All of the following are done for management of clubfoot at birth except –
Correct Answer: Posteromedial soft tissue release
Description: Ans. is 'd' i.e., Posteromedial soft tissue release o Posteromedial soft tissue release is a surgical procedure that is carried out after 9 months of age once a thorough trial of casting is given.Treatment of CTEV in a newborn (Treatment of a fresh case)o The most widely accepted practice is to rely upon conservative treatment by correction and splintage during the first year of life, often using the so-called Ponseti techniqueo Beyond that, if casting and splintage fail to correct the position then operative correction is carried out.Primary conservative treatmento Ideally treatment should be begun immediately after birth, certainly not more than 1 week latero The principles of treatment are :-1) Correction of deformity by manipulation2) Maintenance of this correction by immobilizing the foot in over-corrected position in between the manipulations. Three methods are available for maintenance :-i) A plaster of paris cast (most commonly used)ii) Metal splints (Denis brown splint)iii) Adhesive strappingo Among these, retention in a plaster is much to be preferred, because it holds the foot in the over-corrected position more efficiently and for a longer period than do metal splints or strapping. The plaster must extend to the upper thigh, with the knee flexed 90deg. The plaster must be changed every week for the first 6 weeks and then every 2 weeks until the correction is achieved.Operative treatmento If treatment by manipulation and retention fails, operation should usually be undertaken before 9 months of age, mostly at 4-6 months. The idea behind early operation is to set the tarsal bones in normal relationship to one another and to remove deforming forces, thus allowing the bones to develop in their normal shape from an early age. The procedure used is soft tissue release, i.e. postero-medial release (PMR). The taut structures on the postero-medial side are released.Maintenance of correction after full correction has been achievedo After correction by serial manipulation and casting or by surgery, the foot is maintained in Dennis-Drown splint (DB splint). DB splint is applied for full time (23 hours a day) till the child starts walking, e.g. upto 1-1 1/2 years. After that, DB splint is given at night and in day time CTEV shoes (straight inner border, raised outer border, no heel) is given till skeletal maturity.
Category:
Orthopaedics
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