Operative management of congenital talipes equinovarus deformity: experience and reason
AbstractBackground: Congenital talipes equinovarus is the most common congenital anomaly of the foot and ankle. The prevalence of this condition in our environment is not known due to dearth of medical literature on the subject. The aim of this study was to determine the outcome of our operative management of resistant talipes equinovarus by elongation of tendo-Achilles and posteromedial soft tissue release.
Methods: We present a retrospective review of congenital talipes equinovarus treated by Elongation of tendo Achilles (ETA) and Posterior Medial Release(PMR) at National Orthopaedic Hospital Enugu over a 6- year period (January1995- December 2000).
Results: There were 63(68%) males and 30(32%) females with mean age of 2.06 years at presentation (range 1/12-18years). There was positive family history in 6(7%) patients. More than half of the patients 63(68%) came without any formal referral. The mode of delivery was spontaneous vaginal delivery in 81(87%) and the first child appears to be more affected 22(24%). The deformities on presentation varied from talipes equinovarus 50(54%) to frank equinus in 3(3%) and fifty-four (58%) were bilateral. Sixty- three (68%) had initial treatment ranging from serial casting in 46(50%) to massage by traditional bonesetter in 2(2%) and the average duration of this initial treatment was 20weeks (range 2-106weeks). The average age at surgery was 2.5years (range 3/12-24 years). All patients received postoperative cast for an average of 13 weeks. The commonest post- operative complication was medial wound breakdown. The average duration of follow-up was 30 weeks (range3weeks-3years). Some patients were lost to follow-up immediately the cast was removed. As at last visit 90% were walking pain-free and do not require special shoe. The commonest residual deformity as at last visit was forefoot adduction in 17(18%) patients.
Conclusion: Elongation of tendo-Achilles and posteromedial soft tissue release are common operative procedures for CTEV. The short-term result of these procedures appears very good in our environment. However, the long-term result cannot be effectively analyzed due to high rate of loss to follow-up
Orient Journal of Medicine Vol. 18(1&2) 2006: 24-29