Object: the congenital talipes equinovarus recurrences in children aged 3 to 10 years. Aim: to improve the results of treatment of the congenital clubfoot relapses’ treatment in children 3-10 years old based on the study of the dynamics of structural and functional changes in the affected feet, biomechanical substantiation and the creation of an algorithm for the combined treatment. Methods: clinical; X-ray, biomechanical; graphoanalytic, statistical. New knowledge about abnormal anatomical variations of the anterior tibial muscle tendon attachment to first metatarsal diaphysis in 27-30% of children with congenital talipes equinovarus recurrences were obtained. For the first time, using biomechanical simulation graphical analytical methodics, it was proved that, in the presence of abnormal attachment of the anterior tibial muscle tendon to the first metatarsal diaphysis, a force imbalance in the direction of adduction of the anterior foot portion occurs, and an increase in the values of the rotational forces by increasing the values of their action levers. The scientific data on the role of plantar aponeurosis in the appearance of congenital talipes equinovarus recurrences, in particular, its cavus component, was supplemented. As a result of mathematical modeling, it was shown, that the foot cavus foot deformity correction requires lengthening of the plantar aponeurosis up to 25%, which is possible by creating a constant stretching force exceeding 1000 N or by surgical intervention. For the first time, based on statographical studies, the best restoration dynamics of equilibrium and weight-bearing functions was observed after treatment of congenital talipes equinovarus recurrences in a group of children aged 3 to 10 years who were initially treated by I. Ponseti conservative treatment methodics (93.75% of positive results) compared with the group where the primary treatment was surgical (82.4% of good and satisfactory results). For the first time, as a result of dynamometric studies, it was determined that in children aged 3 to 10 years, after a combined talipes equinovarus recurrences’ treatment, the complete ratio restoration between forces of dorsal flexors of foot and plantar flexors is happening in the period of 9-12 months. Restoration of muscle strength runs faster and to a greater extent in patients whose primary treatment of congenital talipes equinovarus has been accomplished by I. Ponseti methods. The combined algorithm of treatment of patients with congenital talipes equinovarus recurrences in children aged 3 to 10 years is developed. It involves the initial corrective Ponseti plaster casting methodics, followed by a differentiated choose of residual feet deformities’ surgical treatment methodics. That reduces the surgical interventions’ trauma and increases the treatment effectiveness. It is proved, that I. Ponseti stage plaster casting methodics is effective for correction of foot deformities in case of congenital talipes equinovarus recurrences in children aged 3 to 10 years, regardless of primary treatment methodics, with a low complications and recurrences percentage. The braces and the orthoses for the prevention of congenital talipes equinovarus recurrences in children after appliance of Ponseti conservative treatment methodics, were invented (patent of Ukraine number 95542, number 102282). Their usage, together with the proposed combined treatment, made it possible to reduce the number of abovementioned recurrences by 35-48%, thus, to improve the effectiveness of antirecurrent treatment to this patients’ category. The performance of partial plantar fasciotomy, to correct the cavus component in the combined congenital talipes equinovarus recurrences’ treatment in children aged 3 to 10 years, is substantiated. The results of the work were introduced into the clinical practice of the SI "Sytenko Institute of Spine and Joint Pathology of the Ukrainian Academy of Medical Sciences," Lviv Regional Children's Clinical Hospital "OKHMATDIT", Children's Clinical Hospital of Poltava, KNMP "Likarnya intensyvnoho likuvannya "Kremenchutsʹka", Kherson Regional Clinical Hospital. Тraumatology and Orthopaedics.
