درمان تالوس عمودی مادرزادی با گچ‎گیری معکوس «پونستی»

پیش‎زمینه: رایج ترین روش درمان برای تالوس عمودی جراحی گسترده بافت نرم است. یک روش با حداقل تهاجم بر پایه قالب گیری سریالی یا پشت سر هم «دوب» (پونستی معکوس) 15 سال پیش معرفی شد و نتایج قابل توجهی به دست آورد. هدف از این مطالعه بررسی و مقایسۀ نتایج میان مدت قالب گیری با روش گچ‎گیری است.مواد و روش‎ها: 12 بیمار مبتلا به تالوس عمودی در یک مطالعه آینده‎نگر قرار گرفتند، 6 بیمار با 10 فوت مبتلا به پونستی معکوس و 6 نفر دیگر با 10 فوت با جراحی بافت نرم خارجی تحت درمان قرار گرفتند. در یک پیگیری 18 تا 24 ماهه، نتایج با استفاده از محدوده حرکت مچ پا، پرسشنامه اکسفورد و اندازه‎گیری‎های رادیوگرافی مقایسه شدند.یافته‎ها: میانگین حرکات مچ پا در دو گروه قابل مقایسه بود (0.35 = p)؛ نمره پرسشنامه اکسفورد بین دو گروه به لحاظ آماری تفاوت معناداری نداشت (p = 0.876).نتیجه‎گیری: با توجه به نتایج قابل مقایسه بین جراحی گسترده و گچ‎گیری «پونستی معکوس» در این مطالعه میان مدت، تکنیک قالب‎گیری به دلیل ماهیت و طبیعت غیرتهاجمی این روش درمانی توصیه می‎شود.

Reverse Ponseti Casting in Treatment of Congenital Vertical TalusA Clinical Trial

Congenital convex pes valgus or congenital veBackground: The most common method of treatment for vertical talus is the extensive soft tissue release. A minimallyinvasive method based on Dobb’s serial casting (Reverse Ponseti) was introduced 15 years ago and has yielded significant results. The aim of this study was to investigate and compares the midterm results of Casting with the extensive soft tissue release method.Methods:12 patients with vertical talus were included in a prospective study, 6 patients with 10 feet were treated with reverse ponseti, and 6 other patients with 10 feet with externsive soft tissue release. In an 1824 months followup the results were compared together, using ankle range of motion, oxford questionnaire, and radiographic measurements.Results: The mean range of ankle motion was comparable in the two groups (p=0.35), the oxford questionnaire score was not statistically different between the two groups (p=0.876).Conclusion: With the comparable results between the ’’reverseponseti’’ casting land extensive surgical releases in this midterm study, the casting technique is recommended because of its lower cost and noninvasive nature.rtical talus (CVT) is an uncommon congenital foot deformity. Incidence rate of CVT is 1 out of 10,000 live birth. CVT is one of the main causes of rigid flatfoot in newborns (1). Rigid talonavicular joint dislocation is the hallmark (inflexible in the sole of the foot with no arch) of CVT, accompanied by nonflexible equinus. In this structural abnormality, in fact, the convex plantar surface of the foot creates a rockerbottom appearance (2). It occurs as an isolated deformity in half of patients and is associated with neuromuscular and genetic disorders in others (1, 3, 4). There is bilateral involvement in half of CVT patients, and there is no gender predilection (5). Although CVT is not painful for newborns and infants, if not diagnosed and left untreated, leads to major disabilities in the adulthood. Ambulation is not usually delayed; however, the gait is unbalanced. Patient`s shoes often show abnormal wear, and pain often develops in early adolescence (6). As the heels, do not touch the ground, pushoff from the floor is poor and talar head acts as a weightbearing structure, resulting in painful calluses in this region (7, 8).