Correcting Congenital Talipes Equinovarus in Children Using Three Different Corrective Methods: A Consort Study

Abstract

Equinus, varus, cavus, and adduction are typical signs of congenital talipes equinovarus (CTEV). Forefoot adduction remains a difficulty from using previous corrective methods. This study aims to develop a corrective method to reduce the severity of forefoot adduction of CTEV children with moderate deformities during their walking age. The devised method was compared with 2 other common corrective methods to evaluate its effectiveness. A Dennis Brown (DB) splint, DB splint with orthopedic shoes (OS), and forefoot abduct shoes (FAS) with OS were, respectively, applied to 15, 20, and 18 CTEV children with moderate deformities who were scored at their first visit according to the Diméglio classification. The mean follow-up was 44 months and the orthoses were changed as the children grew. A 3D scanner and a high-resolution pedobarograph were used to record morphological characteristics and plantar pressure distribution. One-way MAVONA analysis was used to compare the bimalleolar angle, bean-shape ratio, and pressure ratios in each study group. There were significant differences in the FAS+OS group compared to the DB and DB+OS groups (P < 0.05) for most measurements. The most salient differences were as follows: the FAS+OS group had a significantly greater bimalleolar angle (P < 0.05) and lower bean-shape ratio (P < 0.01) than the other groups; the DB+OS and FAS+OS groups had higher heel/forefoot and heel/LMF ratios (P < 0.01 and P < 0.001) than the DB group. FAS are critical for correcting improper forefoot adduction and OS are important for the correction of equinus and varus in moderately afflicted CTEV children. This study suggests that the use of FAS+OS may improve treatment outcomes for moderate CTEV children who do not show signs of serious torsional deformity.

FIGURE 1

From left to right: A, Dennis Brown Splint; B, orthopedic shoe with orthopedic insole in it. There are anterior and posterior outflares on the shoes and a velcro in the malleolar area to control equinus; C, top view of forefoot abduct shoe for left foot; and D, the schematic bottom view of the forefoot abduct shoe for left foot.

FIGURE 2

A, 3D scanner and malleolar jig for measuring bimalleolar angle. B, The bimalleolar angle is formed between the bimalleolar axis and the longitudinal axis of the foot passing through the second toe. C, Bean–shape ratio is foot width-to-length ratio.

FIGURE 3

A, Pedobarography for static and dynamic measurements; B, the 5 segments of the foot from pressure image. LFF = lateral forefoot; LMF = lateral midfoot; MFF = medial forefoot; MMF = medial midfoot.