Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases

Journal of Orthopaedics and Traumatology

Official Journal of the Italian Society of Orthopaedics and Traumatology

Table 1 Population data, clinical and radiographic assessment and treatment

Age of observation	No. of feet	Previous treatment			Pirani score			Radiographic assessment	Treatment
Age of observation	No. of feet	None	Serial casting	Serial casting + posteromedial release	0–1	1.5–2.5	≥3	Radiographic assessment	Serial casting (Ponseti)	Percutaneous Achilles tenotomy	Open Achilles lenghtening + posterior ankle and subtalar joint release	Selective medial release + cuboid subtractive osteotomy	posteromedial release	posteromedial and lateral release + cuboid subtractive osteotomy
Newborn (0–4 months)	52	52			–	10	42	1 (forced ankle dorsiflexion X-rays at 3 months)	52	51
Non-ambulating child (4–12 months)	12	2	10		–	2	10	–	12	7	2		3
Ambulating child (>12 months)	24	6	10	8	–	3	21	24				1	6	17

Clinical evaluation was summarized with the Pirani score. Radiographic assessment was not performed in non-ambulating children except in one case. During treatment with serial casting, radiographs were performed in a 3-month-old child, forcing the ankle in dorsiflexion in order to better evaluate the reducibility of the equinus. In this case, radiographs showed reduction of the equinus and thus there was no need for Achilles tenotomy. All newborns and non-ambulating children were treated with serial casting before performing surgery. All ambulating children underwent surgical treatment