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Z Orthop Unfall 2009; 147(2): 241-262
DOI: 10.1055/s-0029-1185472
Refresher Orthopädie und Unfallchirurgie

© Georg Thieme Verlag KG Stuttgart · New York

Der kongenitale Klumpfuß

K. Waschak1 , C. Radler1 , F. Grill1
  • 1Orthopädisches Spital Speising, Abteilung für Kinder- und Jugendorthopädie, Wien
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Publication History

Publication Date:
08 April 2009 (online)

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Zusammenfassung

Der kongenitale Klumpfuß ist die häufigste angeborene Deformität der unteren Extremität. Seine adäquate Behandlung stellt für Orthopäden nach wie vor eine Herausforderung dar und setzt fundierte Kenntnisse der Pathoanatomie des Klumpfußes und der bestehenden Therapiemöglichkeiten voraus. Diese Arbeit bietet neben den pathoanatomischen Grundlagen zum Verständnis der Klumpfußdeformität ein Update der diagnostischen und therapeutischen Möglichkeiten und soll durch einen Überblick über Ergebnisse der konservativen und operativen Behandlungskonzepte und deren Diskussion zum optimalen individuellen Management des kongenitalen Klumpfußes beitragen.

Abstract

Congenital talipes equinovarus is the most common deformity of the lower limb. The adequate treatment of clubfeet is still a challenge for orthopaedic surgeons and requires well-founded knowledge of pathoanatomy and established therapeutical options. This refresher, in addition to pathoanatomical fundamentals, provides an update on diagnostic and therapeutical facilities. By reviewing the results of conservative and surgical treatment concepts and their discussion it shall contribute to optimal individual management of congenital talipes equinovarus.

Literatur

  • 1 Rebbeck T R, Dietz F R, Murray C, Buetow K H. A single-gene explanation for the probability of having idiopathic talipes equinovarus.  Am J Hum Genet. 1993;  53 1051-1063
    PubMedGoogle Scholar
  • 2 Lochmiller C, Johnson D, Scott A. et al . Genetic epidemiology study of idiopathic talipes equinovarus.  Am J Med Genet. 1998;  79 90-96
    CrossrefPubMedGoogle Scholar
  • 3 Wynne-Davies R. Family studies and the cause of congenital clubfoot talipes equinovarus, talipes calcaneo-valgus and metatarsus varus.  J Bone Joint Surg [Br]. 1964;  46 445-463
    PubMedGoogle Scholar
  • 4 Engell V, Dambiorg F, Andersen M. et al . Club foot: a twin study.  J Bone Joint Surg [Br]. 2006;  88 374-376
    PubMedGoogle Scholar
  • 5 Idelberger K. Die Ergebnisse der Zwillingsforschung beim angeborenen Klumpfuß.  Verhandlungen der Deutschen Orthopädischen Gesellschaft. 1939;  33 272
    PubMedGoogle Scholar
  • 6 Ippolito E. Update on pathologic anatomy of clubfoot.  J Pediatr Orthop [Br]. 1995;  4 17-24
    PubMedGoogle Scholar
  • 7 Ippolito E, Ponseti I V. Congenital clubfoot in the human fetus: A histological study.  J Bone Joint Surg [Am]. 1980;  62 8-22
    PubMedGoogle Scholar
  • 8 Zimny M L, Willig S J, Roberts J M. et al . An electron microscopic study of the fascia from the medial and lateral sides of clubfoot.  J Pediatr Orthop. 1985;  5 577-581
    PubMedGoogle Scholar
  • 9 Krauspe R, Wess K M, Raab P. et al . Biochemical analysis of collagen in clubfeet and in controls.  J Bone Joint Surg [Br]. 2002;  84-B (Suppl. 1) 17
    PubMedGoogle Scholar
  • 10 Fukuhara K, Schollmeier G, Uhthoff H K. The pathogenesis of clubfoot. A histomorphometric and immunhistochemical study of fetuses.  J Bone Joint Surg [Br]. 1994;  76 450-457
    PubMedGoogle Scholar
  • 11 Sano H, Uhthoff H K, Jarvis J G. et al . Pathogenesis of soft-tissue contracture in club foot.  J Bone Joint Surg [Br]. 1998;  80 641-644
    CrossrefPubMedGoogle Scholar
  • 12 Handelsman J E, Badalamente M A. Neuromuscular studies in clubfoot.  J Pediatr Orthop. 1981;  1 23-32
    PubMedGoogle Scholar
  • 13 Loren G J, Karpinski N C, Mubarak S J. Clinical implications of clubfoot histopathology.  J Pediatr Orthop. 1998;  18 765-769
    CrossrefPubMedGoogle Scholar
  • 14 Maffulli N, Capasso G, Testa V, Borrelli L. Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot.  Foot Ankle. 1992;  13 18-23
    PubMedGoogle Scholar
  • 15 Dobbs M B, Walton T, Gordon J E. et al . Flexor digitorum accessorius longus muscle is associated with familial idiopathic clubfoot.  J Pediatr Orthop. 2005;  25 357-359
    PubMedGoogle Scholar
  • 16 Miyagi N, IIsaka H, Yasuda K, Kaneda K. Onset of ossification of the tarsal bones in congenital clubfoot.  J Pediatr Orthop. 1997;  17 36-40
    CrossrefPubMedGoogle Scholar
  • 17 Fritsch H, Eggers R. Ossification of the calcaneus in the normal fetal foot and in clubfoot.  J Pediatr Orthop. 1999;  19 22-26
    CrossrefPubMedGoogle Scholar
  • 18 Spiegel D A, Loder R T. Leg-length discrepancy and bone age in unilateral idiopathic talipes equinovarus.  J Pediatr Orthop. 2003;  23 246-250
    CrossrefPubMedGoogle Scholar
  • 19 Sodre H, Bruschini S, Magalhaes L A. et al . Arterial abnormalities in talipes equinovarus assessed by angiography and the Doppler technique.  J Pediatr Orthop. 1990;  10 101-104
    PubMedGoogle Scholar
  • 20 Katz D A, Albanese E L, Levinsohn E M. et al . Pulsed color-flow Doppler analysis of arterial deficiency in idiopathic clubfoot.  J Pediatr Orthop. 2003;  23 84-87
    CrossrefPubMedGoogle Scholar
  • 21 Ahmed M, Ahmed N, Khan K M. et al . Sensory hypoinnervation in club foot.  J Bone Joint Surg [Br]. 2004;  86 1163-1169
    CrossrefPubMedGoogle Scholar
  • 22 Macnicol M F, Nadeem R D. Evaluation of the deformity in club foot by somatosensory evoked potentials.  J Bone Joint Surg [Br]. 2000;  82 731-735
    CrossrefPubMedGoogle Scholar
  • 23 CEMAT (Canadian Early- and Mid-Trimester Amniocentesis Trial) group . Randomised trial to assess safety and fetal outcome of early and midtrimester amniocentesis.  Lancet. 1998;  351 242-247
    CrossrefPubMedGoogle Scholar
  • 24 Byron-Scott R, Sharpe P, Hasler C. et al . South Australian population-based study of congenital talipes equinovarus.  Paediatr Perinat Epidemiol. 2005;  19 227-237
    CrossrefPubMedGoogle Scholar
  • 25 Pryor G A, Villar R N, Ronen A, Scott P M. Seasonal variation in the incidence of congenital talipes equinovarus.  J Bone Joint Surg [Br]. 1991;  73 632-634
    PubMedGoogle Scholar
  • 26 Carney B T, Coburn T R. Demographics of idiopathic clubfoot: is there a seasonal variation?.  J Pediatr Orthop. 2005;  25 351-352
    PubMedGoogle Scholar
  • 27 Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current management.  J Bone Joint Surg [Br]. 2007;  89 995-1000
    PubMedGoogle Scholar
  • 28 Chung C, Nemechek R, Larsen I, Ching G. Genetic and epidemiological studies of clubfoot in Hawaii: general and medical considerations.  Hum Hered. 1969;  19 321-342
    CrossrefPubMedGoogle Scholar
  • 29 Lovell M E, Morcuende J A. Neuromuscular disease as the cause of late clubfoot relapses: report of 4 cases.  Iowa Orthop J. 2007;  27 82-84
    PubMedGoogle Scholar
  • 30 Grill F. Der Klumpfuß.  Orthopäde. 1996;  25 364-378
    PubMedGoogle Scholar
  • 31 Herzenberg J E, Carol N C, Christafensen M R. et al . Clubfoot analysis with three-dimensional computer modeling.  J Pediatr Orthop. 1988;  8 257-262
    PubMedGoogle Scholar
  • 32 Hubbard A M, Meyer J S, Davidson R S. et al . Relationship between the ossification center and cartilaginous anlage in the normal hindfoot in children: study with MR imaging.  Am J Roentgenol. 1993;  161 849-853
    PubMedGoogle Scholar
  • 33 Howard C B, Benson M K. The ossific nuclei and the cartilage anlage of the talus and calcaneum.  J Bone Joint Surg [Br]. 1992;  74 620-623
    PubMedGoogle Scholar
  • 34 Hee H T, Lee E H, Lee G S. Gait and pedobarographic patterns of surgically treated clubfeet.  J Foot Ankle Surg. 2001;  40 287-294
    CrossrefPubMedGoogle Scholar
  • 35 Shimode K, Myagi N, Majima T. et al . Limb length and girth discrepancy of unilateral congenital clubfeet.  J Pediatr Orthop [Br]. 2005;  14 280-284
    PubMedGoogle Scholar
  • 36 Bar-on E, Mashiach R, Inbar O. et al . Prenatal ultrasound diagnosis of club foot: outcome and recommendations for counselling and follow-up.  J Bone Joint Surg [Br]. 2005;  87 990-993
    PubMedGoogle Scholar
  • 37 Mammen L, Benson C B. Outcome of fetuses with clubfeet diagnosed by prenatal sonography.  J Ultrasound Med. 2004;  23 497-500
    PubMedGoogle Scholar
  • 38 Bar-Hava I, Bronshtein M, Orvieto R. et al . Caution: prenatal clubfoot can be both a transient and a late-onset phenomenon.  Prenat Diagn. 1997;  17 457-460
    CrossrefPubMedGoogle Scholar
  • 39 Tillett R, Fisk N M, Murphy K, Hunt D M. Clinical outcome of congenital talipes equinovarus diagnosed antenatally by ultrasound.  J Bone Joint Surg [Am]. 2000;  82 876-880
    CrossrefPubMedGoogle Scholar
  • 40 Cooper J M, Dietz F R. Treatment of idiopathic clubfoot.  J Bone Joint Surg [Am]. 1995;  77 1477-1489
    PubMedGoogle Scholar
  • 41 Simons G W. Analytical radiography of clubfeet.  J Bone Joint Surg [Br]. 1977;  59 485-489
    PubMedGoogle Scholar
  • 42 Davis L A, Hatt W S. Congenital abnormalities of the feet.  Radiology. 1955;  64 818-825
    PubMedGoogle Scholar
  • 43 Heywood A WB. The mechanics of the hindfoot in clubfoot as demonstrated radiographically.  J Bone Joint Surg [Br]. 1964;  46 102-107
    PubMedGoogle Scholar
  • 44 Thometz J G, Liu X C, Tassone J C, Klein S. Correlation of foot radiographs with foot function as analyzed by plantar pressure distribution.  J Pediatr Orthop. 2005;  25 249-252
    PubMedGoogle Scholar
  • 45 Ralder C, Manner H M, Suda R. et al . Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment.  J Bone Joint Surg [Am]. 2007;  89 1177-1183
    CrossrefPubMedGoogle Scholar
  • 46 Aurell Y, Andriesse H, Johansson A, Jonsson K. Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method.  J Pediatr Orthop [Br]. 2005;  14 347-357
    PubMedGoogle Scholar
  • 47 Gigante C, Talenti E, Turra S. Sonographic assessment of clubfoot.  J Clin Ultrasound. 2004;  32 235-242
    CrossrefPubMedGoogle Scholar
  • 48 Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report.  J Pediatr Orthop. 2008;  28 53-59
    PubMedGoogle Scholar
  • 49 Suda R, Suda A J, Grill F. Sonographic classification of idiopathic clubfoot according to severity.  J Pediatr Orthop [Br]. 2006;  15 134-140
    PubMedGoogle Scholar
  • 50 Cahuzac J P, Navaskues J, Baunin C. et al . Assessment of the position of the navicular by three-dimensional magnetic resonance imaging in infant foot deformities.  J Pediatr Orthop [Br]. 2002;  11 134-138
    PubMedGoogle Scholar
  • 51 Moritani T, Aihara T, Oguma E. et al . MR evaluation of talonavicular angle in congenital talipes equinovarus.  Clin Imaging. 2000;  24 243-247
    CrossrefPubMedGoogle Scholar
  • 52 Saito S, Hatori M, Kokubun S. et al . Evaluation of calcaneal malposition by magnetic resonance imaging in the infantile clubfoot.  J Pediatr Orthop [Br]. 2004;  13 99-102
    PubMedGoogle Scholar
  • 53 Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method.  J Pediatr Orthop. 2001;  21 719-726
    CrossrefPubMedGoogle Scholar
  • 54 Liu X C, Thometz J G, Tassone C. et al . Dynamic plantar pressure measurement for the normal subject – free-mapping model for the analysis of pediatric foot deformities.  J Pediatr Orthop. 2005;  25 103-106
    PubMedGoogle Scholar
  • 55 Flynn J M, Donohoe M, Mackenzie W G. An independent assessment of two club-foot-classification systems.  J Pediatr Orthop. 1999;  18 323-327
    PubMedGoogle Scholar
  • 56 Pirani S, Outerbridge H K, Moran M, Sawatsky B. A method of assessing the virgin clubfoot. Pediatric Orthopaedic Society of North America. Miami; Annual Meeting; May 1995
    Google Scholar
  • 57 Dyer P J, Davis N. The role of the Pirani scoring system in the management of clubfoot by the Ponseti method.  J Bone Joint Surg [Br]. 2006;  88 1082-1084
    PubMedGoogle Scholar
  • 58 Morris C, Doll H A, Wainwright A. et al . The Oxford ankle foot questionnaire for children.  J Bone Joint Surg [Br]. 2008;  90 1451-1456
    PubMedGoogle Scholar
  • 59 Dimeglio A, Bonnet F, Mazeau P, De Rosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot.  J Pediatr Orthop [Br]. 1996;  5 173-180
    PubMedGoogle Scholar
  • 60 Bösch J. Zur Technik der Klumpfußbehandlung.  Z Orthop. 1964;  85 429
    PubMedGoogle Scholar
  • 61 Ponseti I V. Congenital clubfoot: fundamentals of treatment. Oxford; Oxford University Press 1996
    Google Scholar
  • 62 Cooper D M, Dietz F R. Treatment of idiopathic clubfoot: a thirty-year follow-up note.  J Bone Joint Surg [Am]. 1995;  77 1477-1489
    PubMedGoogle Scholar
  • 63 Herzenberg J E, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot.  J Pediatr Orthop. 2002;  22 517-521
    CrossrefPubMedGoogle Scholar
  • 64 Shack N, Eastwood D M. Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity.  J Bone Joint Surg [Br]. 2006;  88 1085-1089
    CrossrefPubMedGoogle Scholar
  • 65 Tindall A J, Steinlechner C WB, Lavy C BD. et al . Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world?.  J Pediatr Orthop. 2005;  25 627-629
    PubMedGoogle Scholar
  • 66 Radler C, Waschak K, Salzer M. Starting a clubfoot programm in a developing country. European Federation of National Associations of Orthopaedics and Traumatology. Nizza; 9th EFORT congress May/2008
    Google Scholar
  • 67 Pittner D E, Klingele K E, Beebe A C. Treatment of clubfoot with the Ponseti method: a comparison of casting materials.  J Pediatr Orthop. 2008;  28 250-353
    PubMedGoogle Scholar
  • 68 Haft G F, Walker C G, Crawford H A. Early clubfoot recurrence after use of Ponseti method in a New Zealand population.  J Bone Joint Surg [Am]. 2007;  89 487-493
    CrossrefPubMedGoogle Scholar
  • 69 Thacker M M, Scher D M, Sala D A. et al . Use of the foot abduction orthosis following Ponseti casts: is it essential?.  J Pediatr Orthop. 2005;  25 225-228
    CrossrefPubMedGoogle Scholar
  • 70 Barker S L, Lavy C BD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot.  J Bone Joint Surg [Br]. 2006;  88 377-379
    PubMedGoogle Scholar
  • 71 Scher D M, Feldman D S, van Bosse H JP. et al . Predicting the need for tenotomy in the Ponseti method for correction of clubfeet.  J Pediatr Orthop. 2004;  24 349-352
    PubMedGoogle Scholar
  • 72 Dobbs M B, Gordon J E, Walton T, Schoenecker P L. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity.  J Pediatr Orthop. 2004;  24 353-357
    PubMedGoogle Scholar
  • 73 Morcuende J A, Dolan L A, Dietz F R, Ponseti I V. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method.  Pediatrics. 2004;  113 376-380
    CrossrefPubMedGoogle Scholar
  • 74 Abdelgawad A A, Lehman W B, Van Bosse H J. et al . Treatment of idiopathic clubfoot using the Ponseti method: minimum 2 year follow-up.  J Pediatr Orthop [Br]. 2007;  16 98-105
    PubMedGoogle Scholar
  • 75 Radler C, Suda R, Manner H M, Grill F. Early results of the Ponseti method for treatment of idiopathic clubfoot.  Orthop Ihre Grenzgeb. 2006;  144 80-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 76 Bor N, Herzenberg J E, Frick S L. Ponseti management of clubfoot in older infants.  Clin Orthop. 2006;  444 224-228
    PubMedGoogle Scholar
  • 77 Lourenco A F, Morcuende J A. Correction of neglected idiopathic club foot by the Ponseti method.  J Bone Joint Surg [Br]. 2007;  89 378-381
    PubMedGoogle Scholar
  • 78 Böhm S, Limpaphayom N, Alaee F. et al . Early results of the Ponseti method for treatment of clubfoot in distal arthrogryposis.  J Bone Joint Surg [Am]. 2008;  90 1501-1507
    CrossrefPubMedGoogle Scholar
  • 79 Alvarez C M, Tredwell S J, Keenan S P. et al . Treatment of idiopathic clubfoot utilizing botulinum A toxin: a new method and its short-term outcomes.  J Pediatr Orthop. 2005;  25 229-235
    PubMedGoogle Scholar
  • 80 Ramachandran M, Eastwood D M. Botulinum toxin and its orthopaedic applications.  J Bone Joint Surg [Br]. 2006;  88 781-787
    PubMedGoogle Scholar
  • 81 Henn 3rd R F. Subtalar release in clubfeet: a retrospective study of 10-year outcomes.  Foot Ankle Int. 2008;  29 390-395
    CrossrefPubMedGoogle Scholar
  • 82 Dobbs M B, Nunley R, Schoenecker P L. Long-term follow up of patients with club-feet treated with extensive soft-tissue release.  J Bone Joint Surg [Am]. 2006;  88 986-996
    CrossrefPubMedGoogle Scholar
  • 83 Laaveg S J, Ponseti I V. Long term results of treatment of congenital clubfoot.  J Bone Joint Surg [Am]. 1980;  62 23-31
    PubMedGoogle Scholar
  • 84 Cummings R J, Bashore C J, Bookout C B, Elliott M J. Avascular necrosis of the talus after McKay clubfoot release for idiopathic congenital clubfoot.  J Pediatr Orthop. 2001;  21 221-224
    CrossrefPubMedGoogle Scholar
  • 85 Kuo K N, Hennigan S P, Hastings M E. Anterior tibial tendon transfer in residual dynamic clubfoot deformity.  J Pediatr Orthop. 2001;  21 35-41
    PubMedGoogle Scholar
  • 86 Pohl M, Nicol R O. Transcuneiform and opening wedge medial cuneiform osteotomy with closing wedge cuboid osteotomy in relapsed cluboot.  J Pediatr Orthop. 2003;  23 70-73
    CrossrefPubMedGoogle Scholar
  • 87 Schaefer D, Hefti F. Combined cuboid/cuneiform osteotomy for clubfoot correction of residual adductus deformity in idiopathic and secondary club feet.  J Bone Joint Surg [Br]. 2000;  82 881-884
    CrossrefPubMedGoogle Scholar
  • 88 Lourenco A F, Dias L S, Zoellick D M, Sodre H. Treatment of residual adduction deformity in clubfoot: the double osteotomy.  Pediatr Orthop. 2001;  21 713-718
    PubMedGoogle Scholar
  • 89 Legaspi J, Li H Y, Chow W, Leong J C. Talectomy in patients with recurrent deformity in club foot. A long-term follow-up study.  J Bone Joint Surg [Br]. 2001;  83 384-387
    CrossrefPubMedGoogle Scholar
  • 90 Mirzayan R, Early S D, Matthys G A, Thordarson D B. Single-stage talectomy and tibiocalcaneal arthrodesis as a salvage of severe, rigid equinovarus deformity.  Foot Ankle Int. 2001;  22 209-213
    PubMedGoogle Scholar
  • 91 Freedman J A, Watts H, Otsuka N Y. The Ilizarov method for the treatment of resistant clubfoot: is it an effective solution?.  J Pediatr Orthop. 2006;  26 432-437
    PubMedGoogle Scholar
  • 92 Ferreira R C, Costa M T, Frizzo C G, Santin R A. Correction of severe clubfoot using a simplified setting of the Ilizarov device.  Foot Ankle Int. 2007;  28 557-568
    CrossrefPubMedGoogle Scholar

Dr. Karin Waschak

Orthopädisches Spital Speising
Abteilung für Kinder- und Jugendorthopädie

Speisingerstraße 109

1130 Wien

Email: karin.waschak@oss.at

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