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The aim of this study is; to measure the attitudes of parents with children with congenital pes equinovarus towards the physical education class and to evaluate the anxiety level of participants, to measure the importance of physical activity for parents and the anxiety generated. This study was conducted with 213 parents of children with pes equinovarus. A survey form, Parents attitude scale towards physical education class (PASTPEC) and Beck anxiety scale (BAI) were applied to the families. Descriptive statistics were given with percentage and mean ± standart deviation (sd). The mean score taken from the BAI is 14.90±11.91. Accordingly, 64.8% of the participants had mild anxiety, 15.0% had moderate anxiety, and 20.2% had severe anxiety. PASTPEC mean total score is 89.58±10.83. 25.8% of the participants stated that their children did a different physical activity. When asked whether they had done any planned physical activity, 33.8% (n=72) answered positively. Severe anxiety is significantly lower in families whose children engage in activities on a regular basis. The frequency of anxiety is higher in those with low income status and those with low education status of their partner. PASTPEC score were found to be higher in those who did physical activity from parents, those with good income status, and those with high educational status of their spouse and themselves. The degree of pes equinovarus and the presence of other chronic diseases of the child do not change the attitude. The degree of pes equinovarus and whether the child has other chronic diseases did not have an effect on the severity of the parent's anxiety and PASTPEC score. The main influencing factors are education level and income status. The importance of social economic and social cultural levels of societies in terms of preventive medicine has also been shown in this study. [ABSTRACT FROM AUTHOR]

Clubfoot is one of the most common musculoskeletal birth deformities worldwide. The prevalence varies among individual countries and populations. There is a lack of nationwide incidence studies in Central Europe. We analyzed the incidence of clubfoot in the Czech Republic over 14 years. Patients born with clubfoot in the Czech Republic were identified using The National Registry of Congenital Anomalies. Demographic data were included. Data from 2000 to 2014 were collected and analyzed regarding gender and regional distribution. The study's chosen time frame was grounded on the condition of the Czech industry. Following extensive transformations in 1989, the industry eliminated highly non-ecological operations with significant environmental impact and related health risks. The incidence of clubfoot during the study period was 1.9 (95% CI 1.8–2.0) per 1000 births; males comprised the majority (59%). The incidence significantly differed among individual regions of the Czech Republic (p < 0.001). The incidence in the Czech Republic was higher than in previous European studies. We found significant regional differences in incidence, which could indicate that there may be exogenous pathogenic factors. For this reason, we plan to follow up our work with an up-to-date study. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) is a prevalent congenital foot deformity. The Ponseti method is a non-surgical treatment for clubfoot, which entails a sequence of casts and braces. The accelerated Ponseti method is a modified version of the standard Ponseti method, involving more frequent cast changes. Methods: A total of 60 patients with idiopathic congenital talipes equinovarus (CTEV) under the age of one were carefully chosen and assigned to two groups of A (standard) and B (accelerated). The Pirani score was used to evaluate each clubfoot before applying a cast. In group A, aboveknee casting was performed once a week, while in group B, it was done twice a week. Results: The study involved 60 children with a total of 75 feet. The results indicated a shorter treatment duration with the accelerated Ponseti method, while the occurrence of skin complications was comparable between the two methods. Conclusion: In conclusion, both the accelerated and standard Ponseti methods are equally effective in correcting clubfoot. The accelerated method offers the advantage of reducing the overall treatment duration and has clear benefits, while no notable difference is observed in skin complications between the two methods. [ABSTRACT FROM AUTHOR]

Microdeletion of the short arm of chromosome 18 is one of the most common chromosome deletion syndromes. Its estimated frequency is 1 in 50,000 live-born infants, with female prevalence over males. Around 150 cases have been described till now. The reported abnormalities include growth deficiency, hypotonia, microcephaly, dysmorphic facial features such as ptosis, epicanthal folds, hypertelorism and micrognathia, and relatively small hands and feet. Our patient was a full-term low birth weight (2150 gm) female newborn, showing cleft upper lip and palate (hard and soft palate), bilateral congenital Talipes Equinovarus with rocker bottom foot, microcephaly, atrial septal defect. She was initially conservatively managed with gavage feeding, then shifted into paladai feeding of expressed breast milk. A multidisciplinary approach was adopted due to various malformations and for the potential occurring complications. To our knowledge, this is the first case diagnosed during the neonatal period. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to investigate the value of whole exome sequencing (WES) for clubfoot (CF) fetuses with or without other structural abnormalities and to further explore the genetic causes of fetal CF. Methods: this study included 83 singleton pregnancies diagnosed with fetal CF referred to our center between January 2016 and March 2022; cases were divided into two groups: isolated CF and non-isolated CF. After excluding cases with positive karyotyping and chromosomal microarray analysis results, WES was performed for the eligible fetuses and parents. Monogenic variants detected by WES and perinatal outcomes were recorded and evaluated at postnatal follow-up. Results: overall, clinically significant variations were identified in 12.0% (10/83) of fetuses, and the detection rate was significantly higher in the non-isolated than in the isolated CF group (8/36, 22.2% vs. 2/47, 4.3%, p = 0.031). We additionally detected eight (9.6%) fetuses harboring variants of unknown significance. We identified 11 clinically significant variations correlating with clinical phenotypes in nine genes from ten fetuses, with KLHL40 being the most frequent (n = 2). Furthermore, we observed a significant difference in termination and survival rates between isolated and non-isolated CF cases (27.6 vs. 77.8% and 59.6 vs. 19.4%, p < 0.001 for both). Conclusion: our data indicate that WES has a high additional diagnostic yield for the molecular diagnosis of fetal CF, markedly enhancing existing prenatal diagnostic capabilities and expanding our understanding of intrauterine genetic disorders, thus assisting us to better interpret fetal phenotype in the future. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of Tibialis Anterior Tendon Transfer in treatment of cases of Dynamic Foot Supination in Relapsed Clubfoot. Methods: Pediatric Unit of Orthopedic Surgery Department, Zagazig University Hospitals. All patients fulfilling the inclusion criteria included in the study in a time period of 6 months were 12 patients. A total of 12 patients (9 males and 3 females) with 1 bilateral, 7 right feet and 4 left feet. The 9 males were (1 bilateral, 5 right foot and 3 left foot). The 3 females were (2 right foot and 1 left foot). Results: We studied 12 cases 9 males and 3 females with mean age of 4.83±0.71 to assess outcome of Tibialis Anterior Tendon Transfer in Management of Relapsed Clubfoot. Conclusion: Tibialis anterior tendon transfer has been the treatment of choice for cases of relapsed CTEV in the form of dynamic supination for years. It has a high success rate and very low post-operative complications and very low incidence of residual deformity if done correctly. [ABSTRACT FROM AUTHOR]

Background: Congenital Talipes Equinovarus (CTEV) is a multitude of deformities involving equinus, varus, adductus, and cavus deformities. Clubfoot affects 1 in every 1000 infants born worldwide, with various incidences according to geographical areas. It has been previously hypothesized that the possible genetic role in Idiopathic CTEV (ICTEV) might have a treatment-resistant phenotype. However, the genetic involvement in recurrent ICTEV cases is yet to be determined. Aim: To systematically review existing literature regarding the discovery of genetic involvement in recurrent ICTEV to date to further understand the etiology of relapse. Methods: A comprehensive search was performed on medical databases, and the review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed on several medical databases: PubMed (MEDLINE), Scopus, the Cochrane Library, and European PMC on May 10, 2022. We included studies reporting patients with recurring idiopathic CTEV or CTEV of unknown cause after treatment, reporting whole-genetic sequencing, whole-exome sequencing, Polymerase Chain Reaction, or Western blot analysis as methods of genetic analysis (intervention) and providing results of idiopathic CTEV genetic involvement. Non-English studies, literature reviews, and irrelevant articles were excluded. Quality and risk of bias assessments were performed using Newcastle-Ottawa Quality Assessment Scale for non-randomized studies where appropriate. The authors discussed data extracted with the primary outcome of gene(s) frequency being reported of their involvement in recurrent ICTEV cases. Results: Three pieces of literature were included in this review. Two studies analyzed the genetic involvement in CTEV occurrence, while one analyzed the protein types found. Discussion: With included studies of less than five, we could not perform other forms of analysis apart from qualitatively. Conclusion: The rarity of literature exploring the genetic etiology of recurrent ICTEV cases has been reflected in this systematic review, giving opportunities for future research. [ABSTRACT FROM AUTHOR]

Introduction: Popliteal pterygium syndrome (PPS) is a rare autosomal-dominant condition that causes fixed flexion deformity of the knee. The popliteal webbing and shortening of the surrounding soft tissue could limit the functionality of the affected limb unless it is surgically corrected. We reported a case of PPS in a pediatric patient encountered in our hospital. Case: A 10-month-old boy came with a congenital abnormally flexed left knee with bilateral undescended testis and syndactyly of the left foot. The left popliteal pterygium extending from the buttock to the calcaneus was observed, with an associated fixed flexion contracture of the knee and equine position of the ankle. Normal vascular anatomy was seen in the angiographic CT scan; therefore, multiple Z-plasty and fibrotic band excision were performed. The sciatic trunk was exposed on the popliteal level, and the fascicular segment was excised from the distal stump and sutured to the proximal stump under the microscope to extend the sciatic nerve for approximately 7 cm. No postoperative complications were reported. Multiple tendons and soft tissue reconstruction were performed when the patient was 2-year-old to correct the adductus and equine deformity of the left foot. Discussion: Surgical correction for popliteal pterygium demands staged techniques to deal with the shortened structure. In our case, multiple Z-plasty were performed, and the fibrotic band was excised until its base with meticulous consideration of the underlying neurovascular bundle. Fascicular shifting technique for sciatic nerve lengthening can be considered in unilateral popliteal pterygium with difficulty extending the knee due to shortened sciatic nerve. The unfavorable outcome of nerve conduction disturbance resulting from the procedure may be multifactorial. Still, the existing foot deformity, including a certain degree of pes equinovarus could be treated by multiple soft tissue reconstructions and adequate rehabilitation to achieve the desired outcome. Conclusion: Multiple soft tissue procedures resulted in acceptable functional outcomes. However, the nerve grafting procedure is still a challenging task. Further study is required to explore the technique in optimizing the nerve grafting procedure for popliteal pterygium. [ABSTRACT FROM AUTHOR]

To establish international recommendations for the management of spastic equinovarus foot deformity. Delphi method. International study. A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. A consensus was established when at least 80% of experts agreed on a statement A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy. [ABSTRACT FROM AUTHOR]

Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years' experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell–Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications. [ABSTRACT FROM AUTHOR]

The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents. [ABSTRACT FROM AUTHOR]

The number of deep learning (DL) layers increases, and following the performance of computing nodes improvement, the output accuracy of deep neural networks (DNN) faces a bottleneck problem. The resident network (RN) based DNN model was applied to address these issues recently. This paper improved the RN and developed a rectified linear unit (ReLU) based conditional generative adversarial nets (cGAN) to classify plantar pressure images. A foot scan system collected the plantar pressure images, in which normal (N), planus (PL), and talipes equinovarus feet (TE) data-sets were acquired subsequently. The 9-foot types named N, PL, TE, N-PL, N-TE, PL-N, PL-TE, TE-N, and TE-PL were classified using the proposed DNN models, named resident network-based conditional generative adversarial nets (RNcGAN). It improved the RN structure firstly and the cGAN system hereafter. In the classification of plantar pressure images, the pixel-level state matrix can be direct as an input, different from the previous image classification task with image reduction and feature extraction. cGAN can directly output the pixels of the image without any simplification. Finally, the model achieved better results in the evaluation indicators of accuracy (AC), sensitivity (SE), and F1-measurement (F1) by comparing to artificial neural networks (ANN), k-nearest neighbor (kNN), Fast Region-based Convolution Neural Network (Fast R-CNN), visual geometry group (VGG16), scaled-conjugate-gradient convolution neural networks (SCG-CNN), GoogleNet, AlexNet, ResNet-50–177, and Inception-v3. The final prediction of class accuracy is 95.17%. Foot type classification is vital for producing comfortable shoes in the industry. [ABSTRACT FROM AUTHOR]

Hallux valgus interphalangeus (HVIP) is a deviation of the distal phalanx in relation to the proximal phalanx. Its etiology is considered multifactorial, including growth development disturbances, external pressure, and biomechanical alteration involving the interphalangeal joint. Here, we report a case of HVIP with the presence of a large ossicle at the lateral side, which was considered related to HVIP development. A 21-year-old woman presented HVIP that had developed since childhood. She complained of pain in her right great toe that worsened in the previous several months, particularly when walking and wearing shoes. Surgical correction consisted of Akin osteotomy, fixation with headless screw, ossicle excision, and medial capsulorrhaphy. The interphalangeal joint angle was improved from 28.69⁰ pre-operatively to 8.93⁰ post-operatively. The wound healed uneventfully and the patient was satisfied. Akin osteotomy with concomitant ossicle excision was effective in this case. Gaining more knowledge regarding ossicles around the foot will provide a better understanding of deformity correction, especially from the biomechanical standpoint. [ABSTRACT FROM AUTHOR]

Methotrexate (MTX), a folate antagonist, is used in various fields, including malignancies and rheumatoid or inflammatory autoimmune diseases. MTX is used for the non-surgical treatment of ectopic pregnancies and the elective termination of pregnancy. The teratogenic effects of MTX have been recognized since the 1960s. Fetal methotrexate syndrome (FMS) was established based on the study of congenital anomalies. Generally, there is a risk of FMS when MTX is used between four and six weeks after conception. Here, we reviewed the literature regarding MTX usage and described a case of FMS that was born with a rare anomaly, such as tibial hemimelia, in a mother who had received MTX 4 months before conception for the management of an ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Clubfoot is a congenital anomaly affecting 1/1,000 live births. Ponseti casting is an effective and affordable treatment. About 75% of affected children have access to Ponseti treatment in Bangladesh, but 20% are at risk of drop-out. We aimed to identify the areas in Bangladesh where patients are at high or low risk for drop-out. This study used a cross-sectional design based on publicly available data. The nationwide clubfoot program: ‘Walk for Life’ identified five risk factors for drop-out from the Ponseti treatment, specific to the Bangladeshi setting: household poverty, household size, population working in agriculture, educational attainment and travel time to the clinic. We explored the spatial distribution and clustering of these five risk factors. The spatial distribution of children

ABSTRACT Congenital clubfoot is one of the most common congenital deformities of the lower limbs, with an estimated incidence of 1 for every 1,000 live births. Its treatment is controversial, and currently the Ponseti method has been widespread, showing promising results and decreasing the need for extensive surgical releases, as was usually done until the introduction of the technique. Currently used in approximately 55 countries, the method has changes and scopes that vary according to the society in which it is applied, with the results and peculiarities of the method molded according to the sample studied. Objective: To evaluate the clinical outcome of clubfoot treatment using the Ponseti method under local conditions. Methods: The clinical evaluation will include a descriptive analysis of the sample, as well as radiographic evaluation and family satisfaction with the treatment. Results: In total, 46% of the patients had good results and no family was dissatisfied with the treatment results. No statistically relevant relationships were found between the studied variables. Conclusion: The results are good and generally similar to those in the literature. Our epidemiological data generally agree with those reported by other authors. Level of Evidence IV, Case Series.

Prenatal diagnosis of clubfoot traditionally relied on two-dimensional ultrasonography. To enhance diagnosis and predict postnatal outcomes, we examined the parameters that differentiate pathological clubfoot using three-dimensional ultrasonography. In our retrospective study, we examined the findings of prenatal ultrasound and the postnatal outcomes of pregnancies with suspected congenital clubfoot between 2018 and 2021. Based on the three-dimensional perspective, we measured the angles of varus, equinus, calcaneopedal block, and forefoot adduction and compared the sonographic variables between the postnatal treated and non-treated groups. We evaluated 31 pregnancies (47 feet) with suspected clubfoot using three-dimensional ultrasonography. After delivery, a total of 37 feet (78.7%) underwent treatment involving serial casting only or additional Achilles tenotomy. The treated group showed significantly greater hindfoot varus deviation (60.5° vs. 46.6°, p = 0.026) and calcaneopedal block deviation (65.6° vs. 26.6°, p < 0.05) compared to the non-treated group. The calcaneopedal block had an area under the curve of 0.98 with a diagnostic threshold of 46.2 degrees (sensitivity of 97%, specificity of 90%, positive predictive value of 97%, and negative predictive value of 90%). During prenatal evaluation of clubfoot using three-dimensional ultrasonography, the calcaneopedal block deviation has the potential to predict postnatal treatment.

ARPKD is a rare, infantile form of PCKD. It's a Ciliopathic disorder with multi-organ involvement. The pathognomonic features are predominately seen in the kidneys and liver. We herein report a case of ARPKD that presented in an antenatal mother whose prenatal screening ultrasonogram revealed enlarged, echogenic kidney with severe oligohydramnios. ARPKD was suspected and due to its poor compatibility with life, patient underwent MTP. Fetal autopsy confirmed ARPKD with potter's sequence - oligohydramnios and CTEV. This extremely rare ARPKD associated with CTEV was seen in only one other published case in India. [ABSTRACT FROM AUTHOR]

Background: Antonio Scarpa (1752-1832) is generally remembered for his discoveries in the field of anatomy, but he also provided some important contributions to the history of surgery. Methods: We analyzed main treatises written by Scarpa, highlighting how he contributed to the development of modern surgery. Results: Scarpa made great innovations in three branches of surgery: abdominal surgery (hernia), orthopedics (clubfoot) and vascular surgery (aneurism). Furthermore, he contributed to the birth of modern ophthalmology. [ABSTRACT FROM AUTHOR]

Abstract Background The Ponseti method is the gold standard for clubfoot treatment. However, relapse and residual gait deviations are common, and follow-up until 7 years of age is recommended. We evaluated the reliability of the foot drawing method, a new instrument for the follow-up of clubfoot. The method uses drawings of the foot in the neutral position and external rotation to measure foot length and outward rotation. Methods Nineteen children aged 2.5–7 years who were treated with the Ponseti method for congenital clubfoot were included. Two raters made the drawings twice (D1 and D2). Each rater measured foot length, foot rotation, and foot–tibial rotation independently (D1). Later, the raters repeated the measurements (D2). Interrater reliability was assessed using the D1 from each rater. Intrarater reliability was assessed using the measurements from each rater’s D1 and D2. Bland–Altman plots were used to visualize the limits of agreement (LoA). The mean, 95% confidence interval, and one standard deviation of the differences in all measurements were calculated. Results The mean differences between and within raters were: foot length

Background: Myelomeningocele is a lifelong condition that features several comorbidities, such as hydrocephalus, scoliosis, club foot, and lower limb sensory and motor disabilities. Its management has progressed over time, ranging from supportive care to early postnatal closure to prenatal closure of the defect. Recent research discovered that fetal myelomeningocele closure (fMMC) provided superior neurological outcomes to those of postnatal closure. When performed at 12 months of age, fMMC can avert or delay the need for a ventriculoperitoneal shunt and reversed the hindbrain herniation. Moreover, fMMC reportedly enhanced motor function and mental development at 30 months of age. However, its long-term outcomes remain dubious. Purpose: This systematic review aimed to determine the longterm neurological cognitive, behavioral, functional, and quality of life (QoL) outcomes after fMMC. Methods: The PubMed, Directory of Open Access Journals, EBSCO, and Cochrane databases were extensively searched for articles published in 2007-2022. Meta-analyses, clinical trials, and randomized controlled trials with at least 5 years of followup were given priority. Results: A total of 11 studies were included. Most studies revealed enhanced long-term cognitive, behavioral, functional, and QoL outcomes after fMMC. Conclusion: Our results suggest that fMMC substantially enhanced patients' long-term neurological cognitive, behavioral, functional, and QoL outcomes. [ABSTRACT FROM AUTHOR]

Acquired equinovarus deformity is rare, with most cases related to congenital disorders such as clubfoot. We describe a unique case of traumatic capsuloligamentous soft-tissue entrapment within the calcaneocuboid joint in a 13-year-old girl, causing an acquired equinovarus deformity. This required surgical exploration and joint fixation. Assessing soft-tissue entrapment on magnetic resonance imaging can be beneficial as a potential cause of an acquired post-traumatic non-reducible foot deformity in children. We discuss the intricate capsuloligamentous structures that reinforce the calcaneocuboid joint and highlight the importance of interrogating such structures in the context of inversion injuries to the ankle. [ABSTRACT FROM AUTHOR]

Arthrogryposis multiplex congenita (AMC) is one of the most common congenital joint contracture syndromes. Talectomy has been proposed for severe foot deformities in AMC, but the literature is limited. The purpose of this systematic review is to evaluate the indications, outcomes and complications of talectomy in arthrogrypotic foot deformities. The articles were found through Embase and Medline. Screening was conducted by two independent investigators with disagreements resolved by a third reviewer. Relevant data regarding demographics, outcomes and complications were collected. Of 232 feet, 71.98 % and 62.22 % had clinical and radiographic improvements respectively. Amongst 122 patients, 92.62 % could ambulate following surgery. Recurrent deformities and revision surgery were seen in 16.81 % and 13.36 % of cases respectively. Talectomy is a valid surgical option for severe arthrogrypotic foot deformities with favorable post-operative outcomes and low complication rate. [ABSTRACT FROM AUTHOR]

Purpose: Clubfoot is among the most common musculoskeletal congenital anomalies. Poor understanding of clubfoot can cause lack of awareness that leads to complications in treating this condition because of late medical intervention. This is considered as a significant public health problem, especially in communities where the burden of clubfoot deformity remains unrecognized. We assessed the level of awareness and knowledge on clubfoot among residents of rural areas and determined the knowledge and attitudes of the public toward the risk factors and general consequences of clubfoot. Methods: This cross-sectional study, conducted from January to July 2021, included the general population of small city and rural area residents. The participants completed a self-administered survey on the web. The questionnaire was pre-tested in a pilot study to ensure comprehension and ease of administration. Results: Altogether, 41.6% of the participants recognized the scientific name of clubfoot in their native language, whereas 38.9% identified the disorder after they were shown a photograph of it. The most recognized risk factors of clubfoot according to the participants were family history (52.2%), complicated pregnancy (46.5%), and medications (43.4%). Only 8.8% of the participants considered casting the initial treatment of clubfoot. Conclusion: An individual's residential area plays a role in their level of awareness concerning clubfoot. Our results suggest that many educational interventions for clubfoot must be provided in rural areas, particularly regarding therapeutic options and plans of care. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to know about the outcome of bipolar release of congenital muscular torticollis in children above 5-years. Introduction: Congenital muscular torticollis is the 3rd most common musculo-skeletal anomaly after club foot and developmental dysplasia of hip. It is characterized by shortening of the sternocleidomastoid muscle leading to tilting of head towards and chin to the opposite side. Physical therapy yields excellent results when diagnosed early. Surgery is indicated for late presentation or those with residual deformity after physical therapy. Material and Methods: It was a descriptive observational study utilizing consecutive nonprobability sampling technique. Patients with congenital muscular torticollis and age above 05 years were included in the study. Bipolar release was performed in all and outcome was measured with scoring system of Lee et al. Setting: The study was carried out at the Department of Orthopaedic and Spine Surgery, Haytabad Medical Complex, Peshawar from September 2008 to January 2020. Results: During the study period a total of 29-patients with Congenital Muscular Torticollis (CMT) underwent bipolar release of the SCM muscle. The mean age at surgery was 08.92±2.20 years (range = 05-18 years). Out of 29-patients excellent or good results were noted in 23 (79.3%). A score of 17-18 points was achieved in 17-patients (58.6%) accounting to excellent results whereas 08-patients (27.6%) were graded as good (15-16 points). Fair outcome was noted in 3 patient (10.3%). One patient had poor result in the study. Conclusion: Bipolar release of the sternocleadomastoid is a safe and effective method for treating Congenital Muscular Torticollis even in children older than 5 years. It has got few complications and it provides good cosmetic and functional results. It resolves the deformity and restores the neck range of motion. [ABSTRACT FROM AUTHOR]

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Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: "Idiopathic Clubfoot" (All Fields) AND "Management" OR "Outcomes" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0–12 months). A full-text review of these articles was then performed looking for "complications" or "errors" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients. [ABSTRACT FROM AUTHOR]

Context: Orthopedic education and training can increase surgical capacity and improve clinical outcomes in low- and-middle income countries (LMICs). Aims: We aimed to identify the published reported outcomes of education and training programs pertaining to limb deformities in LMICs. Settings and Design: A state-of-the-art review was conducted using seven databases (Africa-Wide Information, Aim, CINAHL, Embase, Global Health, Medline, and Web of Science). Subjects and Methods: The search included articles with keywords related to limb deformities AND education AND LMICs published between 2017 and 2021. The search yielded 4511 articles for the title and abstract screening. Screening yielded eight articles for full-text review and three articles for extraction. Data on the mechanics, topics, and outcomes of each educational opportunity were extracted using REDCap. Statistical Analysis Used: This was a state-of-the-art review. Results: Three studies met inclusion criteria. The studies were published from 2018 to 2020 and based on the African continent, with partners from the US and UK. Study designs included retrospective comparative, systems approach, and mixed methods all with level IV level of evidence. One study was conducted virtually, with 259,986 viewers of video-based content created by medical students related to various orthopedic topics, including limb deformities. The other two studies were related to an in-person clubfoot training program with 113--185 participants. These two studies included pre- and posttraining evaluation, with outcomes related to participation, knowledge gained, and efficacy. All the studies reported an overall positive effect of the intervention. Conclusions: There is limited available information regarding limb deformity educational interventions in LMICs. The current review suggests a positive impact of such educational interventions and emphasizes a need for more research on the topic. [ABSTRACT FROM AUTHOR]

Background: Congenital Talipes Equino Varus (CTEV) is a common congenital foot deformity that is associated with long term disability. Treatment with Ponseti method has been successful especially for children who present early. We conducted this study between June 2008 and August 2019 at the King Abdulaziz Medical city, Riyadh and it was conducted to investigate the patterns of clubfoot deformity and adherence to ponseti treatment protocol among children with clubfoot deformity and to report the early and late outcome. Methods: It was a retrospective study from one single tertiary institute and all patients were treated with the same surgeon. A total of 93 rigid club foot, age between 1 day to 5 years of both male and female were selected purposively to conduct this study. Face-to face interview method was adopted by using semi-structured questionnaire. Results: Most of the children were boys. More than two third (69.7%) were in the age group less than 12 months. Study found 41 (44.1%) of our sample presented with both feet deformity, 29 (31.2%) had only right foot deformity and the rest of 23 (24.7%) presented only with left foot deformity. (76.3%) of our sample had typical idiopathic clubfoot deformity. The rest of 15.1%(14) and 8.6%(8) had neurogenic and Syndromatic underlying pathology respectively. The mean number of castings was 5 and mean duration of casting was 9 weeks. Majority (81.7%) of the parents were fairly adherent to the Ponseti protocol, where 18.3% reported poor compliance to the instructions for deferent reasons. The initial success rate of 97.9% was reached, with two feet (2.1%) diagnosed as a resistant clubfoot and eventually required posteromedial soft tissue surgery. With mean follow up of 39.1 months. 6 feet (4.4%) developed relapse but were treated with repeated Ponseti method, while 3.7%(5) required re-do TAL, and 3 feet(2.2%) developed late dynamic supination and was corrected by Tibialis Anterior Tendon Transfer to lateral Cuniform bone. Conclusion: This study presents patients with Congenital Talipes Equino Varus (CTEV) deformity which was successfully managed by Ponseti Protocol. Many CTEV patients still present late for treatment. However, the Ponseti method remained very effective with very high initial success rate of 97.9%. Relapsed CTEV can still be treated successfully with repeat casting using the Ponseti method. Strict adherence to the Ponseti recommendations by both treating physician and parents is the golden key to the best final success rate. [ABSTRACT FROM AUTHOR]

Clubfoot is one of the most common congenital anomalies, affecting every 1 of 1000 live births in the UK. Historically, clubfeet have been managed with a variety of conservative and operative techniques. Over the last two decades, the Ponseti serial casting method has become the gold standard of treatment. In July 2021, the British Society of Children's Orthopaedic Surgery (Gelfer et al, 2022) published a consensus statement that outlines the optimal management for clubfoot. This article provides an overview of clubfoot and a summary of the latest management guidelines. [ABSTRACT FROM AUTHOR]

To evaluate the contribution of genetic investigations in case of isolated bilateral clubfoot detected by routine prenatal ultrasound. Pathogenic Copy Number Variations is about 3.9% in fetuses with isolated clubfoot (uni- or bilateral). We hypothesize that this rate could be higher in a homogenous group of fetuses with bilateral clubfoot. This retrospective single-center study included all women referred to our fetal-medicine center between 2013 and 2020 after ultrasound detection of isolated bilateral clubfoot. Genetic counseling was offered in which the woman was offered an amniocentesis for CMA and targeted investigation for Prader-Willi Syndrome (PWS), Steinert's disease and Spinal Muscular Atrophy (SMA). 34 women were referred, 18 of them consented to undergo genetic studies by amniocentesis (18/34; 52.9%). Pathogenic copy number variations (CNVs) were found in 2/18 (11.1%) of cases. One of these CNVs was directly linked to the clubfoot pathology (a deletion in 5q31.1 containing PITX1 gene). Four fetuses (4/18, 22.2%) had variants of unknown significance (VUS). No PWS, SMA or Steinert's disease was found. No case diagnosed with isolated clubfoot prenatally had additional anomalies postnatally. In the case of bilateral isolated clubfoot detected at the antenatal ultrasound, invasive prenatal testing should be offered, and if accepted, a CMA should be done, as pathogenic variations were observed in up to 11.1% of women who got amniocentesis. The findings of this study do not support the systematic recommendation of molecular studies for PWS, SMA, Steinert's disease. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot. Methods: A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with "3°" of posterior varus, "0°" of a neutral position and "3°, 6°, 9°" of valgus as the correction angles. Results: The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus "6°". In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus "3°", neutral "0°", valgus "3°" and valgus "9°" compared with the preoperative stress. Conclusion: The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of "6°" of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis. [ABSTRACT FROM AUTHOR]

Background: In India congenital malformations have emerged as the third commonest cause of perinatal morbidity and mortality, next only to malnutrition and infections. Aim: To know the frequency of congenital musculoskeletal anomalies in neonates. Methods: The present study was undertaken by collecting the data from the Department of Anatomy, PES institute of Medical Sciences and Research, Kuppam, Andra Pradesh, India, for a period of one year fromOctober2021 to October 2022, during which 650new born neonates were examined which included live births and still births. All birth safter 28 completed weeks were examined forcong enitalmusculosk eletalanomalies with in 24-48hours after birth with a written consent from parents/ relatives, opinion of concerned Paediatrician was soughtin confirming the diagnosis. Results: Total births during the study period were 650. The total number of cases with musculoskeletal malformations were 25 with an incidence of 2.9/1000 births and the total number of malformations were 25. 80% of cases were born alive and 20% of cases were still born. MSK malformations were more common in male babies (64%) than in female babies (36%). 56% of cases had low birth weight and 44% had normal birthweight (mean birth weight of all neonates = 2.28 kg). 60% of cases attained the term and 40% were premature babies. Malformations were more common in first and second para(44% each) and declined with increased parity. Conclusion: The current study found a lower incidence of congenital MSK abnormalities than in India and internationally. CTEV incidence was higher than other anomalies in our sample, but lower than other studies. Males had more congenital MSK abnormalities than females. Most newborns with MSK abnormalities were full-term and healthy. Younger moms have more kids with MSK abnormalities, and parity reduces them. Antenatal USG detected most abnormalities. Most patients were from upper-low SES families with poor parental education. Consanguinity seldom caused MSK malformations. [ABSTRACT FROM AUTHOR]

Background and objectives: Many individuals with ignored CTEV, residual CTEV, or recurrent CTEV visit the orthopaedic department. Typically, they start to show up about a year of age. Soft tissue release is frequently insufficient for complete correction in an older child. It is even harder for a patient who has a surgical scar from a prior procedure. In order to repair the deformity in such individuals, fractional distraction using Joshi's external stabilisation device is a useful alternative. We set out to examine the cosmetic, functional, and anatomical outcomes of the short-term follow-up of 45 patients with 16 bilateral instances who had received treatment using Joshi's external stabilisation device. Methods: Joshi's external stabilisation method was applied to 45 patients, including 16 bilateral instances, at the Department of Orthopaedics, Government Medical College, Nizamabad, Telangana, India between October 2021 to September 2022. Patients were chosen without regard to their gender, but this research excluded those who had non-idiopathic club feet. Fractional distraction was the approach of correction used in this investigation. Results: Within the investigation, 33.3% of the participants had already undergone various surgical procedures, included posteromedial surgical release. 66.1% had conservative treatment, that includes serial casting and neglecting CTEV in one kid. In these instances, 66.7% of the individuals had a severity rating of 5 or higher. Youngsters with less severe deformities spent less time distracted. 59.7% achieved excellent and favourable ratings. Conclusion: JESS is a basic and straightforward tool that makes fractional distraction clear and understandable. The parents pick up the diversion strategy quickly and typically complain. For sustaining full correction, an adequate static period is required. Protection splints are essential for maintaining the correction after the external fixator has been taken off. Regardless of how severe the deformity is, the operation is less invasive and yields good outcomes. [ABSTRACT FROM AUTHOR]

Background: Congenital TalipesEquinoVarus (CTEV) is one of the most common congenital anomalies, that needs timely intervention and proper maintenance treatment through meticulous follow up to obtain a satisfactory functional outcome. The type of intervention varies from case to case and it is determined by the severity of the deformity, the type of the deformity and the age at which the child seeks medical attention. Hence clinical as well as radiological evaluation of the deformity is essential before the commencement of treatment in CTEV, as it can contribute to the Outcome of Treatment and its prognosis. Materials and Methods: The present Cohort study was conducted in the Outpatient Division of the Department of Physical Medicine & Rehabilitation, Government Medical College, Thiruvananthapuram,Kerala.50 children with CTEV in the age group of 1 month to 5 years who received Conservative mode of treatment from the Department were studied. Results: In Children with Idiopathic Congenital TalipesEquinoVarus(CTEV), in the age group of 1 month to 5 years, who underwent Conservative mode of treatment with maintenance of correction using an Orthosis, it was found, after Clinical and Radiological Serial assessment, that Initial TaloCalcaneal Angle of more than 10 degrees, Presence of Normal Cuboid Sign and Absence of InterSegmental Joint break in Radiograph of Foot of Children with CTEV have Significant Positive association with Prognosis in terms of Final Outcome of Treatment (Good and Favourable Prognosis) It is also shown that CTEV has Male preponderance and Inverted Cuboid Sign in Radiograph of Foot indicates Severity of the Deformity. Conclusion: This is a Prospective Study of Children with Idiopathic CTEV in the age group of 1 month to 5 years, having undergone Conservative treatment as mentioned with Maintenance of correction using an Ankle Foot Orthosis. They were followed up for one year period from the start of treatment and assessed clinically on monthly basis and radiologically every three months. It is found that Radiological Parameters, viz. TaloCalcanealAngle, Normal/Inverted Cuboid Sign and InterSegmental Joint break have Prognostic significance in terms of Final Outcome of Conservative Management of Idiopathic CTEV. (Initial TaloCalcaneal Angle of more than 10 degrees, Normal Cuboid Sign and Absence of InterSegmental Joint break are Radiological findings indicative of Good and Favourable Prognosis of Outcome) [ABSTRACT FROM AUTHOR]

Objective: The outcome of congenital clubfoot treatment is still challenging if the feet deformities are not completely corrected. Here we explore a minimal invasive procedure with an eight‐plate implant to correct the residual forefoot adduction deformity after treatment of neglected or relapsed clubfoot. Methods: We retrospectively reviewed patients with residual forefoot adduction deformity after clubfoot treatment between January 2013 and June 2016. The patients underwent temporary epiphysiodesis of the lateral column of the mid‐foot, which in detail, an eight‐plate was placed on each side of the calcaneocuboid joint. The foot deformities were recorded according to the weight‐bearing radiographic measurements including talo‐first metatarsal angle, calcaneo‐fifth metatarsal angle and medial‐to‐lateral column length. Results: A total of 13 patients (20 feet) with an average age of 7.8 years old were located with an average duration of 40.8 months follow‐up (range, 28 to 54 months). The average talo‐first metatarsal angle improved from 28.3° (range, 19° to 47°) preoperatively to 8.3° (range, 3° to 18°) and the calcaneo‐fifth metatarsal angle improved from 29.1° (range, 19° to 40°) preoperatively to 8.4° (range, 0° to 21°) at final follow‐up. The mean ratio of the medial‐to‐lateral column length improved from 1.14 ± 0.06 to 1.55 ± 0.09 with statistical significance (t = 3.566; P < 0.001). Conclusions: Eight‐plate epiphysiodesis is an easy and effective method for the correction of residual forefoot adduction deformity after clubfoot treatment in growing children without the need of osteotomy. [ABSTRACT FROM AUTHOR]

Purpose: To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods: A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations—the United Kingdom (UK) and India. Children were divided into age groups of 5–7 and 8–11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an 'emoji' system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results: Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents' responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion: Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Above-knee casts pose a major challenge in the day-to-day activities among walking age clubfoot patients due to complete restriction of knee movement. This current study investigates the effectiveness of below-knee casts compared to above-knee casts for managing walking age clubfoot deformity. Methods: After approval from the institutional ethical committee, we enrolled walking age clubfoot patients for deformity correction through corrective manipulation and casting through below-knee casts over 2 years. The corrective manipulation was performed using the Ponseti technique. The patients were followed for a minimum of 2 years period. To compare the effectiveness of below-knee casts over above-knee casts, we enrolled equal numbers of walking age clubfeet matched for age and gender. We compared the two groups in terms of initial and post-correction Dimeglio scores, individual deformities corrections (maximum ankle dorsiflexion, heel varus correction, foot abduction), failure rates, relapses, and complication rates. Results: 56 patients with 80 clubfeet with a mean follow-up of 39.98 months were considered for the final analysis. There were 29 patients in the below-knee cast group and 27 in the above-knee cast group, with 40 clubfeet each. The patients in the above-knee casting group had significantly better post-correction Dimeglio scores and individual deformity components corrections than the below-knee cast group. There were nil failures in the above-knee casting group and 7.5% in the below-knee cast group. The relapse rate was 15% in both groups, with none requiring any extensive soft tissue procedure. We did not encounter any major complications during the treatment and follow-up. Conclusion: The deformity correction and maintenance are suboptimal with the below-knee casts. Therefore, above-knee casts should be the preferred management modality for correction of walking age clubfoot deformities. [ABSTRACT FROM AUTHOR]

Congenital talipes equinovarus is one of the most common lower limb congenital defects present at birth. The gold standard treatment is the Ponseti method and it harnesses the biomechanical properties of biological tissues. It involves serial gentle manipulation and casting. Part of this method is an Achilles tendon tenotomy prior to the final casts, boots and bars and if needed a tibialis anterior transfer for dynamic supination at a later stage. The Ponseti method does not result in normal feet but results in normal looking feet that are comfortable and function normally. [ABSTRACT FROM AUTHOR]

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