Re: AAOS meeting - Podium Presentation Abstracts

[Guest guest]

,

Thanks for remembering that the AAOS convention was this week, I

forgot.

Here are the printouts of the 12 podium presentation abstracts on

Clubfoot from the meeting.

Ponseti method related Papers are presented at the beginning of this

printout and are not in order of their presentation. At least eight

of the twelve papers presented were Ponseti method related.

Long-Term Follow-Up of Clubfeet Patients Treated With Extensive Soft-

Tissue Release Surgery

Paper No: 241

Thursday, March 23, 2006

10:30 AM - 10:36 AM

Location: McCormick Place S104

Barrett Dobbs, MD Saint Louis MO (a - Shriners Hospital for

Children, Jewish Hospital Foundation)

________________________________________

Our data support a correlation between the extent of soft-tissue

release surgery and the degree of functional impairment. Repeated soft-

tissue release operations in this study resulted in stiff, painful,

and arthritic feet that significantly impaired quality of life

measures.

Although favorable results of foot function have been shown in a long-

term (greater than twenty-five year) follow-up of idiopathic clubfoot

patients treated with the Ponseti method of serial manipulations and

castings, no follow-up of this length is available for clubfoot

patients treated with extensive soft-tissue release surgery.

Forty-five idiopathic clubfoot patients (73 clubfeet) treated with

either a posterior release and plantar fasciotomy (8 patients) or a

Turco-type extensive posterior, medial, and lateral extensive soft-

tissue release surgery (37 patients) were followed for a mean of30

years (range,25 to32 years). Patients were evaluated by detailed lower

extremity examination, radiographic evaluation including

osteoarthritic grading, and three independent quality of life

questionnaires, including the short form 36-medical outcome scale (SF -

36 MOS).

Significant limitation of foot function was noted in the majority of

patients in both treatment groups and was consistent across three

independent quality of life questionnaires. No statistically

significant difference between groups was noted with regard to results

of quality of life measures (p>0.68), ankle range of motion and heel

position (p>0.73), or radiographic examination (p>0.45). Thirty-nine

of forty-five patients had more than one surgery on their affected

clubfoot at the time of latest follow-up. Patients treated with only

one surgery had better ankle and subtalar joint range of motion

(p<0.005) compared to those patients who had multiple surgical

procedures.

The present study demonstrates poor long-term foot function in

patients with clubfoot treated with extensive soft-tissue release

surgery. Our data support a correlation between the extent of soft-

tissue release surgery and the degree of functional impairment.

Repeated soft-tissue release operations in this study resulted in

stiff, painful, and arthritic feet that significantly impaired quality

of life measures.

Natural History And The Effects Of Foot Hyperabduction In Clubfoot

Relapses

Paper No: 244

Thursday, March 23, 2006

10:54 AM - 11:00 AM

Location: McCormick Place S104

Lovell, BS Iowa City IA (n)

Lori Dolan, PhD Iowa City IA (n)

Ignacio V Ponseti, MD Iowa City IA (n)

A Morcuende, MD Iowa City IA (n)

________________________________________

Maximally abducting the last cast and brace in the Ponseti method

significantly reduced rates of relapse and extensive corrective

surgery.

This study evaluates the natural history of clubfoot relapses after

successful correction with the Ponseti method and the effect of foot

hyperabduction on relapse prevention.

Consecutive case-series from 1948 through December 2000. A total of

320 patients (502 clubfeet) having no previous foot surgery other than

tendoachilles tenotomy (7 percent of feet) were evaluated. Two groups

were created based on abduction in the last cast and brace. Group I:

clubfeet (1948-1984) did not receive maximum abduction (n=291). Group

II: clubfeet (1991-2000) with maximum abduction (n= 211).

70 percent were male, 23 percent had family history, 57 percent had

bilateral deformity. 33 percent (95/288) of group I had previous

conservative treatment at outside institutions versus 77 percent

(163/211) of group II. Casting and tenotomy corrected 286/291 (98

percent) of group I and 209/211 (99 percent) of group II. In group I,

170 (58 percent) clubfeet relapsed compared to 59 (28 percent) in

group II (p<0.0001). 91 percent of relapses occur before five years of

age. Noncompliance remained similar at 65 percent in group I and 61

percent in group II. Relapses were related to non-compliance with the

brace (p=0.001). Extensive surgical releases decreased from 11 percent

in group I to 4 percent in group II (p=0.004), and anterior tibialis

transfer from 51 percent to 15 percent (p<0.0001).

Less than 10 percent of feet will relapse after the 6th birthday, but

the tendency to relapse may persist until 11 years of age. Maximum

abduction of the last cast and brace significantly reduced relapses

and the need for extensive corrective surgery.

100 Consecutive club feet treated with the Ponseti technique

Paper No: 246

Thursday, March 23, 2006

11:06 AM - 11:12 AM

Location: McCormick Place S104

Minoo Keki Patel, MD Malvern VIC Australia (n)

Clare Luca, RN Melbourne VIC Australia (n)

_____________________________________

Primary correction was obtained in all cases, with a recurrence rate

of 6% and tendon transfer rate of 10%.

The Ponseti technique of club foot treatment consists of serial

manipulation and casting. Most cases require a percutaneous Achilles

tenotomy. Very few cases, if any, require surgical correction. This

paper reports the 2- 4 year results in the first 100 consecutive cases

of idiopathic club feet treated with the Ponseti technique at one

centre.

All idiopathic club-feet presenting at the paediatric orthopaedic

clinic from 2001 to 2005 were prospectively enrolled in the study. The

feet were graded using the Pirani score. Weekly serial casting using

the Ponseti technique was performed till 60º forefoot abduction was

achieved. Achilles Tenotomy was performed if at least 20º dorsi-

flexion was not obtained. The children were fitted with Dennis-Brown

abduction orthoses set at 45º, and calf length straight last shoes

when the child started walking. Tibialis anterior tendon transfer was

performed at age 2½ for persistent dynamic adductus in an otherwise

well corrected foot.

100 idiopathic club feet in 69 consecutive babies were treated, with a

minimum 2 year follow-up. Achilles tenotomy rates rose from 91% in the

2001 to 98% in the 2005, with a decrease in delayed tenotomy from 1.5%

to 0. Correction without surgery was obtained in all cases. There were

7 cases of recurrence. Partial forefoot recurrence with rigid adductus

was seen in 3 cases, hind foot varus recurrence was seen in 2 cases,

and fore- and hind foot recurrence in 2 cases. Residual internal

tibial torsion was seen in 1 case. Full shoe compliance was seen in

85% cases. 5% cases had persistent shoe non-compliance. 5 cases had a

tibialis anterior transfer, with 5 more waiting for the surgery at age

2½. All 14 cases presenting late (after age 6 months) corrected

successfully.

The Ponseti method offers a reliable alternative to traditional

casting and or surgery. Shoe modifications such as a cut-out heel

counter and decrease abduction to 45º in the DB orthoses improved shoe

compliance, as did peer group support. All recurrences were in cases

treated in the first year of the study, perhaps representing our

learning curve. Achilles Tenotomy is now an integral part of our

protocol for all but the mildest cases. In cases of recurrence

relatively minor surgical intervention was required. Overall parent

satisfaction was close to very high.

Gait Analysis of Children Treated Non-Operatively for Clubfoot:

Physical Therapy vs. Ponseti Casting

Paper No: 247

Thursday, March 23, 2006

11:18 AM - 11:24 AM

Location: McCormick Place S104

Ron El-Hawary, MD Halifax NS Canada (n)

Lori A Karol, MD Dallas TX (n)

Jeans, MSc Dallas TX (n)

B s s III, MD Dallas TX (n)

________________________________________

Ponseti casting and the French method of physical therapy both yielded

equal rates of normal sagittal plane ankle motion.

Currently, clubfoot is initially treated with non-operative methods

including Ponseti casting and the French physical therapy program

(PT). Our purpose was to evaluate the function of children treated

with these techniques.

Seventy-six idiopathic clubfoot patients were enrolled. Successful non-

operative outcomes were achieved in 32 (44 feet) patients treated with

casting and 44 patients (66 feet) treated by PT. Initial Dimeglio

scores were 10-17. At average age 2.3 years (1.9-3.3yr), subjects'

gait was evaluated with a VICON 512 motion analysis system. Cadence

and kinematic data was classified as abnormal if it fell outside of

one standard deviation from normal.

No statistical differences for cadence parameters were found between

the two groups. Two kinematic patterns were identified: Children

treated with PT walked with knee hyperextension (41% of feet)*,

equinus (17%)*, and foot-drop (28%)*; whereas zero casted patients

walked in equinus and only one demonstrated foot-drop. In contrast,

the casted group demonstrated increased stance dorsiflexion (47%)* and

calcaneus (18%). More PT feet had increased internal foot progression

angle (34% vs. 13%)* and increased shank-based foot rotation (56% vs.

33%)*. Both groups had equal rates of normal sagittal-plane ankle

motion (59% PT vs. 55%). [*p<0.05].

Half of the two year-old patients treated non-operatively for clubfoot

had normal sagittal-plane ankle motion. Less than 20% in each group

experienced calcaneus and equinus gaits, respectively. These

differences may be the result of performing percutaneous tendo

Achilles lengthening as part of the Ponseti casting technique, but not

as part of the PT program.

Ponseti's Manipulation in Neglected Clubfoot-Are we Joking?

Paper No: 248

Thursday, March 23, 2006

11:24 AM - 11:30 AM

Location: McCormick Place S104

Shah Alam Khan, MD New Delhi India (n)

________________________________________

Ponseti's method is well known for clubfoot in neonates and infants.

We present the applicability of this technique in neglected clubfoot.

Ponseti's manipulation and casting is a well known technique in the

management ofclubfoot in neonates. Application of this technique in

children with neglected CTEV (i.e age more than 4 years) is not

reported in world literature. We present a series of 19 children (23

feet) with neglected i.e untreated CTEV till the age of 4 years,

treated by the Ponseti's method of casting.

Ours was a prospective observational study. A total of 23 neglected

clubfeet were included in the study. The average age in the study was

5.7 years.Clubfoot was classified on the basis of severity using the

Goldners classification. Feet were manipulated using the Ponseti's

method of manipulation. An average of 8.5 casts were used. Tenotomy of

the Tendo Achilles was done after an average of 6.5 casts.Limited x-

rays were used in pre/post op follow-up( mainly to assess flat top

talus). Patients were followed-up for an average of 4.7 years after

the last cast. All patients were maintained in Pronator shoes in the

day and Wheaton brace in the night till the age of 10 years.

All feet were evaluated using the Dimeglio scoring. Average follow-up

of 4.7 years was done. Correction was not achieved in 5 of the 23

feet. Late relapse after 2 years was seen in 2 cases. There was good

correction in 16 cases and Dimeglio score was <25 at the end of 1 year

of treatment.The dimeglio score was <23 at the end of 3 years in 15

feet and was <20 at end of 4 years in 14 feet.

The problem of neglected clubfoot is rampant in developing countries.

Limited treatment options exsist for neglected clubfeet in old

children.We found that Ponseti's method of manipulation is an equally

effective technique in the management of neglected clubfoot. Although

our initial results are encouraging, predictability of effectiveness

in neglected cluboot can only be established by analysing long term

results.

Neuromuscular Disease As The Cause Of Late Clubfoot Relapses

Paper No: 249

Thursday, March 23, 2006

11:30 AM - 11:36 AM

Location: McCormick Place s104

Lovell, BS Iowa City IA (n)

Lori Dolan, PhD Iowa City IA (n)

Ignacio V Ponseti, MD Iowa City IA (n)

A Morcuende, MD Iowa City IA (n)

________________________________________

Late relapses in patients with idiopathic clubfoot may represent the

onset of a previously undiagnosed neuromuscular disease, and should be

thoroughly evaluated.

Following correction with the Ponseti method some idiopathic clubfeet

still will relapse after seven years of age. A better understanding of

the cause for these late-relapses will greatly help in the management

of this condition.

Consecutive case-series from 1948 through December 1984 including 209

patients (321 clubfeet). Initial corrective treatment, age at relapse,

neurological evaluation, and final treatment for the relapse were

recorded.

There were 13 patients having relapses after the seventh birthday,

representing 6 percent of all patients. In 4 of these patients (6

clubfeet) a neuromuscular disease was diagnosed, representing 31

percent of the late relapses. These patients were initially treated

with an average of 4 casts (range: 2-6) with 2 requiring an Achilles

tenotomy. Patients used the brace for an average of 4 years. The

average age at the relapse prior to the suspicion of neuromuscular

disease was 8.9 years (range: 7.5-10.9 years). Two patients had family

history of neuromuscular disease (myotonic dystrophy and multiple core

disease). In the other two cases (Charcot-Marie-Tooth Disease type IA

and myasthenia gravis) neuromuscular disease was not suspected until

1.3 and 2.5 years after the relapse, respectively. All four patients

had an anterior tibialis transfer, three had a plantar fasciotomy, and

two had peroneus longus to brevis transfers. One patient required a

subsequent posterior tibialis transfer and another patient a triple

arthrodesis (myotonic dystrophy).

Late relapses in patients with idiopathic clubfoot may represent the

onset of a previously undiagnosed neuromuscular disease, and should be

thoroughly evaluated.

Results of a Disease Specific Instrument for Clubfoot Outcome in a

Mixed Treatment goup of Children.

Paper No: 250

Thursday, March 23, 2006

11:42 AM - 11:48 AM

Location: McCormick Place S104

Frederick R Dietz, MD Iowa City IA (n)

Margaret C Tyler, MA, MSW Iowa City IA (n)

C Damiano, DDS (n)

________________________________________

The Roye clubfoot DSI performed well and showed significantly better

results with 'joint sparing' treatment of clubfoot in mid childhood.

The DSI for clubfoot developed by Roye et al. (2001) was employed in a

cohort of patients of similar age to those reported by Roye who had

both joint sparing (Ponseti technique) and joint invading (PR and

PMRL) surgeries to assess the discriminatory ability of the DSI and to

assess whether different treatments resulted in measurably different

outcomes in mid-childhood.

The Disease-Specific Instrument for patients with clubfoot consists of

ten items designed to measure outcomes of treatment for clubfoot in

terms of overall satisfaction, appearance, pain, and physical

limitations with two distinct subscales: satisfaction and function.

Outcomes for patients treated with manipulation and casting +/-

anterior tibial tendon transfer were compared with patients treated by

posterior release or PMR.62 patients were identified and asked the DSI

for clubfoot questions in phone interviews.

The mean age of patients was8.6 years (SD2.2 yr). Internal consistency

reliability (Cronbach's alpha) for the DSI function and satisfaction

subscales and for the total scale were very good. Comparison of

manipulation and casting and anterior tibial tendon transfer patients

(the 'joint sparing' treatments) with posteromedial release or

posterior release (the 'joint invasive' treatments) showed better

outcomes for the 'joint sparing' treatment patients. Function scale

comparison was 87.2 vs. 75.6 (p=0.04); Satisfaction scale comparison

showed 83.1 vs. 74.6 (p>0.05) and the Total score comparison was 85.2

vs. 75.1 (p=0.04)

The DSI developed by Roye et al. performed well regarding internal

consistency as previously reported. The DSI showed significantly

better results with 'joint sparing' treatment of clubfoot even in mid

childhood.

•A Randomized, Double Blind Study of Botox as an Adjunct to

Manipulation and Casting for Clubfoot

Paper No: 251

Thursday, March 23, 2006

11:48 AM - 11:54 AM

Location: McCormick Place S104

Jay Cummings Jr, MD ville FL (n)

E Shanks, MD (n)

________________________________________

There was no significant difference (T test and Chi-square procedures)

between the Botox group and the placebo group in the outcomes measured.

To compare the outcomes of treatment with and without Botox as an

adjunct to the initial serial manipulation and casting for congenital

clubfoot.

After IRB approval and informed consent, 20 newborns (age 0-32 days)

with Dimeglio III congenital clubfeet (n=32) were randomized into

either Botox or placebo groups. All clubfeet underwent serial

manipulation and casting according to the Ponseti technique. Outcomes

measured were days in cast to correction of deformity (judged

clinically and radiographically), the need for percutaneous Achilles

tenotomy to achieve correction, and recurrence requiring further

treatment within six months of completion of initial correction.

There was no significant difference (T test and Chi-square procedures)

between the Botox group and the placebo group in the outcomes measured.

Botox does not appear to speed correction, reduce the need for

percutaneous Achilles tenotomy, or decrease the chance of relapse

after treatment when used as an adjunct to serial manipulation and

casting for congenital clubfoot.

Previous nonrandomized or blinded studies have concluded that Botox is

as effective as percutaneous tenotomy in children treated with the

serial manipulation and casting for congenital clubfeet. We were

unable to confirm the conclusions of those studies.

Averaged 12 Year Follow Up Results Of Circumferencial Subtalar Release

For Congenital Club Foot

Paper No: 242

Thursday, March 23, 2006

10:36 AM - 10:42 AM

Location: McCormick Place S104

Satoru Ozeki, MD Koshigaya Japan (n)

Masataka Kakihana, MD Koshigoya Japan (n)

Yutaka Nohara, MD Koshigaya Japan (n)

Shuji Yamasaki, MD Sapporo Japan (n)

Kiyoshi Kaneda, MD Bibai-city, Hokkaido Japan (n)

________________________________________

Delayed surgical timing and preserved interosseous talo-calcaneal

ligament in circumferential subtalar release for congenital clubfoot

contributed for good clinical results.

There have been a few report on the long-term follow-up of extensive

subtalar release after sufficient conservative treatment for

congenital clubfoot. We delayed surgical timing until the children

were ready to walk and preserved the central half of the interosseous

talo-calcaneal ligament (ITCL) as an axis for the subtalar motion.

Long-term results of the circumferential subtalar release (STR) were

investigated.

From 1986 to 1996, 109 infants with 144 clubfeet visited our clinic

before 3 months old. All children were initially treated

conservatively with a 3-dimensional corrective cast followed with a

Denis-Browne splint. Fifty-seven children with 72 feet then underwent

circumferential STR through a Cincinnati incision. The averaged age at

surgery was 2.9 years old (9 months - 14 years old). McKay's scoring

system was used to evaluate the final clinical results. Forty-three

patients with 55 feet were followed over a 7-year period. The averaged

follow-up period was 12.2 years.

The clinical results were as follows; excellent: 25 feet; good: 21

feet: fair: 8 feet; poor: 1 foot. Radiological examination

demonstrated the sufficient correction for the hind foot; the averaged

anterior and lateral talo-calcaenal angles were 30 and 27 degrees

respectively. The most common residual deformity was forefoot

adduction involving forefoot pronation to the calcaneus.

Circumferential STR maintained an acceptable 3-dimensional correction

in hindfoot. During conservative treatment, care should be taken to

prevent forefoot pronated deformity. To obtain good correction,

surgical release does not stand alone; it is also a product of

conservative treatment.

The Operatively Treated Clubfoot: Long-Term Follow-Up with Gait

Analysis

Paper No: 243

Thursday, March 23, 2006

10:42 AM - 10:48 AM

Location: McCormick Place S104

S Khazzam, MD Columbia MO (n)

Jae Young Roh, MD (n)

Long, MS Milwaukee WI (n)

Ken N Kuo, MD Oak Brook IL (n)

A , MD Chicago IL (n)

Sahar Hassani, MS Chicago IL (n)

Gerald F , PhD Milwaukee WI (n)

________________________________________

The purpose of this study is to examine segmental foot motion during

gait of patients who have undergone surgical clubfoot correction.

Clubfoot (talipes equinovarus) is a complex foot deformity

characterized by adduction, inversion, and equinus. The goal of

surgical treatment is a pain-free, functional, plantigrade foot which

allows development of a normal gait pattern. The purpose of this study

is to examine segmental foot motion during gait of patients who have

undergone clubfoot correction. The four-segment Milwaukee Foot Model

(MFM), including radiographic assessment, was utilized for kinematic

analysis.

This is a prospective study consisting of 17 patients (15M, 2F, mean

age 16y; 25 feet) who underwent surgical correction for clubfoot

deformity (posteromedial soft-tissue release) by one surgeon between

1985 and 1987 (mean age 6.7months; mean follow-up 15.8y). A group of

25 adult patients (13M, 12F, mean age 41y) with no foot pathology was

used as a normal control. International Clubfoot Study Group Outcome

Evaluation (ICFSG) and AOFAS hindfoot and forefoot evaluations were

obtained for all patients. Temporal and three-dimensional kinematic

parameters were obtained via the MFM.

The Clubfoot group showed significant differences as compared to

Normal with increased stance duration, and decreased stride length,

cadence and walking speed (p<0.05). Significantly decreased range of

motion was seen in all foot segments throughout the gait cycle

(p<0.05). Kinematic changes were significant and included hindfoot

plantarflexion and internal rotation shifts (p<0.05) throughout the

gait cycle. The forefoot demonstrated reduced plantarflexion (p<0.01)

and increased valgus (p<0.05) position throughout the gait cycle. 23

of 25 feet revealed ICFSG scores as good to excellent.

Clinical evaluation and functional scores indicated functionally

successful outcome over the long term. Kinematic analysis revealed

subtle deficits in motion patterns which may be useful in further

assessing functional level. We conclude that the 3D ROM and temporal

data provided by the MFM is useful for quantifying long-term outcomes

following surgical correction of clubfoot deformity.

Congenital clubfoot in twins

Paper No: 245

Thursday, March 23, 2006

11:00 AM - 11:06 AM

Location: McCormick Place S104

Vilhelm Engell, MD Vejle Denmark (n)

Mikkel Andersen, MD Odense C Denmark (n)

Damborg, MD Odense Denmark (n)

Kirsten O Kyvik, MD, PhD Odense Denmark (n)

Karsten Thomsen, MD Odense Denmark (n)

________________________________________

Out of 46,418 twins 94 reported to have congenital clubfoot with pair-

and proband-wise concordances indicating a partly genetic etiology.

The aetiology of congenital clubfoot is unclear. Although studies on

populations, families, and twins suggests a genetic component the mode

of inheritance does not comply with distinctive patterns. In 1939

Idelberger reported the concordance rates in twins to be 0.33 for

monozygotic (MZ) and 0.03 for dizygotic (DZ). The purpose of this

study was to a congenital clubfoot twin cohort that enables us to

provide estimates of concordance with a higher accuracy than seen

before.

From the Danish Twin Reigistry all 46,418 twins born from 1931 through

1982 were asked 'Were you born with clubfoot?' 46,418 twins received

and 75% returned the questionnaire. Ninety-four answered 'yes' giving

an overall self-reported prevalence of 0.0027 (c.i.l. 0.22-0.34%).

Out of 55 complete twin pairs 4 were concordant, 2 mz and 2 dzss. The

pair-wise concordance was 17% (c.i.l. 2%-48%) for mz and 5% (c.i.l.

0.6%-18%) for all dz. The probant wise concordance was 29% (c.i.l. 7%-

51%) for mz and 17% (c.i.l. 5%-29%) for dz.

We have found an evidence of a genetic component in congenital

clubfoot. However non-genetic factors must play a predominant role.

Role of calcaneocuboid fusion in children undergoing talectomy

Paper No: 252

Thursday, March 23, 2006

11:54 AM - 12:00 PM

Location: McCormick Place S104

Yi-Meng Yen, MD Venice CA (n)

Marinis Pirpiris, MD Melbourne VIC Australia (n)

E Ching, MD Ventura CA (n)

Craig Kuhns, MD University City MO (n)

Norman Yoshinobu Otsuka, MD Los Angeles CA (n)

________________________________________

The management of the child with a severe, rigid equinovarus foot by

talectomy should include addition of a concomitant calcaneocuboid

fusion.

The aim of management of the child with a severe, rigid equinovarus

foot is to provide a foot, which is plantigrade and painless, with the

ability to be placed within standard footwear.

We identified a retrospective cohort of 17 children with a mean age at

surgery of 5.6 years (range 2.3-9.6 years) that underwent 31 talectomy

procedures (14 isolated talectomies and 17 combined talectomy and

calcaneocuboid fusion for the management of their severe, rigid

equinovarus feet. The average follow-up was 9.7 years (range 2.3-9.5

years) and 3.8 years (range 2.8-9.6 years) respectively.

Assessing the development of post-operative midfoot adductus and

hindfoot varus and equines deformities, we determined that the

addition of calcaneocuboid arthrodesis prevented the development of

adductus, varus, and equines deformities in the longer-term

(p<0.0.001, p<0.05, p=0.01 respectively). Furthermore assessing foot

pain and the ability to tolerate braces, we determined that

significantly fewer children that underwent a concomitant

calcaneocuboid fusion had recurrent foot pain with weightbearing

(p<0.001) and required revision surgery for pain or deformity

(p<0.001).

The addition of a concomitant calcaneocuboid fusion to a talectomy

procedure has significantly better longer-term results.

The original source for all of the papers can be seen at

http://www3.aaos.org/anmeet2006/podium/ppr06_23.cfm

>

> There were a lot of presentations on clubfoot at the AAOS meeting in

> Chicago this week.

> Here is a link to the podium presentations on Thursday (I counted 12

> presentations on clubfoot):

> http://www3.aaos.org/anmeet2006/podium/ppr06_23.cfm

>

> Here's the link to the main page about the meeting in general:

> http://www.aaos.org/wordhtml/am2006.htm

>

> Regards,

> & (3-16-00, left clubfoot)

>