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Conservative Treatment of Pes Equinovarus – History and Recent Trends

Miroslav Raikov, Milena Avdzhiyska, Silvia Ianakieva, Dimitar Raikov, Diyan Dimov

Abstract

Introduction: Pes equinovarus also popular as congenital clubfoot is a combined foot defect, presented by plantar flexion, invertion, and adduction. The treatment of this condition is conservative and operative. The aim of the treatment is to establish the impact on the pathology of the ligaments, tendons and muscles that determine the degree of resistance and the likelihood of recurrence of the disease. Nowadays, the general trend of treatment is the conservative approach, because of the proven much lower residual reactions and relapses that follow the surgeries.

Materials and Methods: The conservative methods of treatment of clubfoot are:

- Method of Kite – it consists of a series of manipulations, followed by plaster boots with typical manipulations over the foot.

- “French method” – It is generally a kinesitherapeutical method with a gradual increase of the intensity of manual stimulation of muscles and stretching of ligaments, temporary immobilised by either day or night splints. The manipulation is performed every day and it’s followed by elastic adhesive tapes to maintain the position.

- Method of Ponseti – the most popular one nowadays – serial casting and gradual complex reduction of the foot deformed elements. This method includes of 8 casts – the first 3 usually correct the foot to a plantigrade foot, next 4-5 casts continue and hold the position in a hypercorrection of the foot (supination and abduction). After the casts, the treatment continues with Dennis Brown’s splints until the 2nd-3rd year.

Results: From the listed methods, the one of Ponseti gives the best results in the treatment of clubfoot. The method of Kite presents an unsatisfactory result and has many critics from the recent data. The “French method” requires a lot of time and patience from parents and physicians.

Conclusion: Presenting much lower grades of complication rate and relapses, conservative treatment approaches of clubfoot deformities become a golden standard in clubfoot treatment worldwide.


Keywords

pes equinovarus, treatment


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