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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]

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]

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]

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]

Background: Following clubfoot surgery, the most frequent remaining deformity is forefoot adduction. For moderate to severe occurrences of this malformation, surgery is frequently necessary. Aim of the study: The study aimed to evaluate the outcomes of double column Osteotomy in treatment of residual forefoot adduction in clubfoot to reach better management plan for treating this residual deformity. Patients and methods: Twenty children (25 feet) with idiopathic clubfeet between 3-7 years of age were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy with soft tissue releases (plantar fasciotomy and abductor hallucis release). Preoperative measurements of certain foot angles were compared with their postoperative values. Results: 11 feet (44%) had excellent, ten (40%) had good, three (12%) had fair and one (4%) had poor outcome. Pain disappeared in almost all cases except two who had mild pain. The forefoot adduction was fully corrected except five cases in which it was partially corrected. Hind foot varus was corrected in all cases except three cases. Supination deformity improved in all cases. Cavus deformity improved in all cases except four cases. Tolerability to footwears/orthoses improved in all cases except three who showed batter tolerability but not optimum. The radiographic foot angles measures improved in all cases at least better than their preoperative measures. There was no major complication. Conclusion: Double column osteotomy is a safe operation can be considered superior to other types of bone surgeries in correction of the adduction, cavus and rotational deformities in idiopathic clubfoot. [ABSTRACT FROM AUTHOR]

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]

Split tendon transfer of the posterior tibialis (SPOTT) is a surgical procedure in which the split posterior tibialis tendon is transferred posterior to the fibula (PO) with insertion on the peroneus brevis tendon to rebalance the forces across the hindfoot. Routing of the split tendon through the interosseous membrane (IO) is a variation with the potential benefit of augmenting ankle dorsiflexion in swing. Does IO routing improve ankle dorsiflexion in swing and/or varus in stance compared to PO routing? A retrospective chart review was completed to identify forty-two patients who underwent a SPOTT procedure for equinovarus foot deformity. 14 patients received IO routing and 28 received PO routing. Two main outcomes: maximum ankle dorsiflexion in swing and average ankle coronal angle in stance were analyzed using a mixed effects model. Both the IO and PO routing significantly improved maximum dorsiflexion in swing (p = 0.018 and p = 0.001, respectively.) There was no significant difference in the maximum dorsiflexion during swing, post-operatively, between the two groups (p = 0.431). Pre-operatively, patients in the IO group exhibited significantly more average ankle varus during stance, with a median of 6.7 degrees of varus compared to a median of 1.8 degrees of varus in the PO group (p = 0.024). The IO group yielded a statistically significant reduction in average ankle varus during stance (p < 0.001) whereas there was no significant change in the PO group (p = 0.138). There was no difference between groups in proportion of patients that achieved an average ankle coronal angle during stance within one SD of normative data (between −8.7 and 0.7 degrees, p = 0.381). The SPOTT procedure utilized for correction of spastic equinovarus foot deformity, can improve ankle kinematics with routing of the tendon through the IO membrane or posterior to the fibula if performed concurrently with the appropriate tendon lengthening to address equinus contracture. More clinical studies are needed to better understand potential confounding factors. • Two split tendon transfer approaches achieved desired ankle varus during stance. • Two split tendon transfer approaches improved dorsiflexion during swing. • Posterior tendon routing exhibited higher chance of under-correction. [ABSTRACT FROM AUTHOR]

Abstract 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.

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]

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]

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]

The article discusses Flannery O'Connor's doubts about her story "The Lame Shall Enter First," despite positive reviews from critics. The story portrays Sheppard as a self-righteous do-gooder who ultimately does harm. O'Connor's doubts stemmed from her lack of sympathy for Sheppard, who adopts a secular, sociological approach to helping others. The story explores themes of alienation, compassion, and the clash between secular and religious perspectives through the characters of Sheppard and Rufus Johnson. [Extracted from the article]

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]

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]

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]

Abstract 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.

Objective: We present prenatal diagnosis of de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis on prenatal ultrasound. Case Report: A 40-year-old, gravida 2, para 1, woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 46,XY. Level II ultrasound at 22 weeks of gestation revealed bilateral hydronephrosis and right clubfoot. At 23 weeks of gestation, repeat amniocentesis revealed the result of arr [GRCh37] 10p12.1p11.23 (26,182,512–29,826,276) × 1 dn with a 3.6-Mb microdeletion of 10p12.1p11.23 encompassing the genes of MYO3A, GAD2, APBB1IP, PDSS1, ABI1, ANKRD26, YME1L1, MASTL, ACBD5, PTCHD3, RAB18, MKX, ODAD2, MPP7, WAC and BAMBI. The pregnancy was subsequently terminated, and a malformed fetus was delivered with facial dysmorphism of low-set ears, broad forehead and flat nasal bridge. Array comparative genomic hybridization (aCGH) analysis of umbilical cord confirmed a 3.6-Mb 10p12.1p11.23 microdeletion encompassing WAC. Conclusion: Application of aCGH is useful in the pregnancy with a normal fetal karyotype and abnormal fetal ultrasound.

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: 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]

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]

BackgroundObjectiveCase DescriptionOutcomesConclusionAnkle osteoarthritis (OA) is a disease involving pain and decreased physical function which can attenuate the tolerance to perform high-load resistance training. Low-load blood flow restriction (BFR) training has been demonstrated to improve muscle strength, muscle size, and physical function in patients suffering from OA.We examined the effects of 12 weeks of BFR-training performed 4 times a week in an individual with Kellgren–Lawrence (KL) grade 4 ankle OA.A 32-year-old woman with KL grade 4 right ankle OA subsequent to a clubfoot repair in childhood performed 12 weeks of BFR-training. Four exercises with concurrent blood flow restriction (60% of arterial occlusion pressure) targeting the lower leg were performed 4 times/week. The following outcome measures were collected at baseline and 12 weeks after BFR-training: The Foot and Ankle Outcome Score (FAOS), calf circumference, maximal isometric muscle strength, single-leg heel raise test, single-leg stance test, and lateral side-hop test.Adherence to the training was 93.75%. The patient demonstrated improvements in FAOS subscale symptoms, pain, and sports/recreational activities by 19–47 points (minimal detectable change (MDC) = 18–21.5 points); maximal muscle strength in plantarflexion (36%), eversion (55%), and inversion (38%) (MDC for plantarflexion = 16.81–29.97%). The single-leg heel raise test and the lateral side-hop test improved with 66% and 51%, respectively. Calf circumference was maintained.BFR-training improved patient-reported outcomes, lower leg muscle strength, and physical function in an individual suffering from KL grade 4 ankle OA following childhood clubfoot repair. [ABSTRACT FROM AUTHOR]