible linkage in chromosome 3 and 13 in a large, multigenerational family with congenital idiopathic clubfoot. Current evidence suggests that muscle development is impaired in patients with congenital idiopathic clubfoot, therefore we hypothesized that mutations in genes related to muscle development could be associated with this deformity. From the areas identified in the linkage study, candidate genes SPRY2, RAF1, IQSEC1, LMO7, and UCHL3 were selected based upon their presence in skeletal muscle as well as their involvement in muscle development. Methods: The exons and splice sites of the five genes were screened via sequence-based analysis in a group of 24 patients with congenital idiopathic clubfoot. All single nucleotide polymorphisms (SNPs) found were compared to public databases to determine allelic frequency and amino acid modification. Results: While many SNPs were found, none proved to be significantly associated with the phenotype of congenital idiopathic clubfoot. The SNPs found were shown to be common amongst a non-clubfoot population and to follow the allelic frequency of the general population. Conclusions: Based upon these results, SPRY2, RAF1, IQSEC1, LMO7, and UCHL3 are not likely to be the major causes of congenital idiopathic clubfoot. Given the complexity of myogenesis, many other candidate genes remain that could cause defects in the hypaxial musculature that is invariably observed in congenital idiopathic clubfoot. Clinical Relevance: This study further identifies genes which are unlikely to be the direct cause of congenital idiopathic clubfoot. It also helps to eliminate suspected genes found within the given bounds of chromosome 3 and 13.
Cureus, 2022
Congenital hypertrophy of intrinsic foot muscles is a rare condition. We report an unusual case of a 24-yearold male with a painless swelling at the plantar and medial aspect of the right foot, which was present since birth. The significant size of deformity and discomfort in wearing shoes were major concerns. MRI revealed expansion of multiple intrinsic foot muscles, which are abductor hallucis, flexor digitorum brevis, and quadratus plantae. We used shear wave elastography (SWE) as an imaging technique besides MRI and ultrasonography, which has not been used or published previously. Muscle shear wave velocity values were measured in abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and quadratus plantaris muscles. The mean stiffness values of muscles on the affected side were significantly higher compared to the healthy side. The median SWE value was 6.67 kPa (range: 4.7-8.6 kPa) on the healthy side, while it ranged between 9.2 and 13.4 kPa on the affected side. Total excision of abductor hallucis and subtotal resection of flexor digitorum brevis and quadratus plantae muscles were performed, and motor and sensory functions were preserved by protecting the neurovascular bundle. Excess skin was also removed. Surgery and postoperative course were uneventful. The patient was allowed to bear weight as tolerated. There was no recurrence, and the patient was satisfied with the shape and size of his foot at the six-month follow-up. Congenital hypertrophy of foot muscle is uncommon especially when multiple intrinsic foot muscles are involved. The main aim is to relieve patients' concerns, correct deformities, and provide comfortable shoe wear.
Study of Congenital Clubfoot in Newborns
International Journal of Anatomy and Research, 2016
Background: Clubfoot or CTEV is one of the most common serious congenital musculoskeletal anomalies with a worldwide incidence of 1 in 1000 live births. Approximately 80% of clubfoot occur as isolated birth defects and are considered idiopathic. Males are more frequently affected (2:1 male to female ratio), bilateral in approximately 50% of all cases, and the right foot is more often affected in unilateral cases.
Idiopathic congenital clubfoot: Initial treatment
Orthopaedics & traumatology, surgery & research : OTSR, 2013
Clubfoot (talipes equinovarus) is a three-dimensional deformity of unknown etiology. Treatment aims at correction to obtain a functional, plantigrade pain-free foot. The "French" functional method involves specialized physiotherapists. Daily manipulation is associated to immobilization by adhesive bandages and pads. There are basically three approaches: the Saint-Vincent-de-Paul, the Robert-Debré and the Montpellier method. In the Ponseti method, on the other hand, the reduction phase using weekly casts usually ends with percutaneous tenotomy of the Achilles tendon to correct the equinus. Twenty-four hour then nighttime splinting in abduction is then maintained for a period of 3 to 4 years. Recurrence, mainly due to non-compliance with splinting, is usually managed by cast and/or anterior tibialis transfer. The good long-term results, with tolerance of some anatomical imperfections, in contrast with the poor results of extensive surgical release, have led to a change in cl...
The Iowa orthopaedic journal, 2015
Clubfoot has been evaluated in many ways, including the most common classifications of clubfoot, described by Caterrall and Piraniis based on six clinical signs. The purpose of this study was to gain better understanding of the heel pad in relation to the term "empty heel", and to propose modification of clubfoot severity scoring system based on "empty heel". A combination of prospective study of 79 clubfoot patients treated with Ponseti method and literature review of heel pad anatomy and biomechanics. The setting was a university teaching hospital. The ethical research committee approved study protocol and informed consent of patients' parent obtained. The selection criteria included patients' diagnosed congenital idiopathic clubfoot, age < 2years, no history of previous treatment and tenotomy indicated. An evaluation of patient was assessed by orthopaedic surgeons trained on Ponseti method and has above 5 years experience. Data analysis performed on...
A hypothesis and model of reduced fetal movement as a common pathogenetic mechanism in clubfoot
Medical Hypotheses, 2009
Background: Clubfoot or Talipes equinovarus is characterised by an adducted forefoot, hindfoot varus, and ankle equinus deformity, varying in severity and ease of correction. It is one of the most common congenital defects, with a prevalence of around 1 per 1000. Ambiguity still surrounds the classification and pathogenesis of clubfoot. Methods: A literature search was performed using Pubmed, Ovid, and the Cochrane Databases, using search terms in isolation or combination: clubfoot, Talipes equinovarus, congenital foot deformities and joint development, identified articles were further hand searched and relevant references identified. Conclusion: We propose that the underlying unifying factor in all cases of clubfoot is a lack of fetal movement. Fetal movement is a key developmental signal in the development of joints, and we suggest that this applies to the morphogenesis of the forefoot. Theories exist to explain specific individual features of clubfoot in certain cases and to explain experimental studies, however no common final pathway has been described. We believe that our hypothesis brings together key elements of these and will simplify understanding and classification of clubfoot.
Clubfoot: the treatment outcome using quantitative assessment of deformity
Malaysian orthopaedic journal, 2012
The recent trend in management of congenital idiopathic clubfoot tends towards conservative treatment. This study reviews the outcomes of treatment in our practice using the quantitative clubfoot assessment of the deformity (QCAD). Thirty patients (38 cases of clubfoot) with congenital idiopathic clubfoot treated at Sarawak General Hospital were followed-up for a mean of 3.6 years. The quantitative assessment consists of limb anthropometric measurement and the Pirani deformity severity score. There were 15 boys and 15 girls, with a mean age of 4.4 years (range, 13m - 8y). Most patients were of the Malay race (67%), followed by Chinese (23%) and others (10%). Eight patients suffered from bilateral congenital idiopathic clubfoot (33%), 12 were left unilateral (40%) and 10 were right unilateral (27%). Out of the total of 30 patients, 12 were treated conservatively with serial casting and 18 patients were treated surgically after resistance to serial casting at the age of nine months. A...
Journal of pediatric orthopedics. Part B, 2015
Clubfoot, talipes equino varus (TEV), is a common congenital foot anomaly. Some cases are resistant to conservative treatment. Many causes of resistance have been reported, among these, the presence of anomalous muscles; however, the effect of the presence of anomalous muscles on the outcome of conservative management is not well studied. These aberrant muscles are discovered during the extensive surgical release as an abnormal finding. The aim of this work is to study the demographic characteristics of patients with resistant TEV that necessitated extensive soft tissue release at Sudan Clubfoot Clinic and to document the prevalence of flexor digitorum accessorius longus (FDAL) muscle in a large series of clubfoot patients treated by extensive surgery: posteromedial release. Also, we introduce a new observation as an indication by which the surgeon can predict the presence of FDAL. On the basis of an observation that there is a special posture of the big toe in extension in relation...
Results of Treatment of Idiopathic Congenital Clubfoot in Children: A 3-YEAR Follow Up Study
2020
OBJECTIVE The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. PATIENTS AND METHODS Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children's Specialized Hospital "Okhmatdet". Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-t...