Pediatrics

PURPOSE OF REVIEW: The present review includes the most up-to-date literature on the causes, epidemiology, diagnosis, and treatment of toe walking. RECENT FINDINGS: The prevalence of toe walking at age 5.5 years is 2% in normally developing children, and 41% in children with a neuropsychiatric diagnosis or developmental delays. A recent systematic review concluded that there is good evidence for casting and surgery in the treatment of idiopathic toe walking, with only surgery providing long-term results beyond 1 year...

This is a review of current literature of noninvasive treatments for pediatric complex regional pain syndrome (CRPS). There are a variety of noninvasive approaches to the treatment of pain, but few pediatric-focused studies have been published in regard to CRPS. In comparison with adult CRPS, there is a greater need for behavioral approaches in children to enable coping with difficult symptoms. Current gaps in knowledge include mechanisms triggering CRPS, pediatric-focused diagnostic criteria, validated tests that are diagnostically specific, definitive treatment protocols, age-based medication recommendations, and validation of specific noninvasive treatments in pediatric populations...

Talipes equinovarus is a complex triplane deformity of the foot and lower leg. Clubfoot should be treated early and aggressively--but gently. Conservative therapy is often successful if begun early. Surgery should follow a progressive approach.

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We report the absence of the posterior tibial artery in a 3-month-old patient with idiopathic clubfoot. Although anomalies of the anterior tibial artery are common, complete absence of the posterior tibial artery associated with talipes equinovarus deformity has not been reported.

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The Ponseti method for clubfoot treatment offers satisfactory initial correction, but success correlates with abduction brace compliance, which is variable. Electrical stimulation as a dynamic intervention to prevent relapses was investigated. Data were compared to a control group. There was a significant improvement in ankle range of motion only in the study group after short-term intervention, and a trend toward greater increase in calf circumference in this group. Parental perception was positive with no compliance issues...

In the present study we compared the rate of relapse after conservative Ponseti treatment method with that of a historical cohort who underwent conventional operative treatment. From June 2002 to December 2004, 70 patients presented with 107 clubfeet and started Ponseti treatment. Of these 70 patients, 9 (15 feet) were excluded because of a teratologic deformity. Thus, 50 patients with 75 clubfeet were studied (41 [82%] boys and 9 [18%] girls). Data were compiled from the clinic assessment forms and patient notes...

Between 1988 and 1995, we studied 91 club feet from a series of 120 recalcitrant feet in 86 patients requiring surgical treatment. There were 48 boys and 20 girls. The mean age at operation was 8.9 months. Surgery consisted of an initial plantar medial release followed two weeks later by a posterolateral release. This strategy was adopted specifically to address the problems of wound healing associated with single-stage surgery and to ascertain the rate of relapse after a two-stage procedure. Immobilisation in plaster was used for three months followed by night splintage...

BACKGROUND: The Ponseti method has become increasingly popular in the treatment of congenital talipes equinovarus (CTEV). Current methods of assessment focus on clinical, functional and radiological outcomes which are subjective and often difficult to repeat. However, integration of biomechanical evaluation can provide objective and quantifiable analysis. This study aims to evaluate the treatment outcome of CTEV patients on the basis of long-term clinical, functional and biomechanical assessment...

We present a unique case of a congenital hereditary common peroneal nerve neuropathy with congenital idiopathic congenital talipes equinovarus that had been treated with the Ponseti method with satisfactory outcome at 5-year follow-up, along with a literature review.

The calcaneocuboid joint is significantly malaligned in some clubfeet. Calcaneocuboid deformity appears to be a combination of medial angulation of the calcaneocuboid joint with medial subluxation of the cuboid on the calcaneus. In moderate and severe cases, incomplete treatment of this deformity may result in rotary valgus of the hindfoot. One hundred consecutive cases of clubfeet requiring operative intervention, all treated at the Medical College of Wisconsin at Milwaukee between 1984 and 1988 were reviewed for incidence and treatment of calcaneocuboid abnormalities...

The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus...

Eighteen children with 26 idiopathic talipes equinovarus deformities were treated by postermedial release (PR) in the interval between 1975 and 1980 and investigated retrospectively. Evaluations included physical examination, functional evaluation, roentgenographic evaluation, and evaluation of foot track tracing pattern. The average follow-up period was 8.2 years. Thirty percent had had previous tendo Achilles lengthenings and 15% had had previous lengthenings plus posterior capsulotomies. Based on Turco's criteria, the results of PR were graded 38...

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BACKGROUND: The clinical features that define congenital talipes equinovarus (CTEV) are the presence of four principal components, equinus, varus, adductus and cavus. Classification systems in CTEV often include a form of assessment of these components and also other concurrent clinical parameters which feature in the condition. METHODS: Over a 14-year period from 1992 to 2006, 95 consecutive cases of CTEV were prospectively assessed and data recorded in order to investigate the relationships between the clinical parameters in CTEV and to compare these relationships with those that one would expect from our knowledge of the pathological anatomy and mechanics of the condition, relating these findings to the commonly used systems for classification...

BACKGROUND: Congenital talipes equinovarus (CTEV) is a common but still not fully understood disorder of the lower limb. It is usually defined as a fixation of the foot in adduction, supination, and varus. Different treatment options exist including the Ponseti method. AIM: We report here the results obtained in infants with CTEV treated by the Ponseti method. PATIENTS AND METHODS: Eighty two patients (114 clubfeet) were enrolled at the Orthopaedic Clinic of Catania University during the period of March 2004 to January 2010 and followed prospectively up to February 2011: 56 patients (68...

The development of evidence-based approaches to the Congenital Talipes Equinovarus (CTEV) is impaired by the diversity of assessment techniques available, many of which have not been validated. Highly objective evaluation techniques that reflect the deformity and permit comparison between studies may lack the necessary link to functional features that are paramount to the patient, namely pain and mobility. Calf wasting is an acknowledged but little investigated component of the pathology. The rapid evolution of digital photography and computerised analytical techniques has yielded an opportunity to explore their role in the assessment of this common paediatric Orthopaedic pathology...

Congenital talipes equinovarus is a common deformity that is present at birth. It can be treated conservatively. Of the techniques available, the Ponseti method is effective in correcting most of these foot deformities and is best started early. Some of the stiffer "teratological" foot deformities may require surgical releases. Other conservative methods may be applied to correct deformity, but they have not been demonstrated to be as effective as the Ponseti method, although they may reduce the extent of subsequent surgical releases...