ORTHOPEDIC TREATMENT AND PASSIVE MOTION MACHINE - CONSEQUENCES FOR THE SURGICAL-TREATMENT OF CLUBFOOT

The efficacy of orthopaedic treatment and its influence on clubfoot su rgery has never been truly demonstrated. In the unsorted mass of clubf eet treated, it is difficult to determine exactly how effective orthop aedic treatment is for severely affected feet. If properly performed, perfectly synchronized, and supported by a Kinetec machine, such treat ment can noticeably reduce the rate of operation and, when operation i s still required, reduce its extent. In grade II soft > stiff feet wit h scores of 5-10, Kinetec-supported orthopaedic treatment is extremely effective. Operation is required in 32% of cases only, and posterior surgery is often sufficient. Lateral release, in this category, is nev er required. In grade III stiff > soft feet, with scores of 10-15, the efficacy of orthopaedic treatment associated with the Kinetec machine is far from negligible and operation most often includes posterior an d medial release (PMR), variably associated with plantar release. Late ral release is exceptional (15%), and operation is necessary in 75% of cases. In grade IV stiff = stiff feet, with scores of 15-20, orthopae dic treatment with the Kinetec machine has a true, though limited, eff ect. In this category, operation is necessary in 90% of cases. Lateral release is performed in 50%. In the postoperative period, orthopaedic treatment combined with use of the Kinetic machine must be continued. Orthopaedic treatment coordinated with use of the machine has conside rably shortened the duration of plaster cast immobilization: 2 months when operation included posterolateral-medial (PLMR) release or PMR, a nd only 1 month when operation was posterior release (PR). The machine has noticeably changed the results and has indisputably influenced op eration on the whole.