Correcting Congenital Talipes Equinovarus in Children using three different corrective methods

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 Dime´glio 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 FASþOS group compared
to the DB and DBþOS groups (P <0.05) for most measurements. The
most salient differences were as follows: the FASþOS group had a
significantly greater bimalleolar angle (P <0.05) and lower bean – shape
ratio (P <0.01) than the other groups; the DBþOS and FASþOS 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 FASþOS
may improve treatment outcomes for moderate CTEV children who do
not show signs of serious torsional deformity.