Corrective bandages and daily manipulations for treatment of congenital vertical talus: a thirteen year follow-up.

PURPOSE: To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed. METHODS: A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008-2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out. RESULTS: After treatment, TAMBA and talocalcaneal angle changed from "vertical" to "oblique" category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that "No surgery" was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°. CONCLUSIONS: The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.

Treatment of clubfoot with the modified Copenhagen method: A 10-year follow-up.

BACKGROUND: Clubfoot is one of the most frequent congenital malformations in the world. Non-operative methods follows limiting surgery to a minimum. The modified Copenhagen method has not been studied enough. STUDY DESIGN: longitudinal retrospective study. OBJECTIVES: To evaluate prognostic factors for clinical rehabilitation with the modified Copenhagen method in a 10-year follow-up period. METHODS: A retrospective study was carried out on a 10-year follow-up of 82 children diagnosed with clubfoot at birth and treated with the modified Copenhagen method. Their sex, side, severity, bilaterality, forefoot orientation, and age when the nonoperative treatment was started were registered, and a cluster analysis was performed to determine which variables were most significant for predicting whether surgical treatment was needed. RESULTS: Of the clubfeet, 13.4% were grade I, 65.9% were grade II, and 20.7% were grade III according to the Harrold and Walker classification. In total, 58 patients needed surgery at some point during the follow-up period. The severity and talo-first metatarsal angle made it possible to determine whether the patients required surgery in 68% (56/82) of the cases. CONCLUSION: The results of the study suggest the possibility of providing physicians with an algorithm which might facilitate assessing whether the children will require surgery or not, depending on the data obtained from the cluster analysis. Clinical relevance This study provides health professionals with an algorithm that might facilitate assessing whether the children will require surgery or not.

Corrective Bandage for Conservative Treatment of Metatarsus Adductus: Retrospective Study.

BACKGROUND: Metatarsus adductus (MA) is the most common congenital foot deformity observed in children. OBJECTIVES: The aims of this study were: (1) to analyze the evolution of a corrective bandage for semirigid MA in newborns and (2) to recommend the age interval at which to start treatment of MA with the corrective bandage alone, without the need of splints. DESIGN: An observational clinical study was conducted. METHODS: The study was conducted at Virgen Macarena University Hospital in Seville, Spain. Children born with semirigid MA at the hospital during the years 2010-2011 were included. Corrective bandaging was applied to all children until clinical correction of the deformity. Sex, laterality of the deformity, weight and length of the newborn, age at the start of treatment, antecedents related to the pregnancy and birth, type of treatment (bandaging, splints), and correction or no correction with bandaging alone were recorded. Age differences at the start of the bandaging treatment between children whose deformity was corrected with and without the need of splints were examined. The receiver operating characteristic curve method was applied to analyze the predictive ability of the age at the start of bandaging treatment relative to whether the deformity was corrected or not corrected with bandaging alone. RESULTS: The bandage achieved complete correction in 68.1% of the children and corrected the deformity more frequently in girls compared with boys. Of the 56 children who began the treatment within the first month of life, 92.8% achieved correction of the foot deformity with the corrective bandaging alone. LIMITATIONS: Patients' follow-up time was only 2 years, so it was only feasible to analyze the corrective bandaging method over the short term and medium term. CONCLUSIONS: Corrective bandages showed high effectiveness, particularly in girls, and overall when started within the first month of life.

Conservative treatment of clubfoot using modified Copenhagen method.

PURPOSE: To evaluate the efficacy of a modified Copenhagen physical therapy method in reducing surgery rates for congenital idiopathic clubfoot. METHODS: This research is a retrospective descriptive study of 82 patients (123 clubfeet). All patients were younger than 2 months at the beginning of the treatment and were initially evaluated to classify clubfoot severity using the Harrold and Walker scale. The study period included the years from 1980 to 2003, with an average monitoring of 14.5 years (range, 3-26 years). RESULTS: After 3 years of treatment, 55% of the involved feet did not need surgery, 2% needed percutaneous tenotomy of the Achilles tendon, and 43% had posterior release. At the end of monitoring, 34% feet did not need surgery, 2% had percutaneous tenotomy of the Achilles tendon, and 64% required posterior releases. CONCLUSION: The Copenhagen method may reduce the necessity of surgical intervention for idiopathic clubfoot.