Agarwal Anil, Barik Sitanshu, Patel Yogesh, Sami Abdus, Gera Mohit
Chacha Nehru Bal Chikitsalaya, New Delhi, India.
All India Institute of Medical Sciences, Nagpur, India.
J Clin Orthop Trauma. 2024 Nov 19;59:102831. doi: 10.1016/j.jcot.2024.102831. eCollection 2024 Dec.
The study aimed to quantify and correlate kinematic coupling linkage of foot abduction (correction of adduction) and inversion, heel varus and ankle equinus for clubfeet corrected by Ponseti technique.
Measurements of foot abduction (derotation of carpopedal block), heel varus and ankle equinus were available from Dimeglio scores in 25 feet. Radiological angles were considered for foot inversion-eversion. Values of above parameters were obtained at the start of treatment (T1), pre tenotomy (T2) and after tenotomy (T3). The values of T2-T1 corresponded to the manipulative phase of Ponseti technique while T3-T2 corresponded to the Achilles tenotomy.
During the manipulative phase, coupling rhythm between foot abduction to correction of equinus, heel varus and inversion was calculated to be 1:0.3, 1:1.1 and 1:0.5 respectively. Post tenotomy, coupling rhythm between ankle dorsiflexion to changes in foot abduction, heel varus and inversion was calculated to be 1:0.5, 1:0.1 and 1:0.4 respectively. A moderate significant correlation was obtained on comparison of T3-T2 values between clinical equinus and foot abduction (r = 0.54, p = 0.05).
The foot inversion, heel varus and ankle equinus corrected at 1.1, 0.5 and 0.3 times respectively of foot abduction in the manipulative phase. The phenomenon of kinematic coupling between various foot movements was however inconsistent during Ponseti treatment of clubfoot. More significant associations were obvious towards late phase of deformity correction when foot alignments were much improved. Larger prospective studies are needed to delineate the precise linkage between foot movements in a pathological condition such as clubfoot.Level of evidence - II.
本研究旨在量化并关联经庞塞蒂（Ponseti）技术矫正的马蹄内翻足的足部外展（内收矫正）与内翻、足跟内翻和踝关节马蹄畸形的运动耦合联系。
从25只足部的迪梅廖（Dimeglio）评分中获取足部外展（腕跗块旋转）、足跟内翻和踝关节马蹄畸形的测量值。考虑足部内翻 - 外翻的放射学角度。在治疗开始时（T1）、跟腱切断术前（T2）和跟腱切断术后（T3）获取上述参数的值。T2 - T1的值对应于庞塞蒂技术的手法操作阶段，而T3 - T2对应于跟腱切断术。
在手法操作阶段，足部外展与马蹄畸形、足跟内翻和内翻矫正之间的耦合节律分别计算为1:0.3、1:1.1和1:0.5。跟腱切断术后，踝关节背屈与足部外展、足跟内翻和内翻变化之间的耦合节律分别计算为1:0.5、1:0.1和1:0.4。临床马蹄畸形与足部外展的T3 - T2值比较时获得中度显著相关性（r = 0.54，p = 0.05）。
在手法操作阶段，足部内翻、足跟内翻和踝关节马蹄畸形分别以足部外展的1.1倍、0.5倍和0.3倍得到矫正。然而，在庞塞蒂治疗马蹄内翻足期间，各种足部运动之间的运动耦合现象并不一致。在畸形矫正后期，当足部对线明显改善时，更显著的关联变得明显。需要更大规模的前瞻性研究来描绘诸如马蹄内翻足等病理状况下足部运动之间的精确联系。证据级别 - II。
