THE HISTORY OF CONSERVATIVE AND OPERATIVE TREATMENT IN THE THERAPY OF TALIPES EQUINO-VARUS

Abstract

This study presents an historical review of the treatment of talipes equino-varus during the last centuries. The aim of the study was to show how knowledge about the pathogenesis and the progress of new techniques in orthopaedic surgery (plaster of Paris, anaesthesiology, asepsis, antisepsis) have influenced the treatment of this disease during the centuries.

This investigation is based on a study of the library of the German Orthopaedic and Science Museum that has more than 3000 historical books and theses from the middle of the 19th century to the present time.

In the 18th and 19th century there were different theories about the pathogenesis of clubfoot. For example, Paré was of the opinion that secondary forces were responsible for the deformity. Camper and Wolff were convinced that intrauterine pressure on the extremities was the reason for pes equinovarus. Little, Stromeyer and Delpech believed that shortening of the muscles was the origin. The pathogenesis of the clubfoot is still obscure.

The concept of therapy with redression and retention during the first month has not changed since Hippocrates. However, the techniques of redression and retention have changed during the decades. Machines and rural instruments were used for redression until the end of the 19th century (Lorenz, Thomas). Retention was improved by the development of new splints (Arceo, Venel, Scarpa). The introduction of plaster of Paris (Mathysen) in the treatment of the clubfoot led to a further improvement of retention in early treatment.

A new era began with asepsis and anaesthesia. These techniques allowed progress in the operative therapy of the tendons. The open and subcutaneous tenotomy was developed by Delpech, Dieffenbach, and Stromeyer.

In spite of the operative possibilities, we conclude that conservative treatment still has a major role in the concept of treatment for equinovarus.