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Background: Recurrent clubfoot (CF) remains a challenging orthopedic condition, often requiring surgical intervention due to deformity rigidity and scarring from previous treatments. External fixation, particularly the Ilizarov technique, has emerged as a promising approach to correct recurrent and complex CF deformities. However, there is considerable variability in reported results regarding success and recurrence rates. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of external fixation with a focus on success rates, recurrence rates, and complication profiles in patients treated for recurrent CF. Methods: A systematic search of five databases (PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library) was performed according to PRISMA guidelines. Studies evaluating external fixation for recurrent clubfoot and reporting quantitative data on success and recurrence rates were included. A total of 438 records were screened and 21 studies met the inclusion criteria. Data extraction was performed on demographic characteristics, treatment details, and outcomes. Meta-analysis was performed using a random effects model to pool success and recurrence rates. Results: The review analyzed 21 studies involving 489 treated feet in 406 patients. The pooled overall success rate was 81.4% (95% CI: 74.5-88.4%), while the pooled recurrence rate was 17.7% (95% CI: 11.3-24.1%). The studies showed minimal heterogeneity (I² = 0%) in both success and recurrence rates. Complications were common, with pin tract infection being the most common (29.3%), followed by toe contractures and digital ischemia. Conclusions: External fixation is an effective approach for recurrent CF, with satisfactory success rates. However, the risk of complications underscores the need for vigilant postoperative care. The results support the use of external fixation for complex CF recurrences, but further studies are needed. [ABSTRACT FROM AUTHOR]

Talipes equinovarus, also called clubfoot, is a relatively common congenital defect affecting approximately one in every 1000 live births. Most cases of clubfoot are expected to be idiopathic and unrelated to an underlying genetic syndrome. In approximately 20% of cases, a clear genetic etiology is identified. Here we present two cases of bilateral clubfoot identified via fetal ultrasound in the first trimester associated with osteogenesis imperfecta diagnosed in the second trimester. Both fetuses presented with multiple fractures and were identified to have loss‐of‐function variants in COL1A1. An association between clubfeet in the first trimester and osteogenesis imperfecta has not been previously reported to the best of our knowledge, which leads to unique opportunities for prompt diagnosis, genetic counseling and testing, and appropriate management. [ABSTRACT FROM AUTHOR]

Background: The implementation of the standard Ponseti technique (SPT) in management of idiopathic clubfoot can be challenging due to the need for frequent travelling and long duration to achieve correction. The one week accelerated Ponseti technique (OWAPT) reduces the duration of correction to seven days and has been reported to be effective and safe. However, children still need to travel for change of cast. Methods: A randomized controlled trial was conducted to compare the SPT and OWAPT for their effectiveness, safety and treatment expenditure. Children under one year of age with untreated idiopathic CTEV were included. Those undergoing correction with OWAPT were hospitalized till tendo-achillis tenotomy. The relevant data was collected and analyzed using appropriate statistical methods. Results: Forty six children (68 feet) were enrolled with 22 (33 feet) in OWAPT group and 24 (35 feet) in SPT group. The mean age at treatment in OWAPT and SPT group was 1.55 months and 2.91 months, while their mean Pirani score was 4.59 and 4.70 respectively. The Pirani score improved significantly within both groups without any significant difference between the two groups. The total number of casts required to achieve correction were also comparable (p = 0.779). The OWAPT was observed to be more economical (p < 0.001) but had more minor complications. Conclusion: The OWAPT is equally effective, achieves faster correction and is more cost-effective than SPT. Its implementation by hospitalizing the children avoids travelling issues and achieves 100% compliance during correction phase. Hospitalization also ensures better plaster care and monitoring for complications. [ABSTRACT FROM AUTHOR]

Introduction: Restrictions on face-to-face (F2F) healthcare services during the recent COVID-19 pandemic necessitated novel provision of care for Ponseti-treated clubfoot patients. This retrospective review compares the effectiveness of telemedicine (TM) using live-stream videoconferencing compared to conventional F2F review, in two cohorts of 78 patients attending routine follow-up, during Ponseti-treated clubfoot bracing in their first 5 years. Methods: Rates of compliance, recurrence of deformity, and type of intervention provided were compared between cohorts. The TM cohort was re-evaluated F2F as part of routine follow-up care. Attendance rates were compared between cohorts and with an equivalent time period the previous year. Results: There was no significant difference in the rate of compliance between cohorts (77% in the TM group, 74% in the F2F group), or in the rate of recurrence. Subsequent F2F review of the TM cohort showed that compliance had improved in some patients, indicating successful TM intervention. There were no missed cases of recurrence. TM follow-up appointments offered similar rates of management of skin problems, brace adjustment, and provision of exercises. At least one element of intervention was provided in 64% of the TM group, and 72% of the F2F group. TM connection was successful in 74% of booked appointments. The number of patients attending was similar to F2F bookings one year prior. Discussion: The use of TM for routine follow-up of Ponseti-treated clubfoot patients can be as clinically effective as F2F assessment, and has potential for integration into routine follow-up care. [ABSTRACT FROM AUTHOR]

Background: Idiopathic congenital talipes equinovarus (CTEV), or clubfoot, is a common congenital deformity affecting approximately 3.25 per 1,000 live births in India. The Ponseti method, a gold standard for CTEV management, offers high efficacy through sequential manipulation and casting, with the standard protocol involving weekly cast changes. The accelerated Ponseti method, reducing casting intervals to 3-5 days, has been proposed as a timeefficient alternative, particularly for resource-limited settings. Patients and Methods: This prospective, comparative study evaluated the efficacy of standard versus accelerated Ponseti methods using the Pirani scoring system. Ninety children with idiopathic CTEV were randomized into standard (weekly casting) or accelerated (biweekly casting) groups. Results: Both treatment methods demonstrated equivalent improvements in Pirani scores and similar rates of Achilles tenotomy and relapse over one year. However, the accelerated Ponseti methods significantly reduced treatment duration (p < 0.0001), addressing logistical and economic challenges while maintaining comparable clinical outcomes. Conclusion: These findings affirm the accelerated Ponseti method as an effective alternative, particularly for low-resource settings, by enhancing treatment accessibility and adherence without compromising correction quality. Future research with larger cohorts and extended follow-ups is warranted to validate long-term benefits. [ABSTRACT FROM AUTHOR]

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Objective: The etiology of congenital talipes equinovarus (CTEV) is unknown, and the relationship between chromosome microdeletion/microduplication and fetal CTEV is rarely reported. In this study, we retrospectively analyzed fetal CTEV to explore the relationship among the CTEV phenotype, chromosome microdeletion/microduplication, and obstetric outcomes. Methods: Chromosome karyotype analysis and single nucleotide polymorphism (SNP) array were performed for the 68 fetuses with CTEV. Results: An SNP array was performed for 68 fetuses with CTEV; pathogenic copy number variations (CNVs) were detected in eight cases (11.8%, 8/68). In addition to one case consistent with karyotype analysis, the SNP array revealed seven additional pathogenic CNVs, including three with 22q11.21 microdeletions, two with 17p12p11.2 microduplications, one with 15q11.2 microdeletions, and one with 7q11.23 microduplications. Of the seven cases carrying pathogenic CNVs, three were tested for family genetics; of these, one was de novo, and two were inherited from either the father or mother. In total, 68 fetuses with CTEV were initially identified, of which 66 cases successfully followed-up. Of these, 9 were terminated, 2 died in utero, and 55 were live births. In 9 cases, no clinical manifestations of CTEV were found at birth; the false-positive rate of prenatal ultrasound CTEVdiagnosis was thus 13.6% (9/66). Conclusion: CTEV was associated with chromosome microdeletion/microduplication, the most common of which was 22q11.21 microdeletion, followed by 17p12p11.2 microduplication. Thus, further genomic detection is recommended for fetuses with CTEV showing no abnormalities on conventional karyotype analysis. [ABSTRACT FROM AUTHOR]

Background: Idiopathic clubfoot is a common skeletal deformity in newborns that can cause functional limitations, pain, and reduced quality of life. The Ponseti method has become the gold standard for clubfoot treatment, replacing previous extensive surgical approaches. However, there is a lack of prospective long-term data comparing surgical and Ponseti treatments. Methods: This is a follow-up on a single-center, prospective, randomized clinical trial that started in 2001. The aim of this study was to compare the Ponseti method with surgical treatment. The current report presents the long-term results at adulthood of 12 clubfeet (9 subjects) in the Ponseti group and 9 clubfeet (5 subjects) in the surgical group. The evaluation included morphology, function, and quality of life, which were assessed through gait analysis, X-rays, and standardized questionnaires (FRS, ICFSG, AOFAS, SF-36). A Functional Rating System for clubfeet was defined as the primary outcome. Results: The Ponseti group had higher Functional Rating System scores, better ankle dorsiflexion mobility, and lower pain levels. Additionally, they reported better quality of life according to the Short Form 36 survey. However, neither group achieved radiographically normal foot morphology. Conclusions: The 18-year follow-up results indicate that the Ponseti method produces superior outcomes in terms of mobility, gait, function, and quality of life when compared to surgically treated feet, despite the presence of persistent morphological deviations. [ABSTRACT FROM AUTHOR]

Introduction: Non-orthopaedic-trained healthcare professionals face challenges in identifying postnatal clubfoot deformities due to the lack of suitable assessment tools, resulting in misdiagnosis. Therefore, this study aimed to develop and validate the Neonatal Clubfoot Screening Checklist (NCSC) to assist non-orthopaedic-trained healthcare professionals in postnatal clubfoot assessment. Methods: The NCSC development involved five phases: conceptual understanding of deformity components, creation of pictorial representations, tool structure design, content and face validation, pilot study and field study. A cross-sectional prospective study was conducted in Sarawak General Hospital from January to June 2021. Non-orthopaedic-trained healthcare professionals were randomly assigned to two groups: one utilising the NCSC for newborn screening and another without it. Results were compared with assessments by the paediatric orthopaedic team. Kappa agreement tests and sensitivity and specificity analyses were performed to evaluate the tool's reliability and validity, respectively. Results: The content and face validity were satisfactory. Six hundred twelve feet were screened using the NCSC, and 596 feet were checked without the tool. The kappa agreement tests showed strong concordance (kappa coefficient=0.725-1.000, P<0.001) between the non-orthopaedictrained personnel and paediatric orthopaedic team for all NCSC items. The NCSC exhibited 100% sensitivity, specificity and positive and negative predictive values. Conclusion: The NCSC is a reliable tool for postnatal clubfoot screening, offering high sensitivity and specificity. It facilitates accurate differentiation of true-positive congenital talipes equinovarus from other foot conditions, reducing misdiagnoses and unnecessary referrals. The NCSC is valuable in resource-constrained settings and for healthcare professionals lacking specialised orthopaedic training. [ABSTRACT FROM AUTHOR]

This report describes a male skeleton recovered from the Samnite necropolis of Barrea (Abruzzo, 8th–5th century BCE), showing one malformed foot consistent with the diagnosis of unilateral congenital clubfoot associated with tarsal and tarsometatarsal coalitions in the same foot. This finding is particularly noteworthy because tarsal coalitions in congenital equinovarus foot have rarely been reported in medical literature, and to our knowledge, never in the paleopathological record. The recovery of this individual with impaired locomotion from a grave containing a complete array of weapons and armor sheds new light on the occupant's identity and social attitudes toward disabled people in Samnite society. In mortuary archaeology, the correlation between warrior burials and social identity in life of the dead in ancient times is a widely debated issue. Some scholars assert that the weapons in these graves suggest the existence of a warrior class; others propose that the military items of the burial assemblage indicate a high social status or significant power. This study suggests that in Samnite society, physical impairment did not prevent someone from being honored as a warrior or high‐status community member. [ABSTRACT FROM AUTHOR]

Understanding joint loading and the crucial role of joint moments is essential for developing treatment strategies in gait analysis, which often requires the precise estimation of joint moments through an inverse dynamic approach. This process necessitates the use of a force plate synchronized with a motion capture system. However, effectively capturing ground reaction force in typically developing (TD) children and those with congenital talipes equino varus (CTEV) presents challenges, while the availability and high cost of additional force plates pose additional challenges. Therefore the study aimed to develop, train, and identify the most effective machine learning (ML) model to predict joint moments from kinematics for TD children and those with CTEV. In a study at the Gait Lab, 13 children with bilateral CTEV and 17 TD children underwent gait analysis to measure kinematics and kinetics, using a 12-camera Qualisys Motion Capture System and an AMTI force plate. ML models were then trained to predict joint moments from kinematic data as input. The random forest regressor and deep neural networks (DNN) proved most effective in predicting joint moments from kinematics for TD children, yielding better results. The Random Forest regressor achieved an average r of 0.75 and nRMSE of 23.03 % for TD children, and r of 0.74 and 23.82 % for CTEV. DNN achieved an average r of 0.75 and nRMSE of 22.83 % for TD children, and r of 0.76 and nRMSE of 23.9 % for CTEV. The findings suggest that using machine learning to predict joint moments from kinematics shows moderate potential as an alternative to traditional gait analysis methods for both TD children and those with CTEV. Despite its potential, the current prediction accuracy limitations hinder the immediate clinical application of these techniques for decision-making in a pediatric population. [ABSTRACT FROM AUTHOR]

In myelomeningocele children, the incidence of equinocavovarus feet, considering all foot deformities, is 25–36%. Treatment options consist of extensive surgeries resulting in rigid feet with better alignment. Ponseti method expanded its indications since the early 2000s, including myelodysplastic feet. However, the literature on success, recurrence, and complication rates remains sparse. Therefore, a systematic review was performed in Pubmed, Scopus, Embase, Lilacs, and Web of Science databases on October 28, 2020 and July 11, 2023. Normality and sample proportion analysis with 95% confidence intervals were estimated. Risks of bias and the quality of studies were also evaluated. Success, recurrence, and complication rates were evaluated and analyzed. Eight case series were identified with 101 patients (176 feet). According to this model, the initial success rate was 93% (95% CI = 0.88–0.96) with I2 = 0%, and the final success was 63% (at 4.9 years of follow-up). Recurrence rate was 62% (95% CI = 50–72), and complication rate was 29% (95% CI = 22–38). Ponseti method for myelodysplastic clubfoot is effective (93% of initial correction). However, there are high complication and recurrence rates, and longer follow-up is needed to identify recurrences and urge for early intervention. Foot abduction brace should be used to avoid recurrences. [ABSTRACT FROM AUTHOR]

We report on a 39-week-old male neonate diagnosed on antenatal sonography with bilateral congenital talipes equinovarus deformity and postnatally confirmed to be having global hypotonia with decreased sensation to touch and pain. The mother is postnatally diagnosed to be having gestational diabetes. On the evaluation of the neonate, he has profound axial and appendicular hypotonia, with absent deep tendon reflexes and negligible power. The neonate has poor oromotor tone and myopathic facies, with intact sensorium and no seizures. Blood investigations including serum lactate dehydrogenase, serum lactate, and serum creatinine phosphokinase are normal. Neuroimaging including ultrasonography and magnetic resonance imaging of the brain is normal. Electroencephalogram is also normal. Whole-exome sequencing reveals a novel mutation of the PIEZO2 gene. Neonate is currently on early intervention and continues to be hypotonic at 5- month follow-up. We discuss in this manuscript this rare cause of peripheral neuropathy, its management, and prognosis. [ABSTRACT FROM AUTHOR]

Background: Myelomeningocele (MMC) is a congenital malformation affecting the central nervous system, categorized as a neural tube defect (NTDs). In untreated cases, the mortality rate within the first six months of life ranges from 35% to 70%. Globally, its incidence is estimated 0.8 to 1 per 1000 live births, and rates are higher in Asia and lower socioeconomic groups. This disease imposes a significant treatment cost and burden due to life-long disabilities. In less developed or developing countries, delays in diagnosis can lead to complications such as infection and rupture. Although rupture is a rare complication in MMC, there are limited studies that have reported it. This study aims to discuss the perioperative management and potential complications of ruptured MMC. Method: This study presents four cases of ruptured MMC that were referred from private hospitals and managed by Hasan Sadikin General Hospital in West Java, Indonesia. Each patiens underwent a clinical assessment and diagnostic evaluation upon arrival, followed by perioperative theraphy and management of any complications that emerged during treatment. Result: In three of the four cases, the children were over 24 h old when they were admitted to the hospital. Three cases were located in the lumbosacral region while one case was located in the thoracic region. Upon arrival, the clinical presentations we observed included microcephaly, small for gestational age (SGA) and congenital talipes equionavrus (CTEV). And we found several complications included wound dehisence, respiratiory failure, hydrocephalus, leg weakness, menigitis and sepsis after surgery. Conclusions: Perioperative management is highlighted as vital, necessitating a multidisciplinary approach and precise surgical techniques to mitigate severe complications. [ABSTRACT FROM AUTHOR]

Background: The treatment results of the Ponseti method for arthrogrypotic clubfoot have been described in only a few case series. Further evaluations are necessary. Methods: Children from two German paediatric orthopaedic hospitals with arthrogryposis-associated clubfoot treated with the Ponseti method between 2004 and 2011 and who were at least five years of age at their last follow-up were retrospectively evaluated. The endpoints were the clinical foot position, necessary surgeries during the follow-up period and radiological constellations. A comprehensive literature review was conducted after a systematic literature search. Results: Seventeen patients (47% with amyoplasia [AP] and 53% with distal arthrogryposis [DA]) met the inclusion criteria. Thirty-one feet were evaluated. The period between the treatment start and the last follow-up examination covered 8.9 ± 2.5 years. After the last cast removal within the initial Ponseti cast series, 74% of the clinical results were good to excellent. However, the clinical outcomes in the patients with AP were significantly worse. Overall, in 23 feet (74%), at least one major surgery at the age of 2.9 ± 2.2 years was necessary during the clinical course. Major surgeries were much more frequent on the feet of the patients with AP than with DA. Lateral X-rays showed normal age-appropriate radiological angles in 4% of the feet, hindfoot equinus in 19%, under-corrected hindfoot in 44%, under-corrected clubfoot in 26% and rocker bottom deformity in 7%. The radiological residual deformities in AP were much more severe than in DA (p = 0.042). Most of the studies reviewed (11 case series, 144 patients) reported high initial clinical correction rates, followed by high recurrence rates and the need for further surgeries. Conclusion: About a quarter of the arthrogrypotic patients benefited from the Ponseti therapy without further major surgery. However, the clinically observed high initial correction rate after Ponseti therapy of arthrogrypotic clubfoot was not accompanied by a correction of the bony foot position in the X-rays. The feet of the patients with DA had better outcomes than those of the patients with AP. Therefore, in outcome studies, a clear distinction between patients with AP and those with DA is necessary. [ABSTRACT FROM AUTHOR]

Background/Objectives: Idiopathic clubfoot is a complex pediatric foot deformity. The Ponseti technique is widely regarded as the standard for correcting deformities, and treatment compliance is essential for preventing relapse. Examining psychosocial effects on parents and/or children during clubfoot treatment provides valuable insights for improving compliance. This scoping review will map the existing literature on the psychological and social effects experienced by parents and/or children with idiopathic clubfoot. It also aims to examine the assessment tools used to measure these impacts and identify factors influencing treatment compliance. Methods: This review will adhere to the Joanna Briggs Institute (JBI) guidelines for scoping reviews. The search will include databases such as Scopus, Web of Science, EBSCOhost, MEDLINE, and PsycINFO and focus on studies published in the last 10 years. This review will include quantitative, qualitative, and mixed-method studies that investigate the psychological and social effects experienced by parents or affected children of any age with idiopathic clubfoot. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension guidelines. The screening and data extraction process will involve two independent reviewers. The analysis will be descriptive and qualitative. Results: The findings will be presented in tables and a narrative summary. Conclusion: This review may guide health practitioners in developing evidence-based interventions to improve treatment adherence. [ABSTRACT FROM AUTHOR]

Background: a-mannosidosis (MAN) is a rare genetic condition that segregates in an autosomal recessive manner. Lack of lysosomal alpha-mannosidase is the underlying cause of the disease. Symptoms of the disease gradually worsen with the age. Newborns are usually asymptomatic, however, some cases are reported with either congenital ankle equinus or hydrocephalus during the first year. Primary symptoms are characterized by immune deficiency, hearing loss, skeletal abnormalities, progressive mental, motor and speech functions' impairment followed by facial asymmetry. Methods: We studied two Saudi families (A and B) with bilateral moderate hearing loss (family A) and clubfoot with glaucoma (family B). Clinical diagnosis was not reached based on phenotype of patients. Therefore, hypothesis-free whole exome sequencing (WES) was performed on DNA samples from affected individuals of both the families, followed by Sanger sequencing and segregation analysis to validate the segregation of the identified variant. Furthermore, 3D protein modelling was performed to determine the in silico effects of the identified variant on the protein structure and function. Results: Re-examination of clinical features revealed that the patients in family A have speech delay and hearing impairment along with craniostenosis, whereas the patients from family B have only clubfoot and glaucoma. WES identified a well known pathogenic homozygous frameshift variant (NM_000528.4: c.2402dupG; p.S802fs*129) in MAN2B1 in both the families. Sanger sequencing confirmed the segregation of the variant with the disease phenotype in both the families. 3D structural modeling of the MAN2B1 protein revealed significant changes in the tertiary structure of the mutant protein, which would affect enzyme function. This report presents a new case where partial and novel a-mannosidosis phenotypes are associated with a MAN2B1 gene pathogenic variant. Conclusion: Patients in both the families have manifested peculiar set of clinical symptoms associated with a-mannosidosis. Family A manifested partial clinical symptoms missing several characteristic features like intellectual disability, dysmorphic features, neurological and abdominal manifestations, whereas family B has no reported clinical symptoms related to a-mannosidosis except the novel symptoms including club foot and glaucoma which has never been reported earlier The current findings support the evidence that biallelic variants of MAN2B1 are associated with new clinical variants of a-mannosidosis. [ABSTRACT FROM AUTHOR]

This paper aims to review the various surgical techniques for gastrocnemius–soleus recession and Achilles tendon lengthening, with a special focus on the treatment of clubfoot and cerebral palsy (CP) equinus contracture. This descriptive review article comprehensively explores different techniques for gastrocnemius recession, including the Hoke percutaneous triple hemisection, Baker's method (Tongue-in-Groove Gastrocnemius–Soleus Recession), the Vulpius method, the Baumann procedure, and the Strayer procedure (Gastrocnemius Recession). The objective is to present a detailed analysis of these methods, covering their indications, procedural nuances, relevance in clinical practice, and outcomes. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this investigation are to investigate the social, demographic, and treatment-related factors that contribute to the management of children with clubfoot. Methods: A prospective observational study was conducted from July to September 2016. Using a semi-structured questionnaire, we conducted interviews with families of children enrolled in the RBSK program between January 2014 and September 2016. Our objective was to collect information regarding their social and demographic characteristics, treatment history, and any factors that may have influenced their care. Results: Of the 136 infants diagnosed with clubfoot, 69.1% were male and 77.2% had the condition in both feet. The majority of the parents (77.9%) were between the ages of 20 and 30. 80.1% of families encountered transportation challenges, while 78.7% were required to travel more than 10 kilometres to access treatment centres. The average waiting time for services was 21 minutes. Healthcare providers referred approximately 75.8% of the children, while 88.9% of parents were motivated to adhere to the treatment plan. The condition's awareness experienced a significant increase, from 1.47% prior to diagnosis to 85.29% subsequent to it. Conclusions: Despite the challenges associated with transportation, the availability of free therapy, useful healthcare guidance, and brief waiting times, parents were primarily motivated to complete treatment. Improving accessibility and alleviating the burden on larger institutions could be achieved by extending clubfoot treatment to community outreach programs. [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic clubfoot (ICF) involves structural abnormalities in the lower extremities. Approximately half of patients have unilateral ICF, which could be due to differences in limb formation. The contralateral unaffected foot may have subclinical ICF. The objectives were to compare ankle and foot kinematics and pedobarography findings between the unaffected foot of patients with unilateral ICF and controls. Methods: Eleven children with unilateral ICF (11 unaffected feet, 11.7 ± 3.8 years) and 15 age-matched controls (30 control feet, 11.1 ± 3.0 years) were enroled. Five complete gait trials were performed. Data were collected using ten cameras and a two m long Footscan system and compared between groups using the Wilcoxon rank sum test. Results: All children with ICF underwent the selective soft tissue release procedure. The unaffected feet showed limited ranges in inversion-eversion and dorsiflexion-plantar flexion on kinematic analysis. There was a delay in landing time in all regions of the foot during heel rise and propulsion. The peak time was achieved significantly later in the unaffected feet compared to the controls. Although plantar pressure parameters were comparable, unaffected feet showed a larger contact area in the midfoot region. Conclusions: Gait data on the unaffected foot in unilateral ICF patients do not correspond to those of controls despite an indistinguishable clinical appearance. This could be due to the effect of treatment, the process of foot development, or a combination. The relationship between genetics and gait deviation in patients with unilateral ICF needs further evaluation. The unaffected foot should receive similar attention during follow-up. [ABSTRACT FROM AUTHOR]

Background: Equinovarus deformity correction was performed by soft tissue release and bone deformity correction, and tendon transfer to maintain deformity correction. Because of the high complication rate of tendon fixation methods, partial or total anterior tibial tendon or posterior tibial tendon transfer to the peroneus tertius tendon was reported. The purpose of this study was (i) to review the results of this tendon transfer technique after release and correction of talipes equinovarus, and (ii) to analyze the complication of this technique. Methods: Between February 2017 and May 2022, 176 patients (210 feet) with equinus and/or varus foot and ankle deformities underwent anterior or posterior tibial tendon transfer to the peroneus tertius in our institute. Preoperative and postoperative foot and ankle range of motion (passive and active) were checked. The postoperative radiographic assessment included antero‐posterior (AP), lateral, and hindfoot alignment radiographs. Preoperative and postoperative lateral tibio‐talar, talo‐calcaneal, talo‐first metatarsal, tibial‐sole angles, hindfoot alignment, and anterior subluxation of the talus were checked. The American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hindfoot scale, and visual analog scale (VAS) were used to assess pain. Paired Student's t‐test was used to compare the clinical scores and radiographic angles before the operation and at the last follow‐up. Results: The mean age of the patients was 23.27 ± 13.44 years (range, 3–69 years). The mean follow‐up time was 25.56 ± 16.37 months (range, 12–68 months). There were significant differences between the preoperative and postoperative measurements of the lateral tibio‐talar angle, lateral talo‐calcaneal angle, lateral talo‐first metatarsal angle, lateral tibial‐sole angle, and hindfoot alignment (p < 0.001). There was significant difference between the preoperative and postoperative AOFAS and VAS scores (p < 0.001). The early complications included infection in one patient, skin necrosis in two patients, and plantar numbness in three patients. The late complications included pin infection in three patients, tibio‐talar joint compression in four patients, forefoot pain in two patients, toe flexion in two patients, and plantar numbness in one patient. There were three cases of complications (1.43%) related to the transferred tendons. Conclusion: Tibialis anterior or posterior tendon transfer to the peroneus tertius is a safe and effective method for equinovarus deformity correction. It yielded excellent outcomes that produced high patient satisfaction and few complications. [ABSTRACT FROM AUTHOR]

Purpose: Review the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described. Methods: A systematic review of the literature was performed with the keywords ''clubfoot", ''Ponseti" and ''anterior tibial". Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included. Results: Six studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small. Conclusion: Several options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle. [ABSTRACT FROM AUTHOR]

Background: The ultra-rare autosomal recessive genetic disorder, You-Hoover-Fong Syndrome (YHFS), is caused by defects in the TELO2 gene and is characterized by intellectual disability, developmental delay, and ocular impairments. This study aims to contribute to a better understanding of YHFS by reviewing previous cases and introducing a novel variant in a new case. Methods: Whole exome sequencing (WES) was conducted on the proband to identify genetic variants, and Sanger sequencing was used to confirm variants within the family. This article presents a comprehensive collection of reported cases of YHFS, incorporating both molecular and clinical data, through an extensive literature search and analysis of English-language studies published until June 2023. Results: Using WES, a novel homozygous missense variant, c.1799A > G (p. Tyr600Cys), was identified in the TELO2 gene in a 4-year-old Iranian male patient. Novel clinical features, including choanal atresia and clubfoot, were also identified. A comprehensive literature review identified 27 patients with YHFS, with 20 variants in the TELO2 gene. Missense pathogenic variants were the most common type of pathogenic variant, and the most common features were microcephaly and intellectual impairment. Conclusion: This study presents the first case of pathogenic variants in TELO2 gene in Iran, expands the genotypic and phenotypic spectrum of YHFS and contributes to the growing body of literature pertaining to YHFS. Furthermore, our findings highlight the importance of genetic testing for non-consanguineous carrier screening, as compound heterozygosity may be a significant factor in the development of YHFS. Further research is needed to clarify the molecular mechanisms underlying YHFS pathogenesis. [ABSTRACT FROM AUTHOR]

Purpose: Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. Methods: A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. Results: High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. Conclusion: These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana. [ABSTRACT FROM AUTHOR]

Background: Clubfoot management according to the Ponseti method, including 4–5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes. Objectives: This systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence. Methods: This scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis. Results: A total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified. Conclusions: Available evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Residual forefoot adduction deformity refers to the persistent inward deviation of the forefoot in patients following corrective procedures for idiopathic clubfoot, with reported incidence rates varying up to 95%. The aim of this work was to evaluate the clinical and radiological results of combined cuboid-cuneiform osteotomy for correcting the residual forefoot adduction deformity of idiopathic clubfoot patients. Methods: Eighteen cases (feet) in 13 children with residual forefoot adduction deformity were treated between October 2022 and September 2023 at the Orthopedic Department of Zagazig University Hospital in Egypt. The children were followed up for at least six months, and all cases underwent a combined cuboid-cuneiform osteotomy with soft tissue releases. Measurements including the anterior talocalcaneal angle (TCA1), anterior talo-first metatarsal angle (TFMA1), calcaneo-fifth metatarsal angle (CFMA), lateral talocalcaneal angle (TCA2), and lateral talo-first metatarsal angle (TFMA2) were taken pre-operatively and post-operatively. Results: The residual forefoot adduction deformities were evaluated clinically and radiologically according to a scoring system modified by Bensahel et al. and supported by the International Clubfoot Society. Based on the total calculated score, the results were categorized into four levels: excellent, good, fair, and poor. Fifty percent of the treated feet had excellent results, 33% had good results, 11% had fair results, and 6% had poor results. Despite nonsignificant complications, 16 patients expressed satisfaction with the operation. Conclusion: Combined cuboid-cuneiform osteotomy is a safe and effective option for correcting residual forefoot adduction deformity in idiopathic clubfoot. It surpasses other bone surgeries for adduction and rotational deformities, resulting in a straight plantigrade foot. [ABSTRACT FROM AUTHOR]

Purpose: Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. Methods: This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. Results: Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. Conclusion: A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system. [ABSTRACT FROM AUTHOR]

Background: Idiopathic clubfoot occurs commonly in children with a prevalence of 1 in 1000. The Pirani scoring system, which consists of a midfoot contracture score and hindfoot contracture score, is traditionally used in assessing the severity of clubfoot deformity. Ponseti protocol is used in the management of clubfoot deformity. The study aimed to evaluate the outcome of the management of clubfoot using the Ponseti protocol and to correlate the outcome with the initial Pirani score. Materials and Methods: Eighty-two children aged 1 week–2 years with 128 idiopathic clubfeet were recruited into the study. The severity of their clubfoot deformities was scored using the Pirani scoring system on recruitment. They were managed with weekly serial manipulation and cast application with or without tendon-Achilles tenotomy according to Ponseti protocol. Results: The average initial Pirani score was 3.6 ± 0.9. The average number of casts used was 5.9 ± 1.3 (range: 4–9 casts). Tenotomy was done in 51.56% of the feet. The group that required tenotomy required more casts and as such longer duration of treatment than the "no tenotomy" group. There was a relapse rate of 2% in the feet of the compliant group, whereas the relapse rate was 69% in the group that was not compliant with the use of foot-abduction brace. The success rate at 6 months follow-up was 84.4%. Conclusions: Ponseti protocol is an excellent method of management of idiopathic clubfoot, and the Pirani scoring system was useful in assessing the initial severity and the outcome. The initial Pirani score correlates with the duration of treatment. [ABSTRACT FROM AUTHOR]

Case: Traumatic pediatric Achilles ruptures are rare, and few cases have been reported among patients with a history of Achilles tenotomy. A 17-year-old boy with a history of Achilles tenotomies for congenital clubfoot as an infant presented with acute midsubstance Achilles tendon rupture of the right leg. The gastrocnemius fascia was dissected to allow for approximation of the ruptured Achilles tendon segments. Furthermore, the plantaris tendon was harvested and sutured around the Achilles tendon-rupture site to improve strength. Conclusions: Patients with a history of clubfoot and chronic Achilles tendon pain should be alerted to the risk of Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

Quantitative muscle fat fraction (FF) responsiveness is lower in younger Charcot–Marie–Tooth disease type 1A (CMT1A) patients with lower baseline calf‐level FF. We investigated the practicality, validity, and responsiveness of foot‐level FF in this cohort involving 22 CMT1A patients and 14 controls. The mean baseline foot‐level FF was 25.9 ± 20.3% in CMT1A patients, and the 365‐day FF (n = 15) increased by 2.0 ± 2.4% (p < 0.001 vs controls). Intrinsic foot‐level FF demonstrated large responsiveness (12‐month standardized response mean (SRM) of 0.86) and correlated with the CMT examination score (ρ = 0.58, P = 0.01). Intrinsic foot‐level FF has the potential to be used as a biomarker in future clinical trials involving younger CMT1A patients. ANN NEUROL 2024;96:170–174 [ABSTRACT FROM AUTHOR]

Objective: This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities. Methods: 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up. Results: Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results. Conclusion: Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes. Level of evidence: IV Retrospective study. [ABSTRACT FROM AUTHOR]

Background: Various treatment modalities are available in the management of club feet but main stay of treatment is manipulation of serial casting and in majority of cases percutaneous Achilles tenotomy. The objective of this study was to assess the effectiveness of accelerated Ponseti Techniques (PST) in the treatment of congenital talipes equinovarus. Material and Methods: This descriptive study was conducted in the Orthopedic Department Jinnah Teaching Hospital Peshawar from July 2022 to July 2023. All the patients fulfilling the inclusion criteria were enrolled. The serial casting was given to all patients in the Outdoor Department. Outcome was assessed through the Pirani scoring system before and after casting. SPSS version 22 was used for statistical analysis. Frequencies and percentages were calculated for categorical variables. Mean± SD was calculated for numerical variables. Results: Out of 52 patients, 32 (61.56%) were males and 20(38.46%) were female. Mean age of patients was 5.8±2.4 months. Base line Pirani score was 6 and the mean follow up Pirani score of patients was 1.48 ±1.01. Serial casting through accelerated technique (PST) was effective in 80.8%of patients. Patients treated with the accelerated Ponseti protocol achieved a mean Pirani score of 4.2, indicating significant improvement in foot deformity. Patients treated with the accelerated PST achieved initial correction in an average of 6.5 weeks. Conclusion: Our study concludes that Accelerated PST is an effective treatment of Congenital Talipes Equinovarus. We recommend further studies with account taken into more variables which can determine the effectiveness of accelerated PST before recommending accelerated PST for club foot.. [ABSTRACT FROM AUTHOR]

Purpose: Selective tibial neurotomy (STN) is a surgical procedure for treating spastic equinovarus foot. Hyperselective neurectomy (HSN) of tibial nerve is a modified STN procedure, which was rarely discussed. This study aimed to describe the branching patterns of the tibial nerve and propose an optimal surgical incision of HSN for treatment of spastic equinovarus foot. Methods: Sixteen lower limbs were dissected to determine the various branching patterns of the tibial nerve and categorized according to these branching patterns. The mean distances from the nerve entry points to the tip of femur's medial epicondyle were measured, as well as their percentage to the overall length of the leg. The surgical incision was designed according to the range of these nerve entry points. Results: The tibial nerve sent out proximal and distal motor branches based on their position relative to the soleus muscle's tendinous arch. For proximal motor branches, the branches innervating the medial gastrocnemius, lateral gastrocnemius and proximal soleus were categorized into types I (9/16), II (5/16) and III (2/16). Measurements from the medial epicondyle to the nerve entry points into the medial gastrocnemius, lateral gastrocnemius and proximal soleus ranged from 14 to 33 mm (4–9% of leg length), 22–45 mm (6–12%) and 35–81 mm (10–22%), respectively. Distal motor branches including the distal soleus, posterior tibialis, flexor digitorum longus and flexor hallucis longus, were classified as types A (8/14), B (4/14) and C (2/14), with the distances from their respective terminal points to the medial epicondyle were 67–137 mm (19–39%), 74–125 mm (20–35%), 116–243 mm (33–69%) and 125–272 mm (35–77%). Conclusions: The motor branches of tibial nerve were classified into two groups and each subdivided into three types. Detailed location parameters may serve as an anatomical basis for designing incision of HSN. [ABSTRACT FROM AUTHOR]

Objective: Prenatal open neural tube defect (ONTD) repair is performed to decrease the risk of needing treatment for hydrocephalus after birth and to preserve motor function. Some centers may not consider patients to be candidates for surgery if severe ventriculomegaly is present and there is no expected benefit in risk for hydrocephalus treatment. This study sought to compare the postnatal outcome of fetuses with ONTD and severe ventriculomegaly (ventricular width ≥ 15 mm) that underwent prenatal repair with the outcome of fetuses with severe ventriculomegaly that underwent postnatal repair and fetuses without severe ventriculomegaly (< 15 mm) that underwent prenatal repair. Methods: This was a retrospective study of fetuses with ONTD that underwent prenatal or postnatal repair between 2012 and 2021 at a single institution. The cohort was divided into two groups based on preoperative fetal ventricular size: those with severe ventriculomegaly (ventricular width ≥ 15 mm) and those without severe ventriculomegaly (< 15 mm). Fetal ventricular size was measured by magnetic resonance imaging before surgery using the standardized approach and the mean size of the left and right ventricles was used for analysis. Motor function of the lower extremities was assessed at the time of referral by ultrasound and if flexion–extension movements of the ankle were seen it was considered as preserved S1 motor function. Postnatal outcomes, including motor function of the lower extremities at birth and the need for a diversion procedure for hydrocephalus treatment during the first year after birth, were collected and compared between groups. Multivariate regression analysis was used to adjust for potential confounders. Results: In this study, 154 patients were included: 145 underwent fetal surgery (101 fetoscopic and 44 open hysterotomy) and nine with severe ventriculomegaly underwent postnatal repair. Among the 145 patients who underwent fetal surgery, 22 presented with severe ventriculomegaly. Fetuses with severe ventriculomegaly at referral that underwent prenatal repair were significantly more likely to need hydrocephalus treatment by 12 months after birth than those without severe ventriculomegaly (61.9% vs 28.9%, P < 0.01). However, motor function assessment at birth was similar between both prenatal repair groups (odds ratio, 0.92 (95% CI, 0.33–2.59), P = 0.88), adjusted for the anatomical level of the lesion. The prenatal repair group with severe ventriculomegaly had better preserved motor function at birth compared to the postnatal repair group with severe ventriculomegaly (median level, S1 vs L3, P < 0.01; proportion with S1 motor function, 68.2% vs 11.1%, P < 0.01). Fetuses with severe ventriculomegaly that underwent prenatal repair had an 18.9 (95% CI, 1.2–290.1)‐times higher chance of having intact motor function at birth, adjusted for ethnicity, presence of club foot at referral and gestational age at delivery, compared with the postnatal repair group. There was no significant difference in the need for hydrocephalus treatment in the first year after birth between prenatal and postnatal repair groups with severe ventriculomegaly (61.9% vs 87.5%, P = 0.18). Conclusions: Although fetuses with ONTD and severe ventriculomegaly do not seem to benefit from fetal surgery in terms of postnatal hydrocephalus treatment, there is an increased chance of preserved motor function at birth. Results from this study highlight the benefit of prenatal ONTD repair for cases with severe ventriculomegaly at referral to preserve motor function. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the initial treatment of clubfoot deformity in Sweden using a national cohort. Secondarily we aimed to analyse the results of the initial treatment in relation to foot severity and additional diseases. Methods: A national register, the Swedish Pediatric Orthopedic Quality Register, was used to extract data on children born with clubfoot in 2016–2019. Children with a registered evaluation after initial treatment were included. Data on deformity severity (Pirani score), casting treatment, and achillotenotomy were extracted. For children with bilateral clubfeet, one foot was included in the analysis. Results: A total of 565 children were included in the analysis. Of these, 73% were boys and 47% had bilateral clubfeet. Children with isolated clubfoot required a median of six casts to correct the deformity, while children with non-isolated clubfoot needed a median of eight casts. Seventy-seven percent underwent an achillotenotomy. Residual deformities of 0.5 or above (often soft-tissue issues) according to the Pirani score were noted in 23% (isolated clubfoot) and 61% (non-isolated clubfoot) after initial treatment. Conclusions: We have described the initial clubfoot treatment of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. The initial treatment was performed to a large extent according to the Ponseti method and international recommendations. Moreover, we discuss the usefulness of the Pirani score in classifying clubfoot deformity after treatment. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) is a prevalent pediatric deformity with a multifactorial etiology. The objective of this meta-analysis was to explore the association between genetic variations in COL9A1 and the susceptibility to CTEV. Methods: A comprehensive analysis of pertinent literature released before November 15, 2023, in electronic bibliographic databases was carried out. The importance of the connection was clarified through odds ratios (ORs) with 95% confidence intervals (CIs), utilizing random or fixed-effects models depending on study heterogeneity. Statistical analysis was executed using Comprehensive Meta-Analysis software (Version 4.0). Results: A total of eight case-control studies involving 833 CTEV patients and 1280 healthy individuals were included in the analysis. Among these, four studies investigated the rs1135056 variant, encompassing 432 CTEV cases and 603 controls; two studies examined the rs35470562 variant, with 189 CTEV cases and 378 controls; and two studies explored the rs592121 variant, including 212 CTEV cases and 299 controls. The results revealed a significant association between the rs1135056 and rs35470562 polymorphisms in the COL9A1 gene, suggesting an increased risk of CTEV in the overall population. Conversely, no such association was found for the rs592121 variant. Conclusion: Our findings reveal a substantial association between the genetic variants COL9A1 rs1135056 and rs35470562 and susceptibility to CTEV. Conversely, the variant rs592121 did not exhibit any corresponding link. However, the limitations imposed by the small study population have compromised the statistical reliability and generalizability of the results. [ABSTRACT FROM AUTHOR]

This document is an editorial from the journal International Orthopaedics, discussing a special issue dedicated to current concepts and recent progress in pediatric orthopaedics and trauma surgery. The field of pediatric orthopaedics has seen significant changes in recent years, with increasing specialization in various areas. The special issue includes high-quality scientific papers from authors in 35 different countries, covering a wide range of topics and clinical innovations. The editorial highlights key papers in the issue, expressing gratitude to the authors and the journal for their contributions. This report, authored by Federico Canavese, Patricia Maria de Moraes Barros Fucs, and Ashok N. Johari, provides an in-depth analysis of a specific topic, written in a culturally sensitive manner. Library patrons conducting research on this topic will find this report to be a valuable resource. [Extracted from the article]

Purpose: The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. Methods: A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. Results: Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1–10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0–25°) and mean plantarflexion range of 37.95° (10–40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17–30) and mean height of heel rise of 6.29 cm (range 4–10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3–16 mm) and thickness of 5.1 mm (1.8–15 mm), comparable with unaffected feet. Conclusions: Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare the results of the Oxford Ankle and Foot Questionnaire (OxAFQ) in children with clubfoot in Canada and India to assess its ability to predict outcomes and capture patient experiences in different cultural contexts. Methods: This is a retrospective study of children with clubfoot in India and Canada who completed the OxAFQ. Statistical analyses were implemented on registry-collected data to test for independent predictors of poor outcomes and compare scores between countries, among children and their parents, and in Canada where relapse data was collected and the effect of a relapse on scores. Results: A total of 361 children were included. The mean Indian OxAFQ scores were higher (p < 0.001) in all domains. Pirani score, tenotomy, laterality, and age at presentation were found to be predictive of outcomes between the sites (p < 0.05). OxAFQ scores decreased after relapse for children in Canada (p < 0.05). Canadian children were found to generally have lower OxAFQ scores in all domains compared to their parents (n = 95; Z = −3.178, −3.493, −3.353, and −3.635 for physical, school and play, emotion, and footwear, respectively; p < 0.001). Indian parents and children showed no significant differences in their scores. Conclusions: A difference was observed in scores between both sites, suggesting there may be differences in how these populations assess personal health outcomes. These findings support the need for cultural validity of patient-reported outcome measures. [ABSTRACT FROM AUTHOR]

Introduction: Congenital talipes equinovarus is an idiopathic and common congenital deformity. Clubfoot treatment includes series stretching, manipulation, and immobilization; and for the relapse and resistant cases, management includes soft tissue releases, osteotomy, and immobilization. Tenotomy of the tendo-Achilles is an essential step in the Ponseti treatment of congenital talipes equinovarus (CTEV). In this study, we did a wide bore needle tenotomy, a minimally invasive technique for the management of equinus deformity. Materials and Methods: The study included 50 patients with 73 idiopathic clubfeet treated with the Ponseti technique. Out of which, 58 feet were treated by a wide bore needle tenotomy with aseptic precautions. Results: Out of all 73 feet managed with the Ponseti technique, 58 feet equinus were treated with a wide bore needle tenotomy, and the rest of the 15 feet equinus were corrected with a cast. The mean age at presentation of all the patients was 4.44 months. Mean cast applied was 7.24, equinus correction in age more than 6 months was only tenotomy. Conclusion: The results of our study showed good correction of deformity with low expenditure and minimal surgical intervention. The percutaneous needle tenotomy procedure offers a reliable and effective procedure for correcting equinus in club foot deformity with less chances of infection and other complications. We found that correction of equinus with cast is more effective at an early age of presentation and with a low Pirani severity score. [ABSTRACT FROM AUTHOR]

Background: Idiopathic clubfoot is one of the most common congenital problems affecting newborns. Several methods are used for grading its severity, of which Pirani score is the most reliable one. The Ponseti method of clubfoot management is effective, producing better results and fewer complications than traditional surgical methods. Methods: The study includes 27 clubfeet who were diagnosed with clubfoot and who were scored using Pirani score and were treated with the Ponseti method with possible Achilles tenotomy. Result: The study showed that the mean Pirani scores before treatment were significantly higher in the tenotomy than in the non-tenotomy group (3.54 vs. 2.23 for the total Pirani score, 2.25 vs. 1.69 for the midfoot Pirani score and 1.29 vs. 0.59 for the hindfoot Pirani score). The study proposes a "before treatment" cutoff point of 2.75 for the total Pirani score, 1.75 for the midfoot Pirani score and 1.25 for the hindfoot Pirani score, where a score above these cutoff points can predict the need for tenotomy. Conclusion: This study showed that the Pre-treatment Pirani score can help surgeons decide whether to do tenotomy or not in patients treated with the Ponseti method. [ABSTRACT FROM AUTHOR]

Diphallia is an exceptionally rare genitourinary anomaly often associated with caudal duplication syndrome, which poses challenges in understanding its diverse nature. This case report presents a unique manifestation in a male infant born at 36 weeks to a mother with uncontrolled diabetes. The infant exhibited complete duplication of the penis, scrotum, testicles, urethra, bladder, sacrum, and right kidney, alongside major anomalies including Tetralogy of Fallot and lumbosacral spinal dysraphism with lipomyelomeningocele. Minor anomalies included abnormal ear creases, hypospadias, hydronephrosis, rectal-urethral fistulas, and a left club foot. This case represents the first documentation of such a complex constellation of supraumbilical presentation that includes abnormal ear creases and cardiac associations of Tetralogy of Fallot, right-sided aortic arch, and mirror aortic arch vessels. [ABSTRACT FROM AUTHOR]

This article discusses a pediatric case of KMT2A-rearranged B-lymphoblastic lymphoma, a rare type of non-Hodgkin lymphoma in children. The KMT2A gene rearrangements are commonly found in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), but are rarely described in lymphomas. The patient in this case had a mass on his back, which was surgically removed and diagnosed as B-lymphoblastic lymphoma. The presence of a KMT2A-rearrangement led to the decision to treat the patient with high-risk chemotherapy. The article emphasizes the need for further research to determine the best treatment approach for this type of lymphoma. [Extracted from the article]

Background: The intraoperative use of tourniquets is associated with several complications, including hyperthermia. We present the first documented case of tourniquet-induced hyperthermia in a pediatric patient at our institution. Case: A 5-year-old female with no past medical history underwent tendon release surgery for congenital talipes equinovarus under general anesthesia. Following inflation of a pneumatic tourniquet to a pressure of 250 mmHg on her left thigh, the patient experienced a gradual increase in body temperature. Despite the implementation of cooling measures, the temperature continued to increase until it plateaued. The hyperthermia gradually resolved upon deflation of the tourniquet. Conclusions: Tourniquet-induced hyperthermia should be considered as a potential cause of intraoperative hyperthermia, particularly in the absence of typical signs of malignant hyperthermia. Early recognition and appropriate management, including deflation of the tourniquet and implementation of cooling measures, are crucial for preventing potential complications associated with hyperthermia. [ABSTRACT FROM AUTHOR]

Background: Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment. Methods: A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction. Results: The majority of participants were male infants aged 4–6 months, with a median age of 4.5 months. Half of them weighed between 3.00 and 4.99 kg at their first hospital visit, with a median weight of 3.20 kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0–3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3–9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts. Conclusions: The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy. [ABSTRACT FROM AUTHOR]

Background: Recognized as one of the most serious musculoskeletal deformities, occurring in 1–2 per 1000 newborns, 80% of clubfeet are idiopathic while 20% present with associated malformations. The etiopathogenesis of clubfoot is described as multifactorial, including both genetic and environmental risk factors. The aim of this study was to analyze possible genetic causes of isolated and syndromic clubfoot in Serbian children, as well as to correlate clinical and genetic characteristics that would provide insight into clubfoot etiopathogenesis and possibly contribute to global knowledge about clinical features of different genetically defined disorders. Methods: We evaluated 50 randomly selected, eligible children with clubfoot aged 3 to 16 years that were initially hospitalized and treated at University Children's Hospital between November 2006 and November 2022. The tested parameters were gender, age, dominant foot, affected foot, degree of deformity, treatment, neuromuscular disorders, positive family history, and maternal smoking. According to the presence of defined genetic mutation/s by whole exome sequencing (WES), patients were separated into two groups: positive (with genetic mutation/s) and negative (without genetic mutation/s). Results: Seven patients were found to be positive, i.e., with genetic mutation/s. A statistically significant difference between categorical variables was found for families with a history of clubfoot, where more than half (57.14%) of patients with confirmed genetic mutation/s also had a family history of genetic mutation/s (p = 0.023). Conclusions: The results from this study further expand the genetic epidemiology of clubfoot. This study contributes to the establishment of genetic diagnostic strategies in pediatric patients with this condition, which can lead to more efficient genetic diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous tenotomy of the Achilles tendon is a procedure that is part of the Ponseti method for clubfoot correction. The need to apply general anesthesia or sedation for this procedure is controversial. The objective of this study is to compare the acute stress generated in infants by percutaneous Achilles tenotomy under local anesthesia vs. peripheral line placement. Material and methods: This cross-sectional study compares the discomfort experienced by 85 infants undergoing percutaneous Achilles tenotomy with local anesthesia with that experienced by 39 infants undergoing peripheral line placement. The following parameters were determined: the duration of the procedure, crying time, average crying intensity, and maximum crying intensity. Other data recorded included the infant's age and complications arising during the procedure. Results: The mean ages of these patients were 1.95 and 2.18 months, respectively. The following data were obtained: the mean duration of the procedure for Group A was 8.13 s and for Group B it was 127.43 s; the mean duration of crying for Group A was 84.24 s and for Group B it was 195.82 s; the mean intensity of crying for Group A was 88.99 dB and for Group B it was 100.98 dB; and the maximum crying intensity for Group A was 96.56 dB and for Group B it was 107.76 dB. Conclusions: Percutaneous Achilles tenotomy can be safely performed as an outpatient procedure, under local anesthesia. This method generates less discomfort than peripheral line placement. [ABSTRACT FROM AUTHOR]

The article discusses the distinct clinical characteristics and genetic underpinnings of Distal Arthrogryposis Type 1 (DA1), emphasizing its similarity to but lack of craniofacial features seen in other related syndromes. It also explores the challenges in surgical management, particularly in correcting contractures of the ankle-foot complex and hands, and highlights the variability in anaesthetic considerations, advocating for tailored approaches based on patient needs and safety profiles.

Background: The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. Methods: 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. Results: Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). Conclusions: The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. Level of evidence: II. [ABSTRACT FROM AUTHOR]

BACKGROUND: Congenital dislocation of the knee (CDK) is rare and can cause significant distress in the delivery room to parents and to healthcare providers, especially if the latter are unaware of this condition. It may not be detected by prenatal ultrasound and can be either an isolated finding or associated with other anomalies such as developmental hip dysplasia and genetic syndromes such as Larsen syndrome. Because of the risk of development of contractures, immediate referral to a specialized provider is needed. Poor prognostic factors include an association with a genetic syndrome, limited knee flexion related to severe quadriceps retraction, and absence of anterior skin grooves. A satisfactory outcome can be anticipated in isolated cases with easy reducibility of the knee. CASE REPORT: A term baby presented unexpectedly with left knee dislocation after delivery. The providers, unaware of the condition, immediately consulted the orthopedic service, who assisted in the diagnosis, and appropriate management was initiated. The baby had serial casting of the leg, which was applied for almost 3 months, with excellent results on the clinical examination. CONCLUSIONS: CDK is a rare finding. The diagnosis is primarily clinical and radiographs are used to confirm and assess the degree of the dislocation. The degree of dislocation is important for management and prognosis. Interventions ranging from serial casting to surgery are required as soon as possible. As the CDK can be associated with genetic syndromes or other dysplasias such as developmental dysplasia of the hip and talipes equinovarus, further evaluation for these conditions is warranted. [ABSTRACT FROM AUTHOR]