RESUMO
Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.2 months; range, 3-40 months), with 19 arthrogrypotic clubfeet, underwent an initial percutaneous Achilles tenotomy to unlock the calcaneus from the posterior tibia followed by weekly Ponseti-style casts. A second percutaneous Achilles tenotomy was performed in 53%. Mean number of casts was 7.7 (range, 4-12). From pretreatment to completion of initial series of casts, mean scores of Dimeglio et al. improved from 16 to 5 (ranges, 12-18 and 2-9, respectively), Catterall scores (as modified by Pirani and colleagues) from 4.8 to 0.9 (ranges, 1.5-6.0 and 0.0-2.0), and maximum passive dorsiflexion from -45 degrees (range, -75 degrees to -20 degrees ) to 10 degrees (range, 0 degrees to 40 degrees ). Ankle-foot orthoses maintained correction. At the minimum followup of 13 months (mean, 38.5 months; range, 13-70 months), the mean maximum dorsiflexion was 5 degrees (range, -20 degrees to 20 degrees ), two patients had posterior releases and no patient's ambulatory ability was compromised by foot shape. Arthrogrypotic clubfeet can be corrected without extensive surgery during infancy or early childhood. Limited surgery may be required as the children age.
Assuntos
Tendão do Calcâneo/cirurgia , Artrogripose/terapia , Braquetes , Moldes Cirúrgicos , Pé Torto Equinovaro/terapia , Manipulações Musculoesqueléticas , Transferência Tendinosa , Artrogripose/complicações , Artrogripose/fisiopatologia , Fenômenos Biomecânicos , Pré-Escolar , Pé Torto Equinovaro/etiologia , Pé Torto Equinovaro/fisiopatologia , Terapia Combinada , Humanos , Lactente , Recidiva , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , CaminhadaRESUMO
Arthrogryposis Multiplex Congenita is a congenital syndrome characterized by multiple contractures, rigid joints, and significant limitation of movement. Intervention, beginning in infancy, requires a comprehensive, holistic, family-centered approach. Long-range goals include achieving maximum range-of-motion and independence in accomplishing activities of daily living. Nursing care must address the developmental, physical, and emotional needs of the child as well as the psychologic concerns and educational needs of parents. The nurse acts as the coordinator of care to assure that the child receives all necessary services, including therapy, social services, and community support. Collaboration between nurse, parents, and other health care providers is crucial to the development and implementation of a long-term therapeutic plan of care which will enhance mobility and independence.