A. Dimeglio et al., ORTHOPEDIC TREATMENT AND PASSIVE MOTION MACHINE - CONSEQUENCES FOR THE SURGICAL-TREATMENT OF CLUBFOOT, Journal of pediatric orthopedics. Part B, 5(3), 1996, pp. 173-180
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.