University of Khartoum

Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence

Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence

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Title: Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence
Author: Shaheen, Samir; Murs, Haitham; Rabih, Mohamed
Abstract: Clubfoot, talipes equino varus (TEV), is a common congenital foot anomaly. Some cases are resist ant to conservative treatment. Many causes of resistance have been reported, among these, the presence of anomalous muscles; however, the effect of the presence of anomalous muscles on the outcome of conservative management is not well studied. These aberrant muscles are discovered during the extensive surgical release as an abnormal finding. The aim of this work is to study the demographic characteristics of patients with resist ant TEV that necessitated extensive soft tissue release at Sudan Clubfoot Clinic and to document the prevalence of flexor digitorum accessorius longus (F DAL) muscle in a large series of clubfoot patients treated by extensive surgery: posteromedial release. Also, we introduce a new observation as an indication by which the surgeon can predict the presence of F DAL. On the basis of an observation that there is a special posture of the big toe in extension in relation to other flexed toes associated with the presence of F DAL, records of patients of clubfoot treated by extensive surgery between 2007 and 20 12 at the Sudan Clubfoot Project were reviewed. Demographic characteristics were studied. Only patients with idiopathic Introduction Congenital talipes equino varus (TEV) or congenital clubfoot is a common foot abnormality in childhood [1]. It affects male s more than females and it is on e of the most common problems encountered in paediatric orthopaedics [2]. The aetiology of idiopathic clubfoot remains elusive [3]. Vascular deficiencies, environmental factor s, factors related to amniotic fluid, abnormal muscle insertion, inutero posit- ioning and genetic factors have been reported to play a role [4]. Pathological anatomy of club foot has been well studied and described as tight posteromedial soft tissue structures as well as bone changes in the tarsal bones [5]. It also lists four components of deformity: cavus, adduction, varus and equinus. These four components are summarized as CAVE [6]. In the majority of cases, the Ponseti method of treatment is successful; however, some cases are resistant. These resi- stant cases are encountered in some idiopathic TEV or could be associated with arthrogryposis or meningomyel- ocele [4]. Resistant cases may also be encountered in cases of anatomical abnormalities such as an aberrant b and Ashok Johari c TEV were included. Resist ant clubfeet necessitated extensive release in 261 patients, 197 males and 64 females. Their ages ranged between 1 day and 1 5 years at presentation. F DAL muscle was found in 48 patients (54 feet) out of 261 patients (411 feet, 13.1 4%). In 46 of the 48 patients (95.8%), the presence of the FDAL could be predicted by a Sign. FDAL is prevalent in 13% of TEV cases, requiring extensive soft tissue release, and the surgeon c a n expect resist ant clubfoot and predict the presence of the F DAL in over 9 5 % before h e operates observing Samir– Adam Sign
URI: http://khartoumspace.uofk.edu/123456789/27732
Date: 2020


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