Dynamics of recovery of foot muscle strength in children with relapses of congenital equinovarus clubfoot after surgical treatment according to the Ponseti method
Keywords:clubfoot, Ponseti method, transposition, dynamometry
Background. In the case of relapses of congenital equinovarus clubfoot (CEVC) at the age of 3–10 years, the approaches to treatment differ significantly. Thus, the treatment of recurrent CEVC at the age of 3–10 years after primary conservative treatment by the Ponseti method is carried out with the transposition of the tendon of the tibialis anterior to the 3rd sphenoid bone. The treatment of recurrent CEVC in children of 3–10 years old after traditional methods of treatment is more complex and less effective. The purpose was to determine the features of the recovery of strength of the foot muscle groups in children with recurrent CEVC before and after surgical treatment by the Ponseti method and after traditional treatment methods. Materials and methods. Dynamometric studies were carried out in 65 children with recurrent CEVC. The patients were divided into 2 groups: group I (33 children) included traditional techniques, which included initial surgical intervention to completely correct all components of the deformity; group II (32 people) — Ponseti method. All patients underwent dynamometry of the muscle groups of the dorsal flexors and plantar extensors of the foot. The study was carried out before treatment, after 6 months, after surgery, and after 1 year. Results. The results of the study showed that in patients who were treated by the Ponseti method (group II), the strength of the dorsal flexor muscle groups of the foot increased statistically significantly
(p = 0.002) to the 6th month after surgery. In patients who were treated by traditional methods, statistically significant changes in the strength of the dorsal flexors of the foot were observed only to the 12th month after surgery. In group I patients, a statistically significant increase (at the p < 0.05 level) in the strength of the muscle groups of the plantar extensors of the foot was observed at all stages of the study. In patients who were treated by the Ponseti method, a statistically significant (p = 0.028) increase in the strength of the plantar extensors of the foot was observed only at the first stage (up to 6 months). Subsequently, the increase in the strength of the muscles of the plantar extensors of the foot significantly slowed down and averaged 0.2 ± 2.3 kg, which is not statistically significant (p = 0.880). Conclusions. In children of group I, the increase in muscle strength occurs more slowly than in group II, and the percentage increase in muscle strength compared to the initial va-lues is much less. Twelve months after the operation, the ratio of the strength of the dorsal flexors to the plantar extensors is almost completely restored in children, which justifies the advisability of using the Ponseti method as the primary method of treating CEVC in children.
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