History of club-foot treatment; part II: tenotomy in the nineteenth century.

Clubfoot is one of the most common congenital orthopaedic anomalies and was described by Hippocrates in the year 400 BC. From manipulation in antiquity to splint and plaster in the Renaissance the treatment had improved before tenotomy. Tenotomy was tested during the 19th century and will be explained in this manuscript; the introduction of subcutaneous tenotomy of the Achilles tendon had focused the attention of surgeons on the surgical treatment of clubfeet. While this operation was very successful in the correction of equinus deformities due to poliomyelitis, cerebral palsy, and old injuries, it was not a panacea for the patient with the congenital clubfoot. To be successful, the forefoot adduction and inversion had to be corrected completely before correction of the equinus deformity could benefit the patient. For this reason operations were extended to include tenotomies of other tendons, particularly the anterior tibial tendon and incisions in the capsules of the talar joints.

History of clubfoot treatment; part III (twentieth century): back to the future.

Clubfoot is one of the most common congenital orthopaedic anomalies and was described by Hippocrates in the year 400 BC. From manipulation in antiquity to splint and plaster in the Renaissance the treatment had improved before tenotomy. Many surgical treatments were tested during the nineteenth and twentieth centuries and will be explained in this manuscript; however, the pathology still continues to challenge the paediatric orthopedic surgeon as it has a notorious tendency to relapse, irrespective of whether the foot is treated with conservative or operative means. Part of the reason that the foot relapses is the surgeon's failure to recognize the underlying pathoanatomy. Clubfoot is often automatically assumed to be an equinovarus deformity, however, other permutations and combinations, such as calcaneovalgus, equinovalgus and calcaneovarus, are possible. Out of these combinations, calcaneovalgus occurs most frequently, followed by equinovarus deformity. In more than 90% of the cases, calcaneovalgus responds to conservative treatment, which involves passive manipulation and usually does not require casting or operative intervention as has been demonstrated by Ponseti.

History of clubfoot treatment, part I: From manipulation in antiquity to splint and plaster in Renaissance before tenotomy.

Idiopathic clubfoot is one of the most common problems in paediatric orthopaedics. The treatment is controversial and continues to be one of the challenges in paediatric orthopaedics. The aim of this review is to assess the different methods of clubfoot treatment used over the years in light of the documentation present in the literature and art paintings from the antiquity to the end of the 19th century. The aim of this paper is to review all treatment methods of the clubfoot over the years that were proposed to provide patients a functional, pain-free, normal-looking foot, with good mobility, without calluses, and requiring no special shoes. Hippocrates was the first to write references about treatment methods of clubfoot. After the Middle Ages and the Renaissance where patients were treated by barber-surgeons, quacks and charlatans, bonesetters, and trussmakers, there were more detailed studies on the disease, with the help of famous names in medicine such as Venel and Scarpa.

Dr Karl Koenig: a brief survey of his extraordinary early years.

Over 70 years ago, an Austrian émigré doctor - Karl Koenig - came to Scotland where he established the Camphill Movement. Today that Movement embraces over 100 communities for children and adults with developmental disabilities in at least 24 countries. One aspect of Koenig's biography that has not been explored concerns his childhood: an extraordinary omission given its inspirational character. Without an appreciation of this critical period in his life, any understanding of his very considerable achievements not least his pioneering success in establishing the Camphill Movement must be incomplete.

[Clubfoot treatment through the ages: the Ponseti method in comparison to other conservative approaches and operative procedures]. / Klumpfußbehandlung im Wandel der Zeit: Die Ponseti-Methode im Vergleich zu anderen konservativen Therapieansätzen sowie operativen Verfahren.

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.

Clubfoot: etiology and treatment Ignacio V. Ponseti, MD, 1914-.

This biographical sketch of Ignacio V. Ponseti, MD, corresponds to the historic text, The Classic: Congenital Club Foot: The Results of Treatment, available at DOI 10.1007/s11999-009-0720-2 and The Classic: Observations on Pathogenesis and Treatment of Congenital Clubfoot, available at DOI 10.1007/s11999-009-0721-1.

Francisco Arceo de Fregenal and the treatment of clubfoot up to the sixteenth century

The correction of clubfoot as a subject of study is somewhat unusual, especially if one considers that up until the Renaissance only two authors dealt with the subject of this inherited disorder. On the one hand is Ambroise Paré, whose contributions to traumatology and orthopaedics are staggering, and on the other, Francisco Arceo de Fregenal, also known as the Ambroise Paré of Spain. Both men developed a method for treating this condition, and a special orthopaedic shoe. So, why is it that in the Spanish literature the French surgeon was considered the pioneer in the development of an orthopaedic boot from the start and not Arceo? Why was the work of the Spaniard not studied in depth, as it deserves to be? These questions troubled us and led us to write this paper, in which as the primary objective we decided to highlight Arceo's contributions to the field of orthopaedics. Concrete arguments and works exist today that have led to common agreement among scholars of the subject that the Spanish surgeon was a Jewish convert. The social, economic and political conditions in Europe at that time may give us some idea of the difficulties for a Jewish convert in the sixteenth century, and clearly, it was difficult for a scientist to have followers who would defend his methods and technical ideas. Nevertheless, we believe that Francisco Arceo de Fregenal deserves more recognition and his work should continue to be studied in more depth.

The clubfoot over the centuries.

The aim of this paper is to review all treatment methods of the clubfoot over the years through the documentation present in the literature and art with the aim of better understanding the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. The initial part of this paper traces the most representative iconographic representations of clubfoot in history to describe how his presence was witnessed since ancient times. Hippocrates, the father of medicine, was the first to present written references about treatment methods of clubfoot. After the dark period of the Middle Ages, during the Renaissance, there were more detailed studies on the disease, with the creation of the first orthopedic orthotics, designed to correct the deformity with the help of famous names in medicine's history. In the XVIII century, as we witness the birth of orthopedics as a distinct discipline in medicine, more and more brilliant minds developed complex orthoses and footwear with the aim of obtaining a proper correction of the deformity. In the last part of the paper, there is a description of the main surgical techniques developed over the years until the return to conservative treatment methods such as the Ponseti method, internationally recognized as the gold standard of treatment, despite the presence of some unresolved issues such as the possible recurrence of the disease.

The clubfoot painted by Jusepe de Ribera: a controversial diagnosis.

The Clubfoot painted by José de Ribera depicts a young beggar affected by a typical equinus clubfoot. He shows a contorted right hand and wrist. His left hand holds a begging note, suggesting some difficulty to speak. This condition may be caused by a cerebral palsy, consisting of a brain injury in the left hemisphere responsible for right hemiplegia and speech disturbance. Recently, it was suggested that the boy's condition is a consequence of arthrogryposis, perhaps amyoplasia or distal arthrogryposis type A1. Some clinical features may suggest the diagnosis of Sheldon-Hall syndrome. Considering all the signs represented on the painting, the diagnosis of hemiplegia due to cerebral palsy cannot be discarded. The present article is a novel analysis of the painting based on previously proposed diagnoses of the boy's condition, namely, hemiplegia and arthrogryposis.

What makes Hephaestus lame?

Hephaestus (or Hephaistos) is an Olympian Greek god, the divine smith, famed for inventions, who taught men glorious crafts. The fixed epithet for Hephaestus, used from the eighth century B.C. by Homer, Hesiod, and other ancient authors until the fifth century A.D., is "Amphiguéeis," i.e., with both feet crooked. He is also called "Kullopodíou," i.e., clubfooted. His body and his gait were described by Homer: "He spake, and from the anvil rose, a huge, panting bulk, halting the while, but beneath him his slender legs moved nimbly ... and with a sponge wiped his face and his two hands withal, and his mighty neck and shaggy breast, ... and grasped a stout staff, and went forth halting; but there moved swiftly to support their lord handmaidens wrought of gold in the semblance of living maids." His anomaly was congenital, as we learn from Hephaestus himself ("I was born misshapen") and from his mother Hera ("But my son Hephaestus whom I bare was weakly among all the blessed gods and shrivelled of foot."). Vase paintings of the sixth century B.C. depict Hephaestus' lameness, but his lameness is not emphasized in the fifth century and thereafter. It is most likely that bilateral congenital clubfeet made Hephaestus lame. Two sons of Hephaestus, Palaemonius and Periphetes, were also reported as having deformed feet.

Anatomy of uncorrected talipes equinovarus in a fifteenth-century American Indian.

Although congenital talipes equinovarus is the most common major musculoskeletal malformation in contemporary populations, its occurrence in archaeological specimens is rare. The deformity of untreated clubfoot in an adult American Indian male is discussed.

A personal revolution in the development of clubfoot correction.

This article presents the author's experience of having worked in London, England, under Denis Browne, whose method of treating equinovarus in the newborn involved manipulation of the baby feet until full correction had been achieved at the very first visit. The feet were then strapped to the sole plates of the Denis Browne splint, which ensured that the baby's normal kicking action maintained mobility at the subtalar joints and also a basic plantigrade posture. When he transferred to India, the author found a large population of children who had been born with talipes equinovarus, but who had never had treatment. He worked at obtaining correction without strong manipulation, using serial plaster casting followed by Denis Browne's splints. His personal reactions to the problems and the merits of the two methods forms the subject of this article.

Congenital idiopathic clubfoot deformities.

Clubfoot is a birth defect that is marked primarily by a deformed talus (ie, ankle) and calcaneous (ie, heel) that give the foot a characteristic "club-like" appearance. In congenital idiopathic clubfoot (ie, talipes equinovarus), the infant's foot points downward (ie, equinus) and turns inward (ie, varus), while the forefoot curls toward the heel (ie, adduction). This congenital disorder has an incidence of 1 in 400 live births, with boys affected twice as often as girls. Unilateral clubfoot is somewhat more common than bilateral clubfoot and may occur as an isolated defect or in association with other disorders (eg, chromosomal aberrations, cerebral palsy, spina bifida, arthrogryposis). Infantile clubfoot deformity is painless and is correctable with early diagnosis and prompt treatment.

Treatment of idiopathic clubfoot: an historical review.

Idiopathic clubfoot, one of the most common problems in pediatric orthopaedics, is characterized by a complex three-dimensional deformity of the foot. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. This controversy is due in part to the difficulty in measuring and evaluating the effectiveness of different treatment methods. We believe the heart of the debate is a lack of understanding of the functional anatomy of the deformity, the biological response of young connective tissue to injury and repair, and their combined effect on the long-term treatment outcomes. The aim of this review is not only to assess the different methods of clubfoot treatment used over the years in light of an evolving understanding of the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management. Further research will be needed to fully understand the pathogenesis of clubfoot, as well as the long-term results and quality of life for the treated foot.