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Muscular strength after extensive operative treatment of congenital talipes equinovarus
1Department of Pediatric Orthopaedics, Karol Marcinkowski University of Medical Sciences of Poznań, Poland. ortop@webmedia.pl
Insights
Children’s congenital talipes equinovarus (clubfoot) surgery impacts muscle strength, with significant deficits in foot extensors and supinators post-operation. Strength recovery varies by muscle group and age, affecting long-term outcomes.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Congenital talipes equinovarus (clubfoot) is a common birth defect requiring surgical intervention.
- The long-term functional outcomes of operative treatments for clubfoot, particularly muscle strength, require further investigation.
Purpose of the Study:
- To evaluate the maximum isometric voluntary contraction (MIVC) strength of key foot muscles in children post-clubfoot surgery.
- To compare muscle strength deficits between different surgical approaches and analyze age-related changes.
Main Methods:
- Assessed MIVC strength of foot extensors, plantar flexors, pronators, and supinators in two groups of children post-clubfoot surgery.
- Group 1: Posteromedial-lateral release (n=28). Group 2: Complete subtalar release via Cincinnati incision (n=32).
- Follow-up periods averaged 85 months (Group 1) and 51 months (Group 2).
Main Results:
- Both surgical groups exhibited decreased MIVC in foot muscles, with the greatest deficits in supinators and extensors.
- Better clinical outcomes correlated with higher extensor muscle MIVC in the posteromedial-lateral release group.
- Plantar flexor strength difference remained stable, while extensor, supinator, and pronator deficits increased with age.
Conclusions:
- Extensive operative treatment for clubfoot leads to persistent muscle strength deficits, particularly in extensors and supinators.
- Muscle strength recovery is age-dependent, with increasing deficits observed in certain muscle groups over time.
- No significant difference in muscle strength outcomes was found between the two surgical techniques evaluated.
Abstract:
Maximum isometric voluntary contraction (MIVC) strength of muscles (extensors, plantar flexors, pronators and supinators of the foot) in children with congenital talipes equinovarus who underwent extensive operative treatment was evaluated. The first group consisted of 28 children (50 clubfeet) operated on with posteromedial-lateral release aged 7 months to 76 months (mean, 22 months), with mean follow-up period of 85 months. The second group consisted of 32 children (39 clubfeet) operated on with complete subtalar release from Cincinnati incision aged from 3 months to 50 months (mean, 11 months), with mean follow-up period of 51 months. In both groups, the muscles moving the foot in the sagittal and coronal plane showed a decreased MIVC. The greatest deficit was observed in the supinators and extensors, less in the pronators and plantar flexors. Better results were accompanied by greater MIVC, but significant relations existed in the first group between the strength of the extensors and the quality of results (better results correlated with better MIVC of the extensors). No significant differences between both patient groups were noted. For the plantar flexors, the difference of the MIVC strength between the normal and affected feet is stable; instead, for the extensors, supinators and pronators, it increases in the analyzed age interval.