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Introduction: Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. Materials and methods: In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. Results: The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Conclusion: Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.

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@#Introduction: Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. Materials and methods: In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. Results: The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Conclusion: Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.

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PURPOSE: To evaluate the outcomes of Ilizarov external fixator (IEF) and minimal invasive surgery (MIS) in correction of neglected club foot (NCF). METHODS: Thirty-seven feet in 24 child, between five and 15 years old were diagnosed as NCF. All were treated with Achilles tendon lengthening (ATL) and IEF for gradual correction. After IEF removal, cast was applied for six weeks to maintain correction of the deformity. RESULTS: There were 20 boys and four girls. Seven children had left (Lt), four children had right (Rt) while 13 children had bilateral foot deformity. The mean age at surgery was 10.3 (range 5-15) years with an average follow-up of 32.5 (range 24-96) months. All feet were graded as severe according to Pirani score. All feet were corrected after an average six weeks in IEF. After two years follow-up, 23 feet (16 patients) showed good results, five feet (3 patients) showed fair results and four feet (2 patients) had Rt side foot fair result while the Lt foot had good result in both patients. Five feet (3 patients) showed poor results. Eight patients had pin site infection. One case had infected skin and subcutaneous tissue and needed debridement. Two cases developed skin sloughing, changes in color and needed close follow-up. CONCLUSION: We recommend combined IEF and MIS as a suitable, efficient and successful salvage procedure in the management of severe idiopathic NCF in children especially in developing countries.

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We report the case of an eleven-year-old girl with untreated bilateral clubfoot. She had a total of nine long leg castings changed weekly, Achilles tendon Z-lengthening and posterior ankle release followed by another six weeks of long leg cast immobilization post-operatively. We encouraged using night-time foot abduction brace for twelve months. Independent walking was achieved six months post-treatment. No recurrence was noted at eighteen months following treatment. The modified Ponseti weekly casting method was successful up to adolescent age; however, more cast changes, longer stretching before each cast application and posterior ankle release will be needed to achieve functional correction.

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The adolescent neglected clubfoot is mostly treated in humanitarian programs by those with a great deal of surgical experience. This deformity needs a major correction, which can compromise the blood circulation and wound healing. A bony correction is preferable over an isolated soft tissue release. The extreme Lambrinudi arthrodesis with a double incision is therefore a preferred tool to correct a neglected clubfoot.

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The approach to treatment of severe untreated or recurrent congenital talipes equinovarus deformities is very different in the world where patients are mobile, have access to repeated return visits for follow-up treatment, and where more sophisticated options for gradual correction with external fixation are available. For treatment, talectomy may be the only option to treat certain neglected clubfoot deformities during humanitarian programs and it may still have to be used as a salvage procedure used in modern foot surgery. Our extensive experience with these deformities has been on global humanitarian programs.

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The Ponseti Method is recognized as the best treatment for congenital idiopathic clubfoot in newborns and its principles became also adopted for treating older children with neglected deformity. This review aims to evaluate the role and effectiveness of serial casting in the treatment of neglected clubfoot, worldwide. Clubfoot is a complex tridimensional congenital foot deformity that can be easily treated after birth by correct manipulation of the foot and serial casting, with a great majority of cases requiring a percutaneous Achilles tenotomy, which can be organized as an ambulatory day procedure, without need for general anesthesia. However, in many low-income countries, treatment is not readily available, and many children grow up with disabling foot deformities. When compared to a newborn's clubfoot, a neglected clubfoot is different and more challenging to treat, as bones become ossified while malaligned and exposed to abnormal forces. Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The upper age limit for the use of Ponseti Method in clubfoot treatment is yet to be established. Success of clubfoot treatment is mostly defined as a pain-free, aesthetically acceptable plantigrade foot, with no need for extensive surgical tissue release after casting and tenotomy. The results of the Ponseti method for the treatment of clubfoot in children after the walking age are encouraging, with more than 80% of success in achieving initial correction and 18-62.5% of relapses. If Ponseti casting is not successful, any further interventions should be carefully selected and planned, in order to maintain the length of the foot and avoid intracapsular scarring or bony fusions.

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INTRODUCTION: Serial Ponseti casting achieves deformity correction in early presenting idiopathic clubfoot cases normally in around 7 casts. However, there are resistant patients where correction requires more casts than usual. In such patients a modification in standard technique might be required right from the beginning. Such patients were collectively called as difficult clubfoot. The aim of this study was to assess the outcome of our modification to Ponseti technique in difficult clubfoot. METHODS: All idiopathic clubfoot cases who were 75th percentile or more in WHO age for weight chart (chubby infants) or untreated clubfoot patients presenting for first time to our clinic at more than 5 months age (late presenters and neglected cases) were included in the study. Patients who had been previously surgically intervened elsewhere, patients over 7 years of age, patients with syndromic clubfoot or clubfoot associated with neurological conditions were excluded from the study. The patients were treated by early tenotomy of tendoachillis and a plantar fascia release before starting serial casting by Ponseti technique. Post correction, strict bracing protocol was followed with regular follow up. Pirani scoring was done at each stage. Measurement of Talocalcaneal angle on AP radiograph, maximum degree of abduction and dorsiflexion was noted once every year. RESULTS: There were total 28 patients in our study. In all, 47 feet were subjected to modified Ponseti protocol. There were 21 male patients. Median age at presentation was 4 months. Mean centile of weight for age as per WHO growth chart was 64. Mean Pirani score at presentation was 5.86 (S.D. ±â€¯0.34). Mean number of casts required for correction was 3.75 ±â€¯1.10. Maximum followup period was 25 months. CONCLUSION: This modification of Ponseti casting for difficult clubfoot patients achieves correction in shorter duration with less number of casts.

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INTRODUCTION: The Ponseti method has been universally adopted for the treatment of children's neglected clubfoot, but not for adult patients. In low- and middle-income countries, there are adult patients with neglected CTEV that remains untreated because the patients have limited access to specialized treatment. CASE REPORT: The Ponseti method was applied in a 26-year-old adult female patient with neglected clubfoot with no previous treatment. The feet had functional mobility and no residual deformities at the end of follow-upperiod. An abduction foot orthosis was prescribed for 1 year after casting period. The patient returned to normal activities after an8-month follow-up period. CONCLUSION: This unique therapeutic success in an adult patient with neglected idiopathic bilateral clubfoot showed that the Ponseti method was a good treatment option.

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INTRODUCTION: Management of neglected clubfoot presents a challenging problem. Treatments traditionally involve extensive posteromedial soft tissue releases, bony procedures, and the Ilizarov technique of differential distraction. CASE REPORT: We present a case of bilateral neglected clubfoot in a 34-year-old female. Management involved the novel combination of the gradual distraction of prepared triple arthrodesis surfaces and the Ponseti regimen which was achieved using the three-dimensional corrective power of hexapod-type circular fixators. Both feet were corrected to achieve plantigrade painless feet. CONCLUSION: Combining the Ponseti regimen with a hexapod fixator has presented an excellent management strategy for neglected clubfeet in an adult. We further propose the use of a generic name, the Ponseti-hex technique, to cover for the use of all makes of hexapod external fixators.

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AIM: To evaluate the effectiveness of the Ponseti method for initial correction of neglected clubfoot cases in multiple centers throughout Nigeria. METHODS: Patient charts were reviewed through the International Clubfoot Registry for 12 different Ponseti clubfoot treatment centers and 328 clubfeet (225 patients) met inclusion criteria. All patients were treated by the method described by Ponseti including manipulation and casting with percutaneous Achilles tenotomy as needed. RESULTS: A painless plantigrade foot was obtained in 255 feet (78%) without the need for extensive soft tissue release and/or bony procedures. CONCLUSION: We conclude that the Ponseti method is a safe, effective and low-cost treatment for initial correction of neglected idiopathic clubfoot presenting after walking age. Long-term follow-up will be required to assess outcomes.

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We conducted a study to determine the effectiveness of the Ponseti technique in the management of idiopathic congenital clubfoot in patients older than 1 year of age. A total of 19 patients with 28 clubfeet (16 males [84.2%], 3 females [15.8%]) were included in the present study. The mean age at presentation was 2.7 (range 1 to 3.5) years. The results of treatment using the Ponseti technique were evaluated using the Pirani and Dimeglio scoring systems. The mean precorrection total Pirani score was 4.84 (range 3.5 to 5.5) and the mean precorrection Dimeglio score was 12.96 (range 10 to 14). The mean postcorrection total Pirani score was 0.55 (range 0 to 1), and the mean postcorrection Dimeglio score was 2.32 (range 2 to 3). These differences were statistically significant (p < .001 and p < .001, respectively). In 92.8% of the feet, satisfactory correction of the deformity was achieved. The mean number of casts applied was 8 (range 5 to 12). All but 1 (3.6%) of the clubfeet required tenotomy to achieve correction. The mean follow-up duration was 2.7 (range 1.5 to 3.5) years. We have concluded that the Ponseti technique is an effective method for the management of idiopathic congenital clubfoot, even in toddlers.

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Background: Neglected clubfoot is a common congenital abnormality of uncertain aetiology. It presents with abnormal foot, adductus, varus and equinus of the foot. In Vietnam, the number of people with clubfoot rather high.\r\n', u'Objectives: To evaluate the results of using compression distraction counter direction threaded rod (CDCTR) and complications in clubfoot orthopedic surgery for older children and adults.\r\n', u'Subjects and methods: We studied and treated 118 severe clubfeet in older children and adults by compression distraction counter direction threaded rod (CDCTR) combined with minimal operative intervention.\r\n', u'The mean age of patients at the time of the surgery was 28.5 years (with the range of 3.5-54 years) and the mean follow-up time was 7.2 years (6 months-14 years). \r\n', u'Results: All cases achieved a plantigrade foot with better walking ability and great satisfaction with the results. There were no complications of note. The gradual correction by CDCTR combined with minimal operative intervention to treatment neglected clubfoot in the older children and adults achieved satisfactory results for functional and aesthetic aspects of the foot. \r\n', u'Conclusion: The role of physical therapy after clubfeet orthopedic surgery is very important in recovering the shape and function of the foot.\r\n', u'

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Clubfoot or talipes equinovarus is the most common congenital anomaly of the foot observed in children as well as in adults. This deformity should be treated immediately after birth, and so the cases of old neglected clubfeet are quite rare now. Moreover, in the cases of old neglected clubfoot, it is very difficult to get satisfactory results because there will be secondary adaptive changes in the tarsal bones and surrounding soft tissues. Therefore, clubfeet are considered to be one of many things requiring on or more of the many different types of treatment. The authors have experienced to treat nine cases of old neglected clubfoot from May, 1978 to April, 1988 at the Department of Orthopedic Surgery, St. Mary's Hospital, and reported herewith. 1. Their average age was 14.8 years old (3 to 25 yesrs old). There were one bilateral clubfeet, left foot in 5 cases and right foot in 4 cases. 2. According to the age of the patients and severity of deformities, two patients from three to ten years old were treated with soft-tissue release and serial casting, and seven patients after ten years old were treated by soft-tissue release, various osteotomies and triple arthrodesis. Postoperative management consisted of long leg cast for first four weeks and short leg walking cast for another four to eight weeks. 3. The results were estimated by the talo-calcaneal index according to Beatson et al(3)radiologically and their external appearance of corrected foot subjectively. The talo-calcaneal index was improved from 17.8° to 37° after operation and all of patients satisfied with the results of their operation.

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