Anterior Distal Tibial Guided Growth for recurrent equinus deformity in idiopathic Congenital Talipes Equinovarus treated with the Ponseti method.

Autor: Mishra AS; Hull Royal Infirmary, Hull, United Kingdom. Electronic address: aryasuman@gmail.com., Shrestha J; Royal Derby Hospital, Derby, United Kingdom., Rajan RA; Royal Derby Hospital, Derby, United Kingdom.
Jazyk: angličtina
Zdroj: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons [Foot Ankle Surg] 2023 Jun; Vol. 29 (4), pp. 355-360. Date of Electronic Publication: 2023 Mar 29.
DOI: 10.1016/j.fas.2023.03.006
Abstrakt: Introduction: Distal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment.
Methods: Patients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles' tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity.
Results: We identified 22 feet in 16 patients, with an average follow-up was 25 (8.8-47.3) months. The mean aDTA changed from 88.9 (82.3-94.5) to 77.0 (65.0-83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot.
Conclusion: This procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment.
Level of Evidence: Therapeutic Level IV.
Competing Interests: Conflict of interest None.
(Copyright © 2023 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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