The dissertation is devoted to improving the results of conservative and surgical methods of treatment of congenital clubfoot and recurrences in children of younger age (early childhood age) by applying supplements in the form of an additional point of corrective effect on the navicular bone during staged plastering by I. Ponseti and ultrasound examination of Achilles tendon after tenotomy. Represent the stage-by-stage schema of treatment of congenital clubfoot and the differential approach to the choice of surgical treatment based on clinical criteria’s, digital plantography data and 3D model based on computed tomography.
Congenital clubfoot is a common malformation that ranks first among congenital diseases of the musculoskeletal system in children. The frequency of congenital clubfoot is approximately from 0,6 to 4,5 cases per 1000 live births.
Congenital clubfoot can be an idiopathic malformation or accompany systemic diseases, arthrogryposis, diastrophic dysplasia, Freeman-Sheldon syndrome, Larsen syndrome. Congenital clubfoot develops under the influence of endogenous and exogenous pathological factors. Basic theories of clubfoot development: mechanical, embryonic, neuromuscular. Mechanical theory, which postulates that clubfoot results from an elevated intrauterine pressure during pregnancy. Embryonic theory associated with toxicosis during pregnancy, viral infection, toxoplasmosis, avitaminosis during embryogenesis.
Some authors suggested that the etiology of clubfoot is neuromuscular in origin and has genetic implications [Mejabi J., 2017; Stoll C., 2020; Ревкович А.С., 2020; Клычкова И.Ю., 2020]: disturbances in nerve impulse conduction and muscular dystonia and an existing muscle imbalance between the strong anterior tibialis tendon and antagonist muscles, lead to recurrence of foot supination, which is a contributing factor to dynamic supination of the foot. A genetic basis for isolated clubfoot is supported by the fact approximately 25% of all patients with isolated clubfoot report a positive family history for clubfoot.
Also, the results of studies on the analysis of calf muscle biopsy in patients with recurrences of clubfoot indicate the presence of fibrous degeneration of muscles, a decrease in the number of muscle fibers, presence of collagen, myoblasts and arterial abnormalities.
Different methods are used to treat congenital clubfoot in the world. At the stages of conservative treatment, the most commonly used methods of passive correction with staged plaster fixation: the method of T. Zatsepin (1947), the method of I. Ponseti (1963), the method of I. Klychkovoyi (2011).
The "gold standard" for the treatment of congenital clubfoot in the world is the method of I. Ponseti, which is based on the biomechanical principles of deformation correction. Its effectiveness according to various retrospective studies is from 80 to 93% [Ponseti I., 1963; Luckett, M.R., 2015; Крестьяшин И. В., 2020]. However, despite the extensive and long-term experience of treatment of this pathology, the frequency of relapses after conservative treatment in children in Ukraine and abroad varies from 3.5% to 56%.
