Re: clubfoot and metatarsus adductus

[Guest guest]

Your more than welcome! It brought up a great topic!

Sincerely,

& Breanna

ritadeane wrote: Thanks for your input, and

! (I wish I had time to respond to each of you individually, but with two

rather demanding children...) I just wanted to let you know that I really

appreciated your responses, and will be contacting my doctor with some

questions. Thanks again! (Rita)

[Guest guest]

Very interesting article , thanks!

Holly and

Re: clubfoot and metatarsus adductus

>More on this topic..

>

>Dr. Ponseti gave me several copies a while ago of journal articles on

>metatarsus adductus. One was published in Feb. 1994 in the Journal of

>Bone and Joint Surgery, written by him, Dr. Weinstein and Pasquale

>Farsetti, titled " The Long-Term Functional and Radiographic Outcomes

>of Untreated and Non-Operatively Treated Metatarsus Adductus. "

>

>It was a long-term study of patients treated in Iowa City more than

>30 years before, some with mild cases that were left untreated, and

>others with more rigid cases that were treated with a few casts. It's

>rather long but here are some highlights:

>

> " Metatarsus adductus is a congenital deformity of the foot that was

>described by Henke in 1863. ... The deformity is present at birth but

>very often is not diagnosed until the first year of life. The

>clinical features are adduction and various degrees of supination of

>the forefoot, often associated with mild valgus angulation of the

>heel and internal tibial torsion.

>

> " Treatment of metatarsus adductus has been controversial. Some

>authors [my note: the footnotes for this sentence include a study by

>Dr. Ponseti among this group] have believed that a passively

>correctable deformity will resolve on its own, whereas they have

>recommended treatment with manipulation and serial plaster casts when

>the deformity is rigid. Other authors have recommended operative

>treatment with use of various techniques, and some have even

>suggested that the procedure be done during the first year of life.

>

> " The purpose of this study was to evaluate the long-term functional

>and radiographic outcomes of untreated and non-operatively treated

>metatarsus adductus.

>

>(and later in the article:)

>

> " Metatarsus adductus should be treated conservatively. ...

>Conservative treatment with serial manipulation and plaster casts is

>sufficient to correct the deformity and to prevent recurrence...

>however the proper technique for treatment with the casts is

>important. A faulty technique could be blamed for the failed

>correction in one of our patients who had a bilateral deformity.

>

> " It is best to start treatment as soon as the deformity has been

>detected and has been deemed not to be passively correctable.

>According to our study, a good final result can be obtained if proper

>treatment begins when the patient is between three and twelve months

>old; however, we observed a good result in one patient who was 16

>months old at the time of the diagnosis, was conservatively managed

>for 4 weeks, and was evaluated 31 years later. "

>

>My note here: The bottom line was that all the patients did well..

>The results were good in all of the untreated feet (mild cases) and

>90 percent of the casted feet (which were more rigid).

>

> " There were no poor results... The passively correctable deformities

>resolved spontaneously. "

>

>(and, later, in talking about what to do if an older child has

>residual metatarsus adductus:)

>

> " Thus, according to the results, we believe that operative treatment

>is not needed or desirable in patients who have residual mild or

>moderate deformities. " [my note here: because whatever residual

>ldeformity they had didn't give them much trouble and wasn't worth

>the risk of surgical correction.]

>

>Hope this was helpful and the excerpts made sense..

>

> and

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