Agarwal Anil, Gupta Shobhit, Rastogi Prateek
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, 110031, India.
J Clin Orthop Trauma. 2020 May-Jun;11(3):453-456. doi: 10.1016/j.jcot.2020.03.004. Epub 2020 Mar 11.
The shortened hallux and deep medial crease are a significant cosmetic deformity in complex clubfeet. We quantitatively determined the correction of hallux length and deep medial crease following treatment of complex clubfeet.
A chart review of 11 patients (17 feet) with complex clubfeet treated with modified Ponseti method was undertaken. Pretreatment clinical photographs and Pirani scores were compared with those obtained at a recent follow-up to analyze outcomes. Hallux length was matched with 2nd toe and graded similar to Pirani score.
Mean patient age at enrollment was 26.8 weeks. Average follow up was 22.6 months. Pre treatment and follow up Pirani score averaged 5.8 and 0.2 respectively. The average number of cast utilized was 7. Incomplete/non correction of hallux was observed in 6 feet (35%), of which 4 suffered an equinus relapse. Deep medial crease corrected in all.
The study describes a clinical method of hallux length quantification in complex clubfeet. Medial crease recovered in all feet. The recovery of hallux length was delayed in some patients and might indicate persistent posteromedial soft tissue contracture/fibrosis in these feet.
在复杂型马蹄内翻足中，拇趾缩短和内侧深褶痕是一种显著的美容畸形。我们定量测定了复杂型马蹄内翻足治疗后拇趾长度和内侧深褶痕的矫正情况。
对11例（17足）采用改良Ponseti方法治疗的复杂型马蹄内翻足患者进行病历回顾。将治疗前的临床照片和Pirani评分与最近随访时获得的照片和评分进行比较，以分析治疗效果。将拇趾长度与第二趾进行匹配，并与Pirani评分进行类似分级。
入组时患者平均年龄为26.8周。平均随访22.6个月。治疗前和随访时Pirani评分平均分别为5.8和0.2。平均使用石膏的次数为7次。6足（35%）观察到拇趾未完全矫正/未矫正，其中4足出现马蹄足复发。所有病例内侧深褶痕均得到矫正。
本研究描述了一种复杂型马蹄内翻足拇趾长度定量的临床方法。所有足的内侧褶痕均恢复。部分患者拇趾长度恢复延迟，这可能表明这些足存在持续性后内侧软组织挛缩/纤维化。
