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Congenital Talipes Equinovarus in Spina Bifida: Treatment and Results

Neto, Joao de Carvalho M.D.; Dias, Luciano S. M.D.; Gabrieli, Ana P. M.D.

Neuromuscular
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Summary The results of the surgical treatment of clubfoot deformity in spina bifida by radical posteromedial-lateral release (PMLR) are presented. In all cases, the Cincinnati incision was used and the tendons excised, including the anterior tibial tendon. In 21 feet, a special K-wire was used to derotate the talus in the ankle mortise. The minimum follow-up was 2 years. The average age at surgery was 14 months. The overall results showed 63% good, 14% fair, and 23% poor results. In the 21 feet in which the talus K-wire was used, 76% had a good result, 14% fair, and 10% poor. The results were also analyzed based on the motor level. In the thoracic/high lumbar level, 50% had a poor result. In the low lumbar and sacral level groups together, of 45 feet, five had a poor result. This study shows that a radical PMLR can produce an overall good and fair result in 77% of the cases. The use of the K-wire to derotate the talus led to an improvement in the result. The tendon excision leading to a flail foot corrects any residual muscle imbalance. The poor results seen in the thoracic/high lumbar patients are likely to be related to the lack of weight bearing in view of their motor paralysis.

Study conducted at The Children's Memorial Medical Center, Chicago, Illinois, U.S.A.

From The Children's Memorial Medical Center, Chicago, Illinois, U.S.A.

Address correspondence and reprint requests to Dr. L. S. Dias at 680 N. Lake Shore Dr., Suite 1208, Chicago, IL 60611, U.S.A.

© Lippincott-Raven Publishers.