Diss. (sammanfattning) Uppsala : Uppsala universitet, 2009. / Härtill 5 uppsatser.

Aim: The aim with this study is to compare different orthotic solutions for pediatric patients with congenital talipes equnivarus.  Method: A search in the databases MEDLINE, CINAHL, PubMed and Scopus were made, and studies was included after the predefined criteria. The included studies were reviewed for risk of bias and validity, relevant data was extract and analyzed with regards to the research question.  Result: The result was presented on 15 different orthotic interventions in 21 different articles. The reported outcome measures were compliance, recurrence of deformity, Pirani- and Dimeglio score, range of motion and functional outcomes.  Conclusion: Based on the results a recommendation cannot be made on what orthosis that gives the best result. Future research should focus on developing and designing an orthosis that satisfies the patient's needs. / Syfte: Syftet med detta arbete är att undersöka olika ortos-lösningar med dess inkluderade resultat för patienter med kongenital idiopatisk klumpfot. Metod: En systematisk sökning i databaserna MEDLINE, CINAHL, PubMed and Scopus genomfördes och väsentliga studier inkluderades utefter de förbestämda kriterierna. Inkluderade studiers validitet och möjliga partiskhet bedömdes samt att relevant data utifrån frågeställningen analyserades och besvarades.  Resultat: Resultatet presenterade 15 olika typer av ortoser, i 21 olika artiklar. De presenterade utfallsmåtten var inom komplians, återfall av deformationen, Pirani- och Dimeglio poäng, rörelseomfång samt inom funktionellt resultat. Slutsats: Baserat på resultat går det inte att presentera en övervägande slutsats om vilken ortos-lösning som ger bäst resultat. Framtida forskning måste utveckla och framställa ortoser som tillfredsställer och möter patienternas behov.

Aim: Through this review we aim to investigate if there is an alternative orthotic treatment for paediatric patients with idiopathic congenital talipes equinovarus showing the same maintenance of correction as the benchmark treatment but with higher adherence. Methods: A literature search was performed in the data bases MEDLINE, CINAHL and Scopus. Predetermined eligibility criteria were used to include and exclude articles. Critical appraisal was performed for the included articles. Relevant data was extracted, analyzed and presented to aid in answering the research question. Results: Of the 204 articles found in databases, seven were included in the final review. Adherence rate and relapse rate was extracted from the seven orthotic interventions. Most of the orthoses presented both better adherence and maintenance of correction than the benchmark treatment. The majority were case series, not including a comparison group and with short-term follow-up. Conclusion: The results indicate that there are orthotic designs that may be preferred over the traditional Denis Browne bar. However, the lack of high-quality evidence and standardization to detect and define a relapse and measure adherence makes it difficult to recommend an alternative orthosis with the present evidence. Factors other than the orthotic design also influence the adherence.

Idiopathic clubfoot causes severe deformity of the foot and lower leg. Due to the complex anatomy and small size of the foot, the condition is difficult to define and describe. This study focused on 3D modeling of different foot positions associated with clubfoot relapse, and investigation of muscle parameters. The 3D modeling was performed in the AnyBody Modeling System to retrieve information about muscle length. Musculoskeletal modeling could provide further understanding of the condition and contribute to assessment and treatment evaluation. Five children that received clubfoot treatment as infants, and five typically developing children, serving as a control group, participated in the study. Despite treatment with the Ponseti method, Achilles tenotomy and use of an abduction orthosis, all participants of the clubfoot group showed signs of relapse. In total, seven affected legs were studied. Data from gait analyses of all participants were compiled and interpreted in the AnyBody Modeling System. The Plug-in-Gait Model for lower extremities and the Oxford Foot Model were used as marker protocol for the study. Studied lower leg muscles were Gastrocnemius Lateralis, Gastrocnemius Medialis, Soleus Lateralis and Soleus Medialis. Muscle length, defined as length of contractile element, for each leg and participant were evaluated using the AnyBody model template LowerExtremity. Compared to the control group, the models of the clubfoot group presented shorter mean muscle lengths of all investigated muscles. / Idiopatisk klumpfot orsakar allvarlig deformation av fot och underben. På grund av fotens anatomi och ringa storlek kan tillståndet vara svårt att beskriva och definiera. Denna studie innefattade 3Dmodellering av olika fotpositioner orakade av recidivklumpfot, för att undersöka muskelegenskaper. AnyBody Modeling System användes för att generera 3D-modeller och ta fram information om muskellängd. Muskuloskeletal modellering skulle kunna öka förståelsen för sjukdomen och bidra till förbättringar av initial bedömning och utvärdering av behandling. Fem barn som behandlades för klumpfot efter födseln deltog i studien. Även fem typiskt utvecklade barn medverkade och fungerade som en kontrollgrupp. Trots behandling med Ponseti-metoden, hälseneförlängning och användning av abduktionsortos, uppvisade samtliga barn i klumpfotsgruppen tecken på återfall. Totalt studerades sju ben med recidivklumpfot. Data från gånganalyser av deltagarna sammanställdes och analyserades i AnyBody Modeling System. Plug-in-Gait Model för nedre extremiteter och Oxford Foot Model användes som markörprotokoll. Under studien analyserades underbensmusklerna Gastrocnemius Lateralis, Gastrocnemius Medialis, Soleus Lateralis och Soleus Medialis. Muskellängd (längd av kontraktilelement) för varje patient och ben beräknades med hjälp av modellmallen LowerExtremity i AnyBody Modeling System. Jämfört med kontrollgruppen visade klumpfotsgruppen kortare medelmuskellängder för samtliga av de analyserade musklerna.