Abstract
This contribution presents the analysis of a group of 14 patients with a serious form of meningomyelocele associated with equinovarosity of the foot. The severity of the condition depends on the neurosegmental level of the lesion as well as the seriousness of the essential malady.
The primary treatment of these patients is aimed at early surgical management of meningomyelocele. It is fundamental that the patient should undergo a thorough neurological examination in which the prognosis of the illness and the expected degree of immobility of the patient should be determined. If full immobility is expected, radical correction of the foot deformity should be deferred. If, at any age, a tendency to verticalise occurs, immediate correction of the foot deformity is required in order to prevent decubitus and provide for posture stability.
The treatment of paralytic clubfoot is above all adversely affected by skin hypaesthesia which tends to cause decubitus and aggravate healing of the wound after the surgery.
Our group consists of 14 patients who were operated for a serious form of lumbar meningomyelocele associated with L2-S2 areflexia soon after birth. The current mean age of the group is 14 years (range 6 to 20). Four patients aged from two to six years were operated. Serious complications of wound healing after surgery occurred in one patient. All four patients are able to walk with a stagger and clumsily with the help of crutches. The remaining ten patients have been left immobile without hope of stable standing.
The treatment of paralytic clubfoot demands intensive cooperation of neurologists and neurosurgeons. It is necessary to carefully think about all aspects of a patient’s prognosis before radical surgical treatment of the foot is considered.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
