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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
D'Osualdo F. 1, Schierano S. 1, Chiandotto V. 2, Furlan R. 2
1 Child Rehabilitation Centre, Institute of Physical Medicine and Rehabilitation, ASS N. 4 “Medio Friuli”, Udine, Italy;
2 Department of Neonatology and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria della Misericordia (SMM), Udine, Italy
BACKGROUND: Numerous studies have been conducted in samples undergoing operative treatment, whereas there are far fewer studies in unselected populations or case series. For this reason, it is difficult to interpret the results of either conservative or operative methods of treatment.
METHODS: Here we present a sample of children with congenital foot deformities, constituting a cohort of 148 consecutive cases born in a 12-year period, seen shortly after birth (mean 3 days), and after a minimum of 12 months. The characteristics of the cohort were compared with those of the other babies born in the same period. Treatment was based on early management, parental involvement and the use of mobile orthoses.
RESULTS: The follow-up data regard all of the infants seen at the Nursery. In 92 cases the defect was bilateral, for a total of 236 feet. There were 23 cases (18%) of supinated equinovarus (SEV), 50 cases (38%) of metatarsus varus (MV), 46 cases (35%) of talipes calcaneovalgus (TC), and 29 cases (23%) presenting minor defects. In 80% of these cases, management was limited to instructing the parents or several sessions of physical therapy. Only 12% were treated beyond the third month of life. Conservative treatment was successful in all cases of TC, MV, first and second grade SEV, and 2 cases of third grade SEV. Operative treatment was necessary in only 4 cases of third grade SEV (7/34 SEV feet). Analysis of the sample revealed a significant difference in the number of uni- and bilateral cases among the various clinical forms and the absence of a strong relationship with the factors usually associated with an intrauterine malposition such as birthweight (BW), birth order and a twin birth.
CONCLUSIONS: The study confirms the benefits of early management and a conservative approach to congenital foot deformities. When surgery was performed, only minor interventions proved necessary.