Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
All India Institute of Medical Sciences, New Delhi, India.
Clin Orthop Surg. 2021 Dec;13(4):558-563. doi: 10.4055/cios20261. Epub 2021 Jul 16.
Complete peroneal nerve dysfunction associated with congenital clubfoot is uncommonly reported. Our retrospective study highlights the recognition of clinical presentation and mid-term outcomes of treatment in these patients.
Eight out of 658 patients undergoing treatment for clubfoot were identified with unilateral complete peroneal nerve dysfunction associated with congenital clubfoot. Three patients presented primarily to our center; 5 were treated elsewhere initially. All patients were treated with Ponseti casts, Achilles tenotomy, and subsequent foot abduction bracing. Diagnosis of complete peroneal nerve dysfunction was confirmed using nerve conduction velocity studies in all patients. After full-time bracing, an insole polythene molded ankle foot orthosis was given. Three patients underwent tibialis posterior transfer to improve foot dorsiflexor power.
The mean age at presentation was 1.3 years (range, 1 week-5 years). All patients had prominence of lateral 3 metatarsal heads and dimpling of intermetatarsal spaces. At a mean follow-up of 5.1 years, mean shortening of 1.2 cm in tibia (range, 1-2.5 cm) and mean calf wasting of 4.4 cm were observed. There was no relapse of any clubfoot deformity till the final follow-up.
Prominence of lateral metatarsal heads and dimpling of intermetatarsal spaces should raise early suspicion of peroneal nerve dysfunction. Standard Ponseti protocol is useful in treatment of these patients. Tibialis posterior transfer to dorsum partially restores the ankle dorsiflexion.
先天性马蹄足伴完全腓总神经麻痹并不常见。我们的回顾性研究强调了这些患者的临床表现和中期治疗结果的认识。
在接受马蹄足治疗的 658 例患者中，有 8 例患者被诊断为单侧完全腓总神经麻痹伴先天性马蹄足。其中 3 例患者最初就诊于我们中心，5 例患者最初在其他地方接受治疗。所有患者均采用潘塞提石膏、跟腱切开术和随后的足部外展支具治疗。所有患者均通过神经传导速度研究确诊为完全腓总神经麻痹。在全天支具固定后，给予聚烯烃成型鞋垫踝足矫形器。3 例患者接受了胫后肌转移以改善足背屈肌力量。
就诊时的平均年龄为 1.3 岁（范围，1 周至 5 岁）。所有患者均有外侧 3 个跖骨头突出和跖间凹陷。平均随访 5.1 年后，观察到胫骨平均缩短 1.2cm（范围，1-2.5cm）和小腿平均萎缩 4.4cm。在最终随访时，没有任何马蹄足畸形复发。
外侧跖骨头突出和跖间凹陷应引起对腓总神经麻痹的早期怀疑。标准的潘塞提方案对这些患者的治疗是有用的。胫后肌转移到背侧部分恢复踝关节背屈。
