Prevention, diagnosis and treatment of clubfoot recurrence. Current concepts review
DOI:
https://doi.org/10.1016/j.rccot.2021.01.002Keywords:
prevention, recurrence, clubfoot, achilles tendon, abduction splint, tendon transfer, foot deformities, risk factorsAbstract
Recurrence is understood to be the progressive appearance of congenital clubfoot deformities usually along the first five years of the child’s life. The main cause of recurrence is the improper use of the abduction splint which has the function of stretching the posterior and internal soft tissues of the leg and foot. Therefore, close communication between the doctor and the child’s parents or guardians is essential in order to make them understand the relevance of abduction splint and to encourage them to use it as prescribed. Clinically, one should pay attention to the first sign of recurrence: the decrease in ankle dorsiflexion range of motion, usually early followed by the appearance of the other associated deformities as described widely for clubfoot. When the cavus deformity of the foot appears before the limitation for ankle dorsiflexion or the equine deformity, a neuromuscular etiology of clubfoot should be suspected. Treatment is performed by the application of the Ponseti method with correction of the deformity (s) with new casts, if necessary tenotomy and maintenance of the foot position with splints. In children aged over four years, it may be necessary to associate a surgical transfer of the anterior tibialis tendon to the third wedge. Regular use of the abduction splint is essential to prevent recurrence of deformities, so emphasis on its use constitutes an essential preventive measure.
Evidence Level: IV.
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References
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