Abstract
Purpose
The aim of our study was to evaluate the pathological anatomy of the ligaments, tendons and muscles in clubfeet, and to show whether the dysbalance of shortened and elongated structures is an adaptive process or a primary factor inducing the misshaped bones and cartilagines.
Methods
Surgical exposure was performed on seven idiopathic clubfeet specimens, aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation).
Results
The medial stabilisation system of the foot was found shortened, but all ligaments could be dissected. On the lateral side, the calcaneofibular ligament in particular was both ‘shortened’ and ‘elongated’, depending on the course of the fibres to the axis of motion in the subtalar and talocalcaneonavicular joint. The main difference to the normal feet was found in the thickened tendon of the tibialis posterior forming a bulbus before dividing into fascicules.
Conclusions
We presume the ossification disturbance of the calcaneus to be the primary fault. This disturbance will influence the reduction of the varus position, so ligaments and tendons will be conformed to the misshaped bones.
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References
Böhm M (1929) The embryologic origin of club-foot. J Bone Joint Surg 11:229–259
Dietz FR, Ponseti IV, Buckwalter JA (1983) Morphometric study of clubfoot tendon sheaths. J Pediatr Orthop 3:311–318
Schlicht D (1963) The pathological anatomy of talipes equinovarus. Aust N Z J Surg 33:1–11
Waisbrod H (1973) Congenital club foot. An anatomical study. J Bone Joint Surg Br 55(4):796–801
Ippolito E (1995) Update on pathologic anatomy of clubfoot. J Pediatr Orthop 4:17–24
Irani RN, Sherman MS (1963) The pathological anatomy of clubfoot. J Bone Joint Surg Am 45:45–52
Scarpa A (1818) A memoir on the congenital club feet of children, and on the mode of correcting that deformity. Translated from Italian by J. H. Wishart. A. Constable and Co., Edinburgh
Settle GW (1963) The anatomy of congenital talipes equinovarus: sixteen dissected specimens. J Bone Joint Surg Am 45:1341–1354
Thiel W (1992) Die Konservierung ganzer Leichen in natürlichen Farben. [The preservation of the whole corps with natural color]. Anat Anat 174:185–195
Diméglio A, Bensahel H, Souchet PH, Mazeau PH, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop 4:129–136
Ponseti IV, Campos J (1972) Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop 84:50–60
Bensahel H, Huguenin P, Themar- Noel C (1983) The functional anatomy of clubfoot. J Pediatr Orthop 3:191–195
Howard CB, Benson MKD (1993) Clubfoot: its pathological anatomy. J Pediatr Orthop 13:654–659
Gardner E, Gray DJ, O´Rahilly R (1959) The prenatal development of the skeleton and joints of the human foot. J Bone Joint Surg Am 41:847–876
Straus Jr WL (1927) Growth of the human foot and its evolutionary significance. Contrib Embryol 101:93–135
Beau A (1939) Recherches sur le développement et la constitution morphologiques de l’articulation du cou-de-pied chez l´homme. Arch Anat Histol Embryol 27:203–258
Harris BJ (1993) Observations on the development of the human foot. In: Sarrafian SK (eds) Anatomy of the foot and ankle. 2nd edn. JB Lippincott Company, Philadelphia
McKee P, Bagnall KM (1987) Skeletal relationships in the human embryonic foot based on three-dimensional reconstructions. Acta Anat 129:34–42
Epeldegui T, Delgado E (1995) Acatablum Pedis. Part I: talocalcaneonavicular joint socket in normal foot. J Pediatr Orthop 4:1–10
Epeldegui T, Delgado E (1995) Acatablum Pedis. Part II: talocalcaneonavicular joint socket in clubfoot. J Pediatr Orthop 4:11–16
Ruth CJ (1961) Surgical treatment of injuries of the fibular collateral ligament of the ankle. J Bone Joint Surg Am 43:229
Wolff J (1986) Das Gesetz der Transformation der Knochen. Berlin, A. Hirschwald. English translation by P. Maquet and R. Furlong. Springer, Berlin Heidelberg New York
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The first part of this article is available at http://www.dx.doi.org/10.1007/s11832-006-0003-3.
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Windisch, G., Anderhuber, F., Haldi-Brändle, V. et al. Anatomical study for an updated comprehension of clubfoot. Part II: Ligaments, tendons and muscles. J Child Orthop 1, 79–85 (2007). https://doi.org/10.1007/s11832-006-0004-2
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DOI: https://doi.org/10.1007/s11832-006-0004-2