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Therapie des Rezidivklumpfußes und residueller Deformitäten nach kongenitalem Klumpfuß

Treatment of recurrent clubfoot and residual deformities after congenital clubfoot

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Zusammenfassung

Rezidive und residuelle Fehlstellungen sind nach Behandlung eines kongenitalen Klumpfußes häufig. Nach erfolgreicher Primärbehandlung nach den Ponseti-Prinzipien treten Rezidive in bis zu 48 % der Fälle auf. Mit konsequenter Ergreifung von Maßnahmen entsprechend den Vorgaben von Ponseti kann jedoch mit gering-invasiven Maßnahmen (Gipsredression, M.-tibialis-anterior-Transfer) in der überwiegenden Zahl der Fälle ein guter, beweglicher, funktionsfähiger Fuß erzielt werden. Anspruchsvoll bleibt die Behandlung der sog. „neglected clubfeet“. In Abhängigkeit vom Alter des Patienten, der Art und dem Ausmaß der Deformität kommen unterschiedliche konservative und/oder operative Verfahren zum Einsatz. Die Gipsredression entsprechend den Ponseti-Prinzipien ist auch eine gute primäre Behandlungsoption bei Rezidiven nach primärer Gelenkreleaseoperation insbesondere bis zum Kindergartenalter; ein operativer Eingriff ist dann häufig nicht mehr oder aber mit deutlich geringerer Invasivität erforderlich. Mit zunehmendem Alter der Patienten und Rigidität der Fehlstellung werden überwiegend knöcherne Eingriffe notwendig. Voraussetzung für eine adäquate Therapie ist eine sorgfältige Evaluation der Fehlstellung und der Funktionsdefizite. Mit zunehmender Zahl an Operationen sinken allerdings die Chancen auf Verbesserung bzw. Erhalt der Funktion. Von daher ist die beste Behandlung eines Rezidivs bzw. Residualklumpfußes die Prophylaxe durch eine konsequente Primärbehandlung und Nachsorge.

Abstract

Relapse and residual deformity after treatment of congenital clubfoot are common problems. Recurrences occur in up to 48 % of cases after successful initial treatment using Ponseti’s technique. By casting and anterior tibial tendon transfer as recommended by Ponseti a flexible and well functioning foot can be achieved in most cases. Neglected clubfoot remains a demanding challenge. Depending on the severity of the deformity, the impairment of function and patient age, conservative and/or different operative treatment options can be considered. Manipulation and casting according to Ponseti is also recommended in toddlers with relapses even after peritalar joint release. Thus the need and extent of operative treatment can be reduced. Additional osteotomy may be indicated in more rigid feet and older children. An accurate evaluation of the existing deformity and functional impairment is mandatory for the individual choice of treatment. The number of previous operative procedures reduces the amount of improvement and mobility of the foot. Therefore, the best and most efficient treatment for recurrent clubfoot is prevention in the form of consistent primary treatment, consistently wearing braces and regular follow-up examinations.

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  1. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    B. Westhoff, K. Weimann-Stahlschmidt & R. Krauspe

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  1. B. Westhoff
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  2. K. Weimann-Stahlschmidt
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  3. R. Krauspe
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Correspondence to B. Westhoff.

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Westhoff, B., Weimann-Stahlschmidt, K. & Krauspe, R. Therapie des Rezidivklumpfußes und residueller Deformitäten nach kongenitalem Klumpfuß. Orthopäde 42, 418–426 (2013). https://doi.org/10.1007/s00132-013-2088-y

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