ISSN : 2663-2187

Management Lines of Residual Forefoot Adduction Deformity

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Mohamed Said Abdelazim Mady; Riad Mansour Megahed; Sami Sadek Ali; Mohamed Mahmoud El-Hefnawy
ยป doi: 10.33472/AFJBS.6.2.2024.549-563

Abstract

Idiopathic clubfoot, scientifically known as congenital talipes equinovarus, which is a complex three-dimensional deformity affecting the joints. Typically, this condition involves hindfoot plantar flexion (equinus), inversion (varus), and forefoot adduction deformity. It is imperative to accurately provide historical details about the presentation, progression, current status, and response to prior parental interventions regarding deformities. Patients manifest with progressive deformities impacting their gait (exhibiting an in-toeing gait). They experience pain and locomotor challenges, particularly over extended distances. Notably, a thickened callous and sizable bursa may manifest over the dorsolateral aspect of the foot, often accompanied by deep fissures and subsequent infection, leading to an inability to wear shoes. To evaluate anatomical measurements of clubfoot deformity, anteroposterior and lateral roentgenograms should be obtained. If the deformity is unilateral, the contralateral foot can be utilized as a control for measurements. Efforts to correct residual forefoot adduction in idiopathic clubfoot encompass a range of approaches, including conservative and surgical interventions. Invariably, osseous procedures are conducted alongside or preceded by soft tissue release. Even in cases of advanced rigid clubfoot, where single-step procedures are generally avoided, initial surgical phases commonly involve soft tissue release. They facilitate the stretching, elongation, and relaxation of critical soft tissue structures, such as vascular and nerve elements, preceding the substantial correction achieved through osseous surgery. A combination of osseous and soft tissue maneuvers is typically employed for persistent or residual forefoot adduction following clubfoot repair.

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