Abstract

Purpose: Author published in International Orthopaedics (SICOT), a new surgical concept, treating 95% relapses/under-corrections in trimorphic extreme clubfoot deformities [1]. Present innovative, comprehensive, serial manipulation and casting technique in newborns, being successful in preventing these failures, is a complement to that. This new casting technique is a continuation of this research in to 4th phase. Clubfoot is a polymorphic deformity (trimorphic term evolved just for convenience of treatment in SICOT publication). Extreme deformities are very common at birth, given the above quoted relapse/ under-corrections rate. With poly-axial movements at every foot joint, clubfoot deformity is a cumulative polyarticular presentation and each one is different.

Material and Methods: Sixteen patients with 21 extreme deformities have been treated till now. An all-inclusive maneuver, reversing all deforming components at each joint, from ankle to toes, is constantly maintained while the foot is being fixed in a well molded below knee cast. This cast, when set after partial correction of the deformity by an all-inclusive maneuver, is further extended as a hood on the front and sides of knee, leaving posterior aspect free. The completed cast has been named as BK Hoody cast or Cobra Hood cast due to its resemblance with it (Figure 2).

Results and Conclusions: The technique is well conceived, evidence based, with gratifying results in all, at 6 months to 2 years follow up, as given in Table 1. After correction, walking keeps the deformity corrected by static and dynamic influences of weight bearing. It is user friendly, prevents cast slipping out, permitting knee movements, cost effective in avoiding future surgeries from failed treatments saving time and human misery. More work will further consolidate the promising results in these cases.

Keywords: Prefix clubfoot in all: Polymorphic deformity;Total correction in newborns; The new patiala technique; Poly-axial maneuvering and casting in newborns; All-inclusive manipulation and casting; Evidence based new concept;Cobra cast; BK Hoody cast

Abbreviations: LMICs: Low, Middle IncomeCountries; EQ: Equinus; AK: Above Knee, BK: Below Knee; Gr: Grade