Limits...
The classic: observations on pathogenesis and treatment of congenital clubfoot. 1972.

Ponseti IV, Campos J - 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 Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. 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/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res. 1972;84:50–60.

Show MeSH

Related in: MedlinePlus

(A) Boy with bilateral clubfoot treated at 2 weeks of age with manipulations and toe-to-groin plaster cast applications weekly until 3 months of age. The left Achilles tendon was sectioned subcutaneously to correct equinus. After the casts the patient wore Denis Browne splints on shoes full-time for 2 months and only at night until 3 years of age when they were discontinued against our advice. The clubfeet at that time were fully corrected. The patient returned at 8 years of age with relapse in both feet, worse on the left than on the right. On the right foot the anterior tibial tendon was transferred to the third cuneiform and the extensor hallucis longus was transferred to the neck of the first metatarsal. On the left foot the anterior tibial tendon was transferred to the third cuneiform following medial soft tissue release and lengthening of the posterior tibial tendon. The Achilles tendon was lengthened bilaterally. At 19 years of age the patient has no complaints and the feet are well aligned. The strength of the transferred anterior tibial is 5 + bilaterally. Subtalar motion is normal on the right and limited to 25 per cent of normal on the left. Ankle dorsiflexion is limited to 10 degrees bilaterally and plantar flexion is free to 25 degrees bilaterally. (B) Standing anteroposterior and lateral roentgenograms. The talocaneal angle is within normal limits on both sides. The naviculars are slightly wedge-shaped bilaterally and the right is medially displaced. The talonavicular joint is slightly narrower on the left than on the right. The left second metatarsal is dense and its head is flat. In the anteroposterior roentgenograms the talco-calcaneal angle is 18 degrees on the right and 20 degrees on the left.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2664437&req=5

Fig5: (A) Boy with bilateral clubfoot treated at 2 weeks of age with manipulations and toe-to-groin plaster cast applications weekly until 3 months of age. The left Achilles tendon was sectioned subcutaneously to correct equinus. After the casts the patient wore Denis Browne splints on shoes full-time for 2 months and only at night until 3 years of age when they were discontinued against our advice. The clubfeet at that time were fully corrected. The patient returned at 8 years of age with relapse in both feet, worse on the left than on the right. On the right foot the anterior tibial tendon was transferred to the third cuneiform and the extensor hallucis longus was transferred to the neck of the first metatarsal. On the left foot the anterior tibial tendon was transferred to the third cuneiform following medial soft tissue release and lengthening of the posterior tibial tendon. The Achilles tendon was lengthened bilaterally. At 19 years of age the patient has no complaints and the feet are well aligned. The strength of the transferred anterior tibial is 5 + bilaterally. Subtalar motion is normal on the right and limited to 25 per cent of normal on the left. Ankle dorsiflexion is limited to 10 degrees bilaterally and plantar flexion is free to 25 degrees bilaterally. (B) Standing anteroposterior and lateral roentgenograms. The talocaneal angle is within normal limits on both sides. The naviculars are slightly wedge-shaped bilaterally and the right is medially displaced. The talonavicular joint is slightly narrower on the left than on the right. The left second metatarsal is dense and its head is flat. In the anteroposterior roentgenograms the talco-calcaneal angle is 18 degrees on the right and 20 degrees on the left.

Mentions: Roentgenograms of these feet rarely show a completely normal foot. Some flattening of the superior articular surface of the talus was observed in 18 cases, and in nearly all there was mild dorso-lateral wedging of the navicular. The navicular was normally aligned with the head of the talus in 33 feet; it was displaced slightly medially in 18 feet and laterally in 7. The talocalcaneal index (the sum of the talocalcaneal angles in the AP and lateral roentgenograms [2]) was within normal limits, from 40 to 85°, in 46 feet and was less than 40° in 12 feet (Figs. 5 and 6).Fig. 5A–B


The classic: observations on pathogenesis and treatment of congenital clubfoot. 1972.

Ponseti IV, Campos J - Clin. Orthop. Relat. Res. (2009)

(A) Boy with bilateral clubfoot treated at 2 weeks of age with manipulations and toe-to-groin plaster cast applications weekly until 3 months of age. The left Achilles tendon was sectioned subcutaneously to correct equinus. After the casts the patient wore Denis Browne splints on shoes full-time for 2 months and only at night until 3 years of age when they were discontinued against our advice. The clubfeet at that time were fully corrected. The patient returned at 8 years of age with relapse in both feet, worse on the left than on the right. On the right foot the anterior tibial tendon was transferred to the third cuneiform and the extensor hallucis longus was transferred to the neck of the first metatarsal. On the left foot the anterior tibial tendon was transferred to the third cuneiform following medial soft tissue release and lengthening of the posterior tibial tendon. The Achilles tendon was lengthened bilaterally. At 19 years of age the patient has no complaints and the feet are well aligned. The strength of the transferred anterior tibial is 5 + bilaterally. Subtalar motion is normal on the right and limited to 25 per cent of normal on the left. Ankle dorsiflexion is limited to 10 degrees bilaterally and plantar flexion is free to 25 degrees bilaterally. (B) Standing anteroposterior and lateral roentgenograms. The talocaneal angle is within normal limits on both sides. The naviculars are slightly wedge-shaped bilaterally and the right is medially displaced. The talonavicular joint is slightly narrower on the left than on the right. The left second metatarsal is dense and its head is flat. In the anteroposterior roentgenograms the talco-calcaneal angle is 18 degrees on the right and 20 degrees on the left.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664437&req=5

Fig5: (A) Boy with bilateral clubfoot treated at 2 weeks of age with manipulations and toe-to-groin plaster cast applications weekly until 3 months of age. The left Achilles tendon was sectioned subcutaneously to correct equinus. After the casts the patient wore Denis Browne splints on shoes full-time for 2 months and only at night until 3 years of age when they were discontinued against our advice. The clubfeet at that time were fully corrected. The patient returned at 8 years of age with relapse in both feet, worse on the left than on the right. On the right foot the anterior tibial tendon was transferred to the third cuneiform and the extensor hallucis longus was transferred to the neck of the first metatarsal. On the left foot the anterior tibial tendon was transferred to the third cuneiform following medial soft tissue release and lengthening of the posterior tibial tendon. The Achilles tendon was lengthened bilaterally. At 19 years of age the patient has no complaints and the feet are well aligned. The strength of the transferred anterior tibial is 5 + bilaterally. Subtalar motion is normal on the right and limited to 25 per cent of normal on the left. Ankle dorsiflexion is limited to 10 degrees bilaterally and plantar flexion is free to 25 degrees bilaterally. (B) Standing anteroposterior and lateral roentgenograms. The talocaneal angle is within normal limits on both sides. The naviculars are slightly wedge-shaped bilaterally and the right is medially displaced. The talonavicular joint is slightly narrower on the left than on the right. The left second metatarsal is dense and its head is flat. In the anteroposterior roentgenograms the talco-calcaneal angle is 18 degrees on the right and 20 degrees on the left.
Mentions: Roentgenograms of these feet rarely show a completely normal foot. Some flattening of the superior articular surface of the talus was observed in 18 cases, and in nearly all there was mild dorso-lateral wedging of the navicular. The navicular was normally aligned with the head of the talus in 33 feet; it was displaced slightly medially in 18 feet and laterally in 7. The talocalcaneal index (the sum of the talocalcaneal angles in the AP and lateral roentgenograms [2]) was within normal limits, from 40 to 85°, in 46 feet and was less than 40° in 12 feet (Figs. 5 and 6).Fig. 5A–B

View Article: PubMed Central - PubMed

ABSTRACT

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. 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/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res. 1972;84:50–60.

Show MeSH
Related in: MedlinePlus