摘要:

The socket of the talocalcaneonavicular ball and socket joint in the foot is termed acetabulum pedis (AP). Observations of 72 feet from necropsies of still-borns or deceased newborns are the basis of our architectural description of AP. It has five walls: the roof or superior wall, the floor or inferior wall, the bottom or anterior wall, the medial wall, and the lateral wall. Variations in the tridimensional situation of the anterior and middle articular facets of the calcaneus modify the ace-tabular floor area. The same is true of the variations in position of the ligaments in both the acetabular floor and the medial wall. These modifications of the acetabular floor and medial wall areas can change the shape of the foot.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Many pathoanatomic studies of clubfeet have been made. Bone changes and ligament and tendon alterations are among the different deformities reported in the literature. The socket of the talocalcaneonavicular joint is termed the acetabulum pedis (AP), and alterations of the joint have been reported previously as malformations associated with clubfoot. We report pathoanatomic observations of AP in three human clubfoot specimens. Anomalies in AP were observed and compared with those in normal feet. In such cases, AP volume is restricted. Surface area is reduced on the acetabular floor and medial wall. Changes occur in the osseous components as well as in the ligaments of the AP.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Serial histological sections in three planes (frontal, sagittal, and transverse) in four cases of clubfoot in fetuses aborted at 16–20 weeks were studied and compared to identical sections obtained in three normal feet. The talus was deformed, with its neck medially angulated and its head dome shaped. The body of the calcaneus was medially bowed and was tilted and rotated medially underneath the talus, and both the talus and the calcaneum were in plantar flexion. The tilting of the talus and the medial tilting and rotation of the calcaneus accounted for the varus deformity of the hindfoot. The varus and adduction deformity of the heel and midfoot caused the supination seen in clubfoot. The skeletal components of the forefoot were adducted as a result of the medial displacement of the navicular and cuboid. Ligamentous and tendon abnormalities were also observed with increased fibrosis of muscle tissue, which may be an important factor in causation of clubfoot.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

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. A radiographic system of evaluation was devised, encompassing a normal grade of 0 and three grades of deformity based on the extent to which the midpoint of the cuboid had deviated from the longitudinal axis of the calcaneus or beyond the tangent defined by the edge of the calcaneus. The author's preferred surgical technique is described. Grade 1 deformity does not require operation; grade 2 deformity required extensive soft tissue release, and grade 3 deformity required a bone procedure in addition to extensive soft tissue release. The results demonstrated that partial release of the calcaneocuboid cuboid joint is never indicated because it may produce valgus of the hindfoot. Based on this sample, ∼25% of all patients requiring operation will require calcaneocuboid release. Operation should be performed without placing undue pressure on the joints, which may produce late fusion; plantar release may be indicated as a means of reducing pressure on the joint surfaces. Operation before ossification of the cuboid should be avoided.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The bony pathoanatomy of clubfoot has been assessed by a three dimensional reconstruction of transverse CT images obtained from 27 feet in children aged 3–10 years. Principal axes of the bones were determined to quantitate interosseous deformity, while visual inspection of the reconstructed images demonstated intraosseous deformity. “Medial spin” and midfoot adduction were analyzed on the AP view of the foot (“top” view), while hindfoot pronosupination was analyzed on the AP view of the ankle (posterior view). This technique allows visualization of deformities which normally cannot be analyzed on plain radiographs, and also shows that a variety of interosseous relationships make up the clinical entity known as clubfoot. Abnormal talar pronation (“intorsion”) was an unexpected finding of this three dimensional analysis.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Gait analysis was used to evaluate 15 patients who had previously undergone clubfoot surgery. Because six patients had had bilateral surgery, 21 feet had undergone previous clubfoot surgery. Three of the operated feet had no residual deformity. In the remaining 18 feet, the reason for referral was intoeing in 13, calcaneovalgus in three, hindfoot varus in one, and supination/adduction in one. Clinical assessment and information from the gait analysis were used to establish a treatment plan. Satisfactory treatment outcome was achieved in 13 patients, one result was unsatisfactory, and one result was undetermined.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A technique of intraoperative ultrasound for evaluation of reduction in congenital talipes equinovarus (CTEV) is reported. Ultrasound (US) scanning enables the surgeon to perform controlled reduction of both cal-caneocuboid and talonavicular joint during the operation because visualization of the relation in the medial and lateral column of the foot is as precise as that obtained with radiographs. The relation between talus and calcaneus in the horizontal plane cannot be visualized. Examination is quick and simple but is more easily performed if the shape of the foot is near-normal; i.e., the foot has been well prepared for operation by nonoperative treatment.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We present our experience, since 1983, in lower-limb lengthening for the treatment of achondroplasic dwarfism. We stress the importance of our method, staged lengthening, which includes two separate operations on the tibia, at the ages of 5 and 10, and two on the femurs, at the ages of 6 and 12. This method allows an overall increase in height varying from 30 to 35 cm and has the advantage of minimizing complications, since children tolerate the lengthening-related problems far better. In 9 years 28 children have undergone limb lengthening, and six of these patients have now completed the first three stages, obtaining a total increase in length from 18 to 23 cm. We discuss the staged lengthening program, pointing out advantages and disadvantages of the method.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ultrasound may be used to distinguish the unossified cartilage and the ossification centres of the tarsal bones. The use of ultrasound to image the normal foot and the foot with congenital talipes equinovarus (CTEV) deformity has been assessed. We describe two standard ultrasound planes that enable the normal foot to be distinguished from the foot with a CTEV deformity even before it becomes clinically apparent. The technique does not take much time, is easily tolerated by the child, and may be repeated frequently to assess the response to treatment. It can be learned easily.

ISSN:0271-6798    

出版商:OVID    

年代:1995

数据来源: OVID