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The classic: congenital club foot: the results of treatment. 1963.

Ponseti IV, Smoley EN - Clin. Orthop. Relat. Res. (2009)

View Article: PubMed Central - PubMed

ABSTRACT

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Eugene N. Smoley, Congenital Club Foot: The Results of Treatment. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-009-0721-1. This article is ©1963 by the Journal of Bone and Joint Surgery, Inc., and is reprinted with permission from Ponseti IV, Smoley EN. Congenital Club Foot: The Results of Treatment. J Bone Joint Surg Am. 1963;45:261–344.

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Part I. (A–D) Anteroposterior and lateral roentgenograms of the feet of a six-week-old baby boy with severe congenital club feet. In the anteroposterior roentgenograms, the talus and calcaneus are superimposed and their axes coincide indicating a severe heel varus deformity. The angle between the axis of the calcaneus and that of the fifth metatarsal (adduction of the fore part of the foot) measures 74 degrees. In the lateral views, the angle formed by the long axis of the calcaneus and that of the first metatarsal (cavus) measures 86 degrees. The calcaneus is in severe equinus and the talusis subluxated forward in relation with the tibial mortise. Treatment consisted in manipulation and application of five plaster casts for the correction of the cavus, the adduction, and the heel varus deformities. This took a total period of one month. A bilateral tenotomy of the tendo achillis was then performed followed by a plaster cast applied for three weeks. (E–H) Anteroposterior and lateral roentgenograms made after removal of the last plaster cast, seven weeks after onset of treatment. In the anteroposterior roentgenograms the angle between the long axis of the talus and that of the calcaneus measures 33 degrees, indicating correction of the heel varus deformity, and the angle between the calcaneus and the fifth metatarsal measures 13 degrees, indicating correction of the adduction of the fore part of the foot. In the lateral roentgenograms the equinus deformity appears corrected and the angle between the long axis of the calcaneus and that of the fifth metatarsal measures 7 degrees, indicating correction of the cavus deformity. Denis Browne splints on shoes were worn full time for ten months and at night until four and one-half years of age. Part II. (I–L) Anteroposterior and lateral roentgenograms made when the boy was seven years old. A good result was obtained in the right foot (I and K) and an acceptable result in the left (J and L). In the anteroposterior roentgenograms, the angle between the long axis of the calcaneus and that of the talus measures 28 degrees on the right and 22 degrees on the left, indicating correction of the heel varus deformity on the right and incomplete correction on the left. The angle between the calcaneus and fifth metatarsal measures —7 degrees on the right and 0 degree on the left, indicating correction of the adduction of the fore part of both feet. In the lateral roentgenograms the angle between the long axis of the calcaneus and that of the first metatarsal measures 32 degrees on the right and 24 degrees on the left, indicating correction of the cavus deformity in both feet.
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Fig3: Part I. (A–D) Anteroposterior and lateral roentgenograms of the feet of a six-week-old baby boy with severe congenital club feet. In the anteroposterior roentgenograms, the talus and calcaneus are superimposed and their axes coincide indicating a severe heel varus deformity. The angle between the axis of the calcaneus and that of the fifth metatarsal (adduction of the fore part of the foot) measures 74 degrees. In the lateral views, the angle formed by the long axis of the calcaneus and that of the first metatarsal (cavus) measures 86 degrees. The calcaneus is in severe equinus and the talusis subluxated forward in relation with the tibial mortise. Treatment consisted in manipulation and application of five plaster casts for the correction of the cavus, the adduction, and the heel varus deformities. This took a total period of one month. A bilateral tenotomy of the tendo achillis was then performed followed by a plaster cast applied for three weeks. (E–H) Anteroposterior and lateral roentgenograms made after removal of the last plaster cast, seven weeks after onset of treatment. In the anteroposterior roentgenograms the angle between the long axis of the talus and that of the calcaneus measures 33 degrees, indicating correction of the heel varus deformity, and the angle between the calcaneus and the fifth metatarsal measures 13 degrees, indicating correction of the adduction of the fore part of the foot. In the lateral roentgenograms the equinus deformity appears corrected and the angle between the long axis of the calcaneus and that of the fifth metatarsal measures 7 degrees, indicating correction of the cavus deformity. Denis Browne splints on shoes were worn full time for ten months and at night until four and one-half years of age. Part II. (I–L) Anteroposterior and lateral roentgenograms made when the boy was seven years old. A good result was obtained in the right foot (I and K) and an acceptable result in the left (J and L). In the anteroposterior roentgenograms, the angle between the long axis of the calcaneus and that of the talus measures 28 degrees on the right and 22 degrees on the left, indicating correction of the heel varus deformity on the right and incomplete correction on the left. The angle between the calcaneus and fifth metatarsal measures —7 degrees on the right and 0 degree on the left, indicating correction of the adduction of the fore part of both feet. In the lateral roentgenograms the angle between the long axis of the calcaneus and that of the first metatarsal measures 32 degrees on the right and 24 degrees on the left, indicating correction of the cavus deformity in both feet.

Mentions: On the anteroposterior roentgenograms, the degree of heel varus deformity was estimated by measuring the angle formed by the long axis of the talus and the calcaneus. A 30-degree angle was considered normal and was classified as 0 degree of heel varus deformity. Thus a measured talocalcaneal angle of 20 degrees corresponded to 10 degrees of heel varus deformity. The adduction of the fore part of the foot was also estimated on the anteroposterior roentgenograms by measuring the angle between the long axis of the calcaneus and that of the fifth metatarsal. On the lateral roentgenograms, the cavus deformity was estimated by measuring the angle between the long axis of the calcaneus and that of the first metatarsal (Fig. 3). The correction of the equinus deformity was estimated by measuring the degree of ankle dorsiflexion. The degree of tibial torsion was estimated clinically by having the patient seated on the edge of the examining table with the knees at 90 degrees of flexion and the feet in slight plantar flexion. In the normal foot, the head of the talus can be palpated in front of the ankle mortise in the same plane as the axis of the thigh. Medial or lateral tibial torsion is indicated by the orientation of the head of the talus in respect to the patella and axis of the thigh.Fig. 3A–L


The classic: congenital club foot: the results of treatment. 1963.

Ponseti IV, Smoley EN - Clin. Orthop. Relat. Res. (2009)

Part I. (A–D) Anteroposterior and lateral roentgenograms of the feet of a six-week-old baby boy with severe congenital club feet. In the anteroposterior roentgenograms, the talus and calcaneus are superimposed and their axes coincide indicating a severe heel varus deformity. The angle between the axis of the calcaneus and that of the fifth metatarsal (adduction of the fore part of the foot) measures 74 degrees. In the lateral views, the angle formed by the long axis of the calcaneus and that of the first metatarsal (cavus) measures 86 degrees. The calcaneus is in severe equinus and the talusis subluxated forward in relation with the tibial mortise. Treatment consisted in manipulation and application of five plaster casts for the correction of the cavus, the adduction, and the heel varus deformities. This took a total period of one month. A bilateral tenotomy of the tendo achillis was then performed followed by a plaster cast applied for three weeks. (E–H) Anteroposterior and lateral roentgenograms made after removal of the last plaster cast, seven weeks after onset of treatment. In the anteroposterior roentgenograms the angle between the long axis of the talus and that of the calcaneus measures 33 degrees, indicating correction of the heel varus deformity, and the angle between the calcaneus and the fifth metatarsal measures 13 degrees, indicating correction of the adduction of the fore part of the foot. In the lateral roentgenograms the equinus deformity appears corrected and the angle between the long axis of the calcaneus and that of the fifth metatarsal measures 7 degrees, indicating correction of the cavus deformity. Denis Browne splints on shoes were worn full time for ten months and at night until four and one-half years of age. Part II. (I–L) Anteroposterior and lateral roentgenograms made when the boy was seven years old. A good result was obtained in the right foot (I and K) and an acceptable result in the left (J and L). In the anteroposterior roentgenograms, the angle between the long axis of the calcaneus and that of the talus measures 28 degrees on the right and 22 degrees on the left, indicating correction of the heel varus deformity on the right and incomplete correction on the left. The angle between the calcaneus and fifth metatarsal measures —7 degrees on the right and 0 degree on the left, indicating correction of the adduction of the fore part of both feet. In the lateral roentgenograms the angle between the long axis of the calcaneus and that of the first metatarsal measures 32 degrees on the right and 24 degrees on the left, indicating correction of the cavus deformity in both feet.
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Related In: Results  -  Collection

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Fig3: Part I. (A–D) Anteroposterior and lateral roentgenograms of the feet of a six-week-old baby boy with severe congenital club feet. In the anteroposterior roentgenograms, the talus and calcaneus are superimposed and their axes coincide indicating a severe heel varus deformity. The angle between the axis of the calcaneus and that of the fifth metatarsal (adduction of the fore part of the foot) measures 74 degrees. In the lateral views, the angle formed by the long axis of the calcaneus and that of the first metatarsal (cavus) measures 86 degrees. The calcaneus is in severe equinus and the talusis subluxated forward in relation with the tibial mortise. Treatment consisted in manipulation and application of five plaster casts for the correction of the cavus, the adduction, and the heel varus deformities. This took a total period of one month. A bilateral tenotomy of the tendo achillis was then performed followed by a plaster cast applied for three weeks. (E–H) Anteroposterior and lateral roentgenograms made after removal of the last plaster cast, seven weeks after onset of treatment. In the anteroposterior roentgenograms the angle between the long axis of the talus and that of the calcaneus measures 33 degrees, indicating correction of the heel varus deformity, and the angle between the calcaneus and the fifth metatarsal measures 13 degrees, indicating correction of the adduction of the fore part of the foot. In the lateral roentgenograms the equinus deformity appears corrected and the angle between the long axis of the calcaneus and that of the fifth metatarsal measures 7 degrees, indicating correction of the cavus deformity. Denis Browne splints on shoes were worn full time for ten months and at night until four and one-half years of age. Part II. (I–L) Anteroposterior and lateral roentgenograms made when the boy was seven years old. A good result was obtained in the right foot (I and K) and an acceptable result in the left (J and L). In the anteroposterior roentgenograms, the angle between the long axis of the calcaneus and that of the talus measures 28 degrees on the right and 22 degrees on the left, indicating correction of the heel varus deformity on the right and incomplete correction on the left. The angle between the calcaneus and fifth metatarsal measures —7 degrees on the right and 0 degree on the left, indicating correction of the adduction of the fore part of both feet. In the lateral roentgenograms the angle between the long axis of the calcaneus and that of the first metatarsal measures 32 degrees on the right and 24 degrees on the left, indicating correction of the cavus deformity in both feet.
Mentions: On the anteroposterior roentgenograms, the degree of heel varus deformity was estimated by measuring the angle formed by the long axis of the talus and the calcaneus. A 30-degree angle was considered normal and was classified as 0 degree of heel varus deformity. Thus a measured talocalcaneal angle of 20 degrees corresponded to 10 degrees of heel varus deformity. The adduction of the fore part of the foot was also estimated on the anteroposterior roentgenograms by measuring the angle between the long axis of the calcaneus and that of the fifth metatarsal. On the lateral roentgenograms, the cavus deformity was estimated by measuring the angle between the long axis of the calcaneus and that of the first metatarsal (Fig. 3). The correction of the equinus deformity was estimated by measuring the degree of ankle dorsiflexion. The degree of tibial torsion was estimated clinically by having the patient seated on the edge of the examining table with the knees at 90 degrees of flexion and the feet in slight plantar flexion. In the normal foot, the head of the talus can be palpated in front of the ankle mortise in the same plane as the axis of the thigh. Medial or lateral tibial torsion is indicated by the orientation of the head of the talus in respect to the patella and axis of the thigh.Fig. 3A–L

View Article: PubMed Central - PubMed

ABSTRACT

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Eugene N. Smoley, Congenital Club Foot: The Results of Treatment. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-009-0721-1. This article is ©1963 by the Journal of Bone and Joint Surgery, Inc., and is reprinted with permission from Ponseti IV, Smoley EN. Congenital Club Foot: The Results of Treatment. J Bone Joint Surg Am. 1963;45:261–344.

Show MeSH
Related in: MedlinePlus