Ghanem I, Seringe R
Universite Rene Descartes, Paris V. Service de Chirurgie Orthopedique infantile, Hopital Saint Vincent de Paul, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(7):615-21.
An ideal method for the assessment of the results of treatment in congenital clubfoot should take into account the morphology of the foot and its function, the personal satisfaction of the patient of his parents, interexaminer variability, and be applied for any type of treatment.
We evaluated at- end of growth the results of treatment of 35 patients with unilateral clubfoot, and analyzed them according to 13 different rating scores already published in the literature. The material was divided in 3 groups; 15 feet having undergone multiple surgeries, 10 feet having had only one posteromedial release procedure, and 10 feet having been treated nonoperatively.
None of the 13 reviewed rating methods seems to be ideal. The results of treatment, for one taken foot, were often different from one method to the other.
The high number of rating scores published in literature, is the direct evidence that there is no concensus in the evaluation of the results of treatment in congenital clubfoot. A unanimous new method should be created and should fill all the prerequisites of the ideal method, described above. Some criteria are very important to consider: A iatrogenic deformity or disability, i.e. severe lateral translation of the foot, acquired convex foot, or calcaneus foot, should be severely penalized; hopping on one foot should be the test used to evaluate the strength of triceps surae muscle in children above 5 years of age ; Radiological evidence of talonavicular dislocation is a very important long term prognostic element.
A new unanimous method for the assessment of the results of clubfoot treatment is necessary. It should be simple, easy to teach, and easy to use.
评估先天性马蹄内翻足治疗效果的理想方法应考虑足部的形态及其功能、患者或其父母的个人满意度、检查者之间的差异，并且适用于任何类型的治疗。
我们在生长末期评估了35例单侧马蹄内翻足患者的治疗效果，并根据文献中已发表的13种不同评分方法对其进行了分析。材料分为3组；15只脚接受了多次手术，10只脚仅接受了一次后内侧松解手术，10只脚接受了非手术治疗。
所审查的13种评分方法似乎都不理想。对于同一只患足，不同方法得出的治疗结果往往不同。
文献中发表的评分方法数量众多，直接证明了在评估先天性马蹄内翻足治疗效果方面没有共识。应该创建一种统一的新方法，该方法应满足上述理想方法的所有先决条件。有一些标准非常重要，需要考虑：医源性畸形或残疾，即足部严重的外侧移位、后天性弓形足或跟骨足，应受到严厉惩罚；单脚跳跃应作为评估5岁以上儿童腓肠肌力量的测试；距舟关节脱位的放射学证据是一个非常重要的长期预后因素。
需要一种统一的评估马蹄内翻足治疗效果的新方法。它应该简单、易于教授且易于使用。
