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Europa Medicophysica 1999 June;35(2):61-8


lingua: Inglese

Congenital foot defects. Follow-up of 148 consecutive cases, born in the years 1986-1997

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.

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