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Congenital clubfoot: Aspects on epidemiology, residual deformity and patient reported outcome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function.

Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation.

Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability.

Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome.

Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet.

Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function.

Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 48
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 464
Keywords [en]
Congenital clubfoot, incidence, ultrasonography, forefoot adduction, navicular position, spurious correction, Ilizarov External Fixator, subjective outcome, stiffness, patient reported outcome, norm group, gender difference
National Category
Surgery
Research subject
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-106366ISBN: 978-91-554-7563-5 (print)OAI: oai:DiVA.org:uu-106366DiVA, id: diva2:224695
Public defence
2009-10-03, Brömssalen, Gävle Sjukhus, Gävle, 13:00 (English)
Opponent
Supervisors
Available from: 2009-09-11 Created: 2009-06-22 Last updated: 2009-09-11Bibliographically approved
List of papers
1. Incidence of congenital clubfoot in Sweden
Open this publication in new window or tab >>Incidence of congenital clubfoot in Sweden
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 6, p. 847-852Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Idiopathic clubfoot is one of the most common congenital orthopedic problems. Nationwide studies of the incidence are scarce. We performed a prospective multicenter study in order to assess the cumulative incidence in Sweden over 2 consecutive years. PATIENTS AND METHODS: 44 clinics identified as treating clubfoot reported new cases prospectively. The medical records of 280 children with clubfoot born during 1995- 1996 were collected and analyzed with special reference to gender, regional distribution and seasonal variation. RESULTS: The average cumulative incidence of clubfoot during the study period was 1.4/10(3) (95% CI 1.2- 1.6). Three-quarters of the cases were boys. In half of the cases both feet were affected. There was significant regional heterogeneity, but no seasonal variation in occurrence of clubfoot. INTERPRETATION: The cumulative incidence was higher than in earlier Scandinavian studies. Gender distribution and laterality were similar to those in previous reports. We found significant regional differences in incidence, but the cause of this observation must be investigated in greater depth.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-25103 (URN)10.1080/17453670610013123 (DOI)000243586300003 ()17260191 (PubMedID)
Available from: 2007-03-03 Created: 2007-03-03 Last updated: 2017-12-07Bibliographically approved
2. Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities.
Open this publication in new window or tab >>Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities.
Show others...
2002 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 12, no 9, p. 2306-12Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.

Identifiers
urn:nbn:se:uu:diva-105166 (URN)10.1007/s00330-001-1243-8 (DOI)12195486 (PubMedID)
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2017-12-13
3. No association between residual forefoot adduction and the position of the navicular in clubfeet treated by posterior release
Open this publication in new window or tab >>No association between residual forefoot adduction and the position of the navicular in clubfeet treated by posterior release
2007 (English)In: Journal of Pediatric Orthopaedics, ISSN 0271-6798, E-ISSN 1539-2570, Vol. 27, no 1, p. 60-66Article in journal (Refereed) Published
Abstract [en]

Medial displacement of the navicular has been considered a major explanation for residual forefoot adduction (FFA) in congenital clubfoot and also a frequent reason for dissatisfaction after limited surgery. In this study, it was hypothesized that there would be an association between the degree of medial displacement of the navicular and residual FFA in clubfeet. The position of the navicular was retrospectively measured by ultrasonography in 49 clubfeet in 35 children at ages 3 to 6 years and correlated to residual FFA measured on footprints and radiographs (talo-first metatarsal angle). In the 49 clubfeet, the navicular was significantly more medially displaced toward the medial malleolus than in the 21 contralateral normal feet (P < 0.001). However, there was no correlation between the degree of medial displacement of the navicular and the degree of FFA measured on footprints (P = 0.690) or on radiographs (P = 0.390). Thus, there were clubfeet with straight forefoot and a medially displaced navicular, that is, "spurious correction," and clubfeet with FFA and the navicular in correct position in relation to the head of the talus. Both patient satisfaction and foot score declined with larger FFA. The results support the view that ultrasonography is a helpful tool for assessing the position of the navicular. The critical issue for analysis is whether the FFA is due to malalignment in the talonavicular joint or more distally.

Keywords
congenital clubfoot, posterior release, forefoot adduction, position of navicular, ultrasonography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-25104 (URN)10.1097/BPO.0b013e31802b6c73 (DOI)17195800 (PubMedID)
Available from: 2007-02-09 Created: 2007-02-09 Last updated: 2017-12-07Bibliographically approved
4. Correction of persistent clubfoot deformities with the Ilizarov external fixator. Experience in 10 previously operated feet followed for 2-5 years.
Open this publication in new window or tab >>Correction of persistent clubfoot deformities with the Ilizarov external fixator. Experience in 10 previously operated feet followed for 2-5 years.
1996 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 67, no 3, p. 283-7Article in journal (Refereed) Published
Abstract [en]

We reviewed the outcome in 10 idiopathic clubfeet in 7 patients treated with the Ilizarov external fixator (IEF) for persistent foot deformities after previous surgery. After follow-up of a median of 40 (25-56) months, 6 patients/parents were satisfied with the results and most of them reported better walking capacity and fewer problems finding shoes that fit. Severe equinus deformity was seen in 9/10 feet prior to treatment in the IEF and in no foot at follow-up. However, persistent reduction of ankle joint motion, limited walking capacity and intermittent pain were commonly found.

National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-105158 (URN)8686470 (PubMedID)
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2017-12-13
5. Patient Reported Outcome at 62-67 years of age in 83 patients treated for Congenital Clubfoot
Open this publication in new window or tab >>Patient Reported Outcome at 62-67 years of age in 83 patients treated for Congenital Clubfoot
(English)Manuscript (Other academic)
Abstract [en]

Patient reported outcome in 83 patients with congenital clubfoot was evaluated at a mean age of 64 years using three validated questionnaires assessing both quality of life (SF-36 and EQ-5D) and foot and ankle function (AAOS Foot and Ankle Questionnaire). In SF-36 male patients scored significantly better than male norms in 7/8 domains, while female patients scored significantly worse than female norms in 2/8 domains. The male patients scored better than male norms in both EQ-5D Index (p=0.027) and VAS (p=0.013) while female patients scored worse than female norms in VAS (p<0.001). Both male and female patients had a significantly worse outcome on the AAOS Core Scale when compared to norms. There was a significant correlation, for both genders, between the SF-36 Physical Component Summary Score and the AAOS Core Scale.

In conclusion the influence on daily life activities was limited to foot and ankle problems, and in female patients’ also in physical aspects of quality of life.

National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-105161 (URN)
Available from: 2009-06-01 Created: 2009-06-01 Last updated: 2010-01-14Bibliographically approved

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