Correction of idiopathic congenital talipes equinus varus by Ponseti technique in newborn

<p class="abstract"><strong>Background:</strong> Clubfoot is one of the commonest congenital anamoly. Though various modalities of treatment are available for this common disorder ranging from surgical release, distraction by external fixator to conservative methods none has proved to be standard for treatment.</p><p class="abstract"><strong>Methods:</strong> A study of 40 cases (62 feets) of clubfoot treatment was done at Post Graduate Institute of Swasthiyog Prathishthan, Miraj by Ponseti technique. Cavus was corrected in first manipulation by first metatarsal lift (supination) followed by forefoot adduction and heel varus in subsequent manipulation until abduction of 60-70 degree is achieved.<strong></strong></p><p class="abstract"><strong>Results:</strong> Post treatment evaluation of results was done. 75% feet had very good results, 20% had good results and 5% had poor results, 11% had relapse of deformity ranging from mild to severe. Two feets required retenotomy before casting, only one feet required RPMR.</p><p class="abstract"><strong>Conclusions:</strong> The Ponseti method of correction of clubfoot is a safe and effective treatment and radically decreases the need for extensive corrective surgeries and achieves functional pain free normal looking plantigrade feet with mobility and required no modified shoes.</p>

Upper ankle joint prostheses in haemophilia patients

SummarySecondary arthrosis of the upper ankle joint (talocalcanean joint) is one of the most frequent forms of haemophilic arthropathy. It is a secondary form of arthrosis not only because of chronic synovitis and cartilage injury resulting from chronic recurrent intraarticular bleeds, but also due to the misalignment of the joint and abnormal joint stress. The consequences are manifest even in young patients and finally lead to subtalar joint ankylosis with the biomechanical disorder of foot drop (talipes equinus). In such clinical situations, implantation of a subtalar joint endoprosthesis is a viable alternative to arthrodesis. Case report:A man (age: 52 years), suffering from severe haemophilia A (residual FVIII activity < 1 %), no inhibitor formation. The patient has a history of several years of painful ankylosis of the right ankle joint and minor talipes equinus, and suffers from symptomatic talonavicular arthrosis. Open joint cleansing considerably improved mobility in the upper ankle joint and alleviated the pain in the talonavicular joint. However, the recovered mobility of the arthrotic upper ankle joint also activated the patient’s arthrosis, associated with severe pain. As there was no contraindication to upper ankle joint replacement, a cement-free prosthesis was implanted. Three months after surgery, the patient was mobile, with good foot rolling properties without orthopedic aids, and without pain in his upper joint ankle. Conclusion: In terms of biomechanics an upper ankle joint endoprosthesis is a superior alternative to arthrodesis in haemophilia patients. In order to minimize the complication rate, the treatment of haemophilia patients should be restricted to specially equipped interdisciplinary treatment centers with adequately trained and experienced surgeons as well as haemo -staseologists.

Ankle Arthroplasty by Excision of the Talar Body: Subtotal Talectomy

We carried out the ankle arthroplasty by excision of the talar body (subtotal talectomy) on 10 ankles of nine patients with talar body tumor, paralytic talipes equinovarus, talipes varus due to spinal injury, or comminuted fracture of the talar body. Talar body excision was initiated by lateral incision and subsequent osteotomy of the fibula. The fibula was everted, leaving the lateral ligament (calcaneofibular ligament) intact. After the talus was exposed, the talar body was excised, leaving about 1.5 cm of head unresected. Subsequently, the fibula was shortened slightly, and the tibia was pulled down to the level of the calcaneus to form a joint, instead of arthrodesis being performed. After surgery, the joint formed by the tibia and calcaneus was mobile in seven of the 10 feet and immobile (arthrodesis) in the remaining three feet. The average follow-up period was 6 years. Although postoperative x-ray revealed slight osteoarthritic changes of Chopart's joint and the tibiocalcaneal joint, none of the patients showed ankle pain that impaired activities of daily living. Subtotal talectomy allows correction of talipes equinus without Achilles tendon lengthening.