Surgeon Develops Treatment For Foot Deformity

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Surgeon Develops Treatment For Foot Deformity

http://www.medicalnewstoday.com/medicalnews.php?newsid=67476

Children born with a foot deformity that causes them to have a rigid

flatfoot once faced extensive surgery to fully correct the problem.

A treatment developed by a pediatric orthopaedic surgeon at

Washington University School of Medicine in St. Louis has shown

early success in correcting congenital vertical talus with minimal

surgery in most cases.

Congenital vertical talus (CVT), or " rocker-bottom flat foot, "

occurs in about 1 in 10,000 live births. Left untreated, the patient

would walk on the inside of the ankle rather than the bottom of the

foot, resulting in pain and disability. CVT afflicts both healthy

children and those with genetic birth defects and neuromuscular

disorders.

B. Dobbs, M.D., who performs surgeries at St. Louis

Children's Hospital, developed a treatment for CVT that involves

gently manipulating the foot and applying long leg casts weekly for

four to six weeks to gradually correct the deformity. After the

casting period, Dobbs and his colleagues take an X-ray to determine

the success of the correction.

" Much of the correction is achieved with casting alone, " says Dobbs,

associate professor of orthopaedic surgery at the School of

Medicine. " In the cases where we are not able to reach full

correction with casting, we reach the rest of the correction with a

minimally invasive surgery. This type of surgery is very small

compared to the extensive release surgery that has been done in the

past. "

In the minor surgical procedure, Dobbs inserts a small pin into a

joint in the foot where it meets the ankle to hold the correct

position for about two months. After the casting treatments or the

surgical pinning, CVT patients wear a nighttime brace for several

years to prevent recurrence.

Details about the treatment in 11 patients with CVT, or a total of

19 feet, are discussed in the March 2007 issue of The Journal of

Bone and Joint Surgery.

His method has caught the attention of pediatric orthopaedic

surgeons worldwide, and he is training other surgeons in the United

States and internationally to use the method successfully.

The difference between Dobbs' method and casting techniques tried in

the past is in the way forces are applied to the foot and the way

the casts are molded, he says.

" What has previously been lacking in any cast treatments for CVT is

a lack of understanding by orthopaedists as to how the joints in the

foot move and work together, " Dobbs says. " Now, thanks to the work

of Ignacio Ponseti, we do have a better understanding of the

mechanics of the foot and ankle which has made it possible to figure

out how best to gradually correct the deformity in CVT. "

The treatment is based on principles developed in the 1950s for

clubfoot, another congenital foot deformity. Ignacio Ponseti, M.D.,

professor emeritus of orthopaedics and rehabilitation at the

University of Iowa, pioneered a method that called for weekly

casting and manipulation of the foot starting soon after birth. When

done correctly, the Ponseti method has greatly reduced the need for

extensive surgery, and as a result, has improved the long-term

outcomes for clubfoot patients. Extensive surgical releases for

clubfoot can result in feet that are painful and arthritic in

adulthood, which is something that is not often seen in clubfoot

patients treated successfully with the Ponseti method.

" Our ultimate goal is that our new minimally invasive treatment for

CVT will result in better long-term outcomes for patients just as

the Ponseti method has done for clubfoot, " Dobbs says.

Dobbs M, Purcell D, Nunley R, Morcuende J. Early Results of a New

Method of Treatment for Idiopathic Congenital Vertical Talus. The

Journal of Bone and Joint Surgery March 2007, Vol. 89-A, Supplement

2, Part 1, pp. 111-121.