Gupta Parmanand, Mittal Naveen, Jindal Nipun, Verma Preeti, Sharma Mrinalini
Government Medical College Hospital Chandigarh, Chandigarh, India.
Orthos Bone and Joint Clinic, Rachna 1, HIG, Sector 4 Vaishali, Ghaziabad, UP, India.
Int Orthop. 2017 Nov;41(11):2365-2369. doi: 10.1007/s00264-017-3603-2. Epub 2017 Aug 21.
The relapse rate after Ponseti method of correction has reduced in recent years which is attributable to the better appreciation of the need to achieve the correct degree of abduction. Ponseti recommended clinical 'overcorrection' of the foot to 70 of abduction. However, no scientific basis for this figure was found in literature. As the indications of Ponseti method extend to older children, we conducted a study to find out the amount of foot abduction to be achieved before applying a foot abduction brace in various age groups.
The normal 197 feet of children up to eight years of age were considered for study. The measurements included foot-bimalleolar angle in neutral and maximum possible abduction, thigh foot angle and leg foot angle.
The foot bimalleolar angle in neutral had a mean of 82.6 degrees and in maximum abduction a mean of 99.0 degrees. The mean leg foot angle was 66.4 degrees and the mean thigh foot angle was 60.5 degrees. It was found that these variables do not change with age. From the study we concluded that achieved abduction should be about 60-70 degrees before applying foot abduction brace in all children till age eight years with clubfeet treated with Ponseti technique, keeping the leg foot angle or the thigh foot angle as a guideline. This is against the common perception of keeping the abduction at 70 degrees for infants and reducing the abduction to 30 to 40 degrees for older children. Both the leg foot angle and thigh foot angles are reliable indicators of correction.
近年来，庞塞蒂矫正法后的复发率有所降低，这归因于人们对实现正确外展程度必要性的更好理解。庞塞蒂建议将足部临床“过度矫正”至70°外展。然而，文献中未发现该数值的科学依据。随着庞塞蒂方法的适应证扩展至大龄儿童，我们开展了一项研究，以确定在不同年龄组应用足部外展支具前应实现的足部外展量。
本研究纳入了197例8岁及以下儿童的正常足部。测量指标包括中立位和最大可能外展时的足双踝角、大腿-足角和小腿-足角。
中立位时足双踝角的平均值为82.6°，最大外展时为99.0°。小腿-足角的平均值为66.4°，大腿-足角的平均值为60.5°。发现这些变量不随年龄变化。从研究中我们得出结论，对于所有接受庞塞蒂技术治疗的8岁及以下马蹄内翻足儿童，在应用足部外展支具前，应将外展角度达到约6０-70°，以小腿-足角或大腿-足角作为指导。这与普遍观念不同，普遍观念认为婴儿应保持70°外展，大龄儿童应将外展角度降至30至40°。小腿-足角和大腿-足角都是可靠的矫正指标。
