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DOI: 10.1055/s-0029-1185472
© Georg Thieme Verlag KG Stuttgart · New York
Der kongenitale Klumpfuß
Publication History
Publication Date:
08 April 2009 (online)
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Zusammenfassung
Der kongenitale Klumpfuß ist die häufigste angeborene Deformität der unteren Extremität. Seine adäquate Behandlung stellt für Orthopäden nach wie vor eine Herausforderung dar und setzt fundierte Kenntnisse der Pathoanatomie des Klumpfußes und der bestehenden Therapiemöglichkeiten voraus. Diese Arbeit bietet neben den pathoanatomischen Grundlagen zum Verständnis der Klumpfußdeformität ein Update der diagnostischen und therapeutischen Möglichkeiten und soll durch einen Überblick über Ergebnisse der konservativen und operativen Behandlungskonzepte und deren Diskussion zum optimalen individuellen Management des kongenitalen Klumpfußes beitragen.
Abstract
Congenital talipes equinovarus is the most common deformity of the lower limb. The adequate treatment of clubfeet is still a challenge for orthopaedic surgeons and requires well-founded knowledge of pathoanatomy and established therapeutical options. This refresher, in addition to pathoanatomical fundamentals, provides an update on diagnostic and therapeutical facilities. By reviewing the results of conservative and surgical treatment concepts and their discussion it shall contribute to optimal individual management of congenital talipes equinovarus.
Literatur
- 1 Rebbeck T R, Dietz F R, Murray C, Buetow K H. A single-gene explanation for the probability of having idiopathic talipes equinovarus. Am J Hum Genet. 1993; 53 1051-1063
- 2 Lochmiller C, Johnson D, Scott A. et al . Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998; 79 90-96
- 3 Wynne-Davies R. Family studies and the cause of congenital clubfoot talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Joint Surg [Br]. 1964; 46 445-463
- 4 Engell V, Dambiorg F, Andersen M. et al . Club foot: a twin study. J Bone Joint Surg [Br]. 2006; 88 374-376
- 5 Idelberger K. Die Ergebnisse der Zwillingsforschung beim angeborenen Klumpfuß. Verhandlungen der Deutschen Orthopädischen Gesellschaft. 1939; 33 272
- 6 Ippolito E. Update on pathologic anatomy of clubfoot. J Pediatr Orthop [Br]. 1995; 4 17-24
- 7 Ippolito E, Ponseti I V. Congenital clubfoot in the human fetus: A histological study. J Bone Joint Surg [Am]. 1980; 62 8-22
- 8 Zimny M L, Willig S J, Roberts J M. et al . An electron microscopic study of the fascia from the medial and lateral sides of clubfoot. J Pediatr Orthop. 1985; 5 577-581
- 9 Krauspe R, Wess K M, Raab P. et al . Biochemical analysis of collagen in clubfeet and in controls. J Bone Joint Surg [Br]. 2002; 84-B (Suppl. 1) 17
- 10 Fukuhara K, Schollmeier G, Uhthoff H K. The pathogenesis of clubfoot. A histomorphometric and immunhistochemical study of fetuses. J Bone Joint Surg [Br]. 1994; 76 450-457
- 11 Sano H, Uhthoff H K, Jarvis J G. et al . Pathogenesis of soft-tissue contracture in club foot. J Bone Joint Surg [Br]. 1998; 80 641-644
- 12 Handelsman J E, Badalamente M A. Neuromuscular studies in clubfoot. J Pediatr Orthop. 1981; 1 23-32
- 13 Loren G J, Karpinski N C, Mubarak S J. Clinical implications of clubfoot histopathology. J Pediatr Orthop. 1998; 18 765-769
- 14 Maffulli N, Capasso G, Testa V, Borrelli L. Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot. Foot Ankle. 1992; 13 18-23
- 15 Dobbs M B, Walton T, Gordon J E. et al . Flexor digitorum accessorius longus muscle is associated with familial idiopathic clubfoot. J Pediatr Orthop. 2005; 25 357-359
- 16 Miyagi N, IIsaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot. J Pediatr Orthop. 1997; 17 36-40
- 17 Fritsch H, Eggers R. Ossification of the calcaneus in the normal fetal foot and in clubfoot. J Pediatr Orthop. 1999; 19 22-26
- 18 Spiegel D A, Loder R T. Leg-length discrepancy and bone age in unilateral idiopathic talipes equinovarus. J Pediatr Orthop. 2003; 23 246-250
- 19 Sodre H, Bruschini S, Magalhaes L A. et al . Arterial abnormalities in talipes equinovarus assessed by angiography and the Doppler technique. J Pediatr Orthop. 1990; 10 101-104
- 20 Katz D A, Albanese E L, Levinsohn E M. et al . Pulsed color-flow Doppler analysis of arterial deficiency in idiopathic clubfoot. J Pediatr Orthop. 2003; 23 84-87
- 21 Ahmed M, Ahmed N, Khan K M. et al . Sensory hypoinnervation in club foot. J Bone Joint Surg [Br]. 2004; 86 1163-1169
- 22 Macnicol M F, Nadeem R D. Evaluation of the deformity in club foot by somatosensory evoked potentials. J Bone Joint Surg [Br]. 2000; 82 731-735
- 23 CEMAT (Canadian Early- and Mid-Trimester Amniocentesis Trial) group . Randomised trial to assess safety and fetal outcome of early and midtrimester amniocentesis. Lancet. 1998; 351 242-247
- 24 Byron-Scott R, Sharpe P, Hasler C. et al . South Australian population-based study of congenital talipes equinovarus. Paediatr Perinat Epidemiol. 2005; 19 227-237
- 25 Pryor G A, Villar R N, Ronen A, Scott P M. Seasonal variation in the incidence of congenital talipes equinovarus. J Bone Joint Surg [Br]. 1991; 73 632-634
- 26 Carney B T, Coburn T R. Demographics of idiopathic clubfoot: is there a seasonal variation?. J Pediatr Orthop. 2005; 25 351-352
- 27 Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current management. J Bone Joint Surg [Br]. 2007; 89 995-1000
- 28 Chung C, Nemechek R, Larsen I, Ching G. Genetic and epidemiological studies of clubfoot in Hawaii: general and medical considerations. Hum Hered. 1969; 19 321-342
- 29 Lovell M E, Morcuende J A. Neuromuscular disease as the cause of late clubfoot relapses: report of 4 cases. Iowa Orthop J. 2007; 27 82-84
- 30 Grill F. Der Klumpfuß. Orthopäde. 1996; 25 364-378
- 31 Herzenberg J E, Carol N C, Christafensen M R. et al . Clubfoot analysis with three-dimensional computer modeling. J Pediatr Orthop. 1988; 8 257-262
- 32 Hubbard A M, Meyer J S, Davidson R S. et al . Relationship between the ossification center and cartilaginous anlage in the normal hindfoot in children: study with MR imaging. Am J Roentgenol. 1993; 161 849-853
- 33 Howard C B, Benson M K. The ossific nuclei and the cartilage anlage of the talus and calcaneum. J Bone Joint Surg [Br]. 1992; 74 620-623
- 34 Hee H T, Lee E H, Lee G S. Gait and pedobarographic patterns of surgically treated clubfeet. J Foot Ankle Surg. 2001; 40 287-294
- 35 Shimode K, Myagi N, Majima T. et al . Limb length and girth discrepancy of unilateral congenital clubfeet. J Pediatr Orthop [Br]. 2005; 14 280-284
- 36 Bar-on E, Mashiach R, Inbar O. et al . Prenatal ultrasound diagnosis of club foot: outcome and recommendations for counselling and follow-up. J Bone Joint Surg [Br]. 2005; 87 990-993
- 37 Mammen L, Benson C B. Outcome of fetuses with clubfeet diagnosed by prenatal sonography. J Ultrasound Med. 2004; 23 497-500
- 38 Bar-Hava I, Bronshtein M, Orvieto R. et al . Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon. Prenat Diagn. 1997; 17 457-460
- 39 Tillett R, Fisk N M, Murphy K, Hunt D M. Clinical outcome of congenital talipes equinovarus diagnosed antenatally by ultrasound. J Bone Joint Surg [Am]. 2000; 82 876-880
- 40 Cooper J M, Dietz F R. Treatment of idiopathic clubfoot. J Bone Joint Surg [Am]. 1995; 77 1477-1489
- 41 Simons G W. Analytical radiography of clubfeet. J Bone Joint Surg [Br]. 1977; 59 485-489
- 42 Davis L A, Hatt W S. Congenital abnormalities of the feet. Radiology. 1955; 64 818-825
- 43 Heywood A WB. The mechanics of the hindfoot in clubfoot as demonstrated radiographically. J Bone Joint Surg [Br]. 1964; 46 102-107
- 44 Thometz J G, Liu X C, Tassone J C, Klein S. Correlation of foot radiographs with foot function as analyzed by plantar pressure distribution. J Pediatr Orthop. 2005; 25 249-252
- 45 Ralder C, Manner H M, Suda R. et al . Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg [Am]. 2007; 89 1177-1183
- 46 Aurell Y, Andriesse H, Johansson A, Jonsson K. Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method. J Pediatr Orthop [Br]. 2005; 14 347-357
- 47 Gigante C, Talenti E, Turra S. Sonographic assessment of clubfoot. J Clin Ultrasound. 2004; 32 235-242
- 48 Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop. 2008; 28 53-59
- 49 Suda R, Suda A J, Grill F. Sonographic classification of idiopathic clubfoot according to severity. J Pediatr Orthop [Br]. 2006; 15 134-140
- 50 Cahuzac J P, Navaskues J, Baunin C. et al . Assessment of the position of the navicular by three-dimensional magnetic resonance imaging in infant foot deformities. J Pediatr Orthop [Br]. 2002; 11 134-138
- 51 Moritani T, Aihara T, Oguma E. et al . MR evaluation of talonavicular angle in congenital talipes equinovarus. Clin Imaging. 2000; 24 243-247
- 52 Saito S, Hatori M, Kokubun S. et al . Evaluation of calcaneal malposition by magnetic resonance imaging in the infantile clubfoot. J Pediatr Orthop [Br]. 2004; 13 99-102
- 53 Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop. 2001; 21 719-726
- 54 Liu X C, Thometz J G, Tassone C. et al . Dynamic plantar pressure measurement for the normal subject – free-mapping model for the analysis of pediatric foot deformities. J Pediatr Orthop. 2005; 25 103-106
- 55 Flynn J M, Donohoe M, Mackenzie W G. An independent assessment of two club-foot-classification systems. J Pediatr Orthop. 1999; 18 323-327
- 56 Pirani S, Outerbridge H K, Moran M, Sawatsky B. A method of assessing the virgin clubfoot. Pediatric Orthopaedic Society of North America. Miami; Annual Meeting; May 1995
- 57 Dyer P J, Davis N. The role of the Pirani scoring system in the management of clubfoot by the Ponseti method. J Bone Joint Surg [Br]. 2006; 88 1082-1084
- 58 Morris C, Doll H A, Wainwright A. et al . The Oxford ankle foot questionnaire for children. J Bone Joint Surg [Br]. 2008; 90 1451-1456
- 59 Dimeglio A, Bonnet F, Mazeau P, De Rosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot. J Pediatr Orthop [Br]. 1996; 5 173-180
- 60 Bösch J. Zur Technik der Klumpfußbehandlung. Z Orthop. 1964; 85 429
- 61 Ponseti I V. Congenital clubfoot: fundamentals of treatment. Oxford; Oxford University Press 1996
- 62 Cooper D M, Dietz F R. Treatment of idiopathic clubfoot: a thirty-year follow-up note. J Bone Joint Surg [Am]. 1995; 77 1477-1489
- 63 Herzenberg J E, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002; 22 517-521
- 64 Shack N, Eastwood D M. Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity. J Bone Joint Surg [Br]. 2006; 88 1085-1089
- 65 Tindall A J, Steinlechner C WB, Lavy C BD. et al . Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world?. J Pediatr Orthop. 2005; 25 627-629
- 66 Radler C, Waschak K, Salzer M. Starting a clubfoot programm in a developing country. European Federation of National Associations of Orthopaedics and Traumatology. Nizza; 9th EFORT congress May/2008
- 67 Pittner D E, Klingele K E, Beebe A C. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. J Pediatr Orthop. 2008; 28 250-353
- 68 Haft G F, Walker C G, Crawford H A. Early clubfoot recurrence after use of Ponseti method in a New Zealand population. J Bone Joint Surg [Am]. 2007; 89 487-493
- 69 Thacker M M, Scher D M, Sala D A. et al . Use of the foot abduction orthosis following Ponseti casts: is it essential?. J Pediatr Orthop. 2005; 25 225-228
- 70 Barker S L, Lavy C BD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg [Br]. 2006; 88 377-379
- 71 Scher D M, Feldman D S, van Bosse H JP. et al . Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004; 24 349-352
- 72 Dobbs M B, Gordon J E, Walton T, Schoenecker P L. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004; 24 353-357
- 73 Morcuende J A, Dolan L A, Dietz F R, Ponseti I V. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113 376-380
- 74 Abdelgawad A A, Lehman W B, Van Bosse H J. et al . Treatment of idiopathic clubfoot using the Ponseti method: minimum 2 year follow-up. J Pediatr Orthop [Br]. 2007; 16 98-105
- 75 Radler C, Suda R, Manner H M, Grill F. Early results of the Ponseti method for treatment of idiopathic clubfoot. Orthop Ihre Grenzgeb. 2006; 144 80-86
- 76 Bor N, Herzenberg J E, Frick S L. Ponseti management of clubfoot in older infants. Clin Orthop. 2006; 444 224-228
- 77 Lourenco A F, Morcuende J A. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg [Br]. 2007; 89 378-381
- 78 Böhm S, Limpaphayom N, Alaee F. et al . Early results of the Ponseti method for treatment of clubfoot in distal arthrogryposis. J Bone Joint Surg [Am]. 2008; 90 1501-1507
- 79 Alvarez C M, Tredwell S J, Keenan S P. et al . Treatment of idiopathic clubfoot utilizing botulinum A toxin: a new method and its short-term outcomes. J Pediatr Orthop. 2005; 25 229-235
- 80 Ramachandran M, Eastwood D M. Botulinum toxin and its orthopaedic applications. J Bone Joint Surg [Br]. 2006; 88 781-787
- 81 Henn 3rd R F. Subtalar release in clubfeet: a retrospective study of 10-year outcomes. Foot Ankle Int. 2008; 29 390-395
- 82 Dobbs M B, Nunley R, Schoenecker P L. Long-term follow up of patients with club-feet treated with extensive soft-tissue release. J Bone Joint Surg [Am]. 2006; 88 986-996
- 83 Laaveg S J, Ponseti I V. Long term results of treatment of congenital clubfoot. J Bone Joint Surg [Am]. 1980; 62 23-31
- 84 Cummings R J, Bashore C J, Bookout C B, Elliott M J. Avascular necrosis of the talus after McKay clubfoot release for idiopathic congenital clubfoot. J Pediatr Orthop. 2001; 21 221-224
- 85 Kuo K N, Hennigan S P, Hastings M E. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. J Pediatr Orthop. 2001; 21 35-41
- 86 Pohl M, Nicol R O. Transcuneiform and opening wedge medial cuneiform osteotomy with closing wedge cuboid osteotomy in relapsed cluboot. J Pediatr Orthop. 2003; 23 70-73
- 87 Schaefer D, Hefti F. Combined cuboid/cuneiform osteotomy for clubfoot correction of residual adductus deformity in idiopathic and secondary club feet. J Bone Joint Surg [Br]. 2000; 82 881-884
- 88 Lourenco A F, Dias L S, Zoellick D M, Sodre H. Treatment of residual adduction deformity in clubfoot: the double osteotomy. Pediatr Orthop. 2001; 21 713-718
- 89 Legaspi J, Li H Y, Chow W, Leong J C. Talectomy in patients with recurrent deformity in club foot. A long-term follow-up study. J Bone Joint Surg [Br]. 2001; 83 384-387
- 90 Mirzayan R, Early S D, Matthys G A, Thordarson D B. Single-stage talectomy and tibiocalcaneal arthrodesis as a salvage of severe, rigid equinovarus deformity. Foot Ankle Int. 2001; 22 209-213
- 91 Freedman J A, Watts H, Otsuka N Y. The Ilizarov method for the treatment of resistant clubfoot: is it an effective solution?. J Pediatr Orthop. 2006; 26 432-437
- 92 Ferreira R C, Costa M T, Frizzo C G, Santin R A. Correction of severe clubfoot using a simplified setting of the Ilizarov device. Foot Ankle Int. 2007; 28 557-568
Dr. Karin Waschak
Orthopädisches Spital Speising
Abteilung für Kinder- und Jugendorthopädie
Speisingerstraße 109
1130 Wien
Email: karin.waschak@oss.at