In the past more than 50 years, this is the first instance of a case with a distinctive pathoanatomy. Resistant/rigid club foot is a common orthopaedic problem that hasn't been fixed despite several operations and odd circumstances like this one. This is particularly true when older kids, teenagers, or adults who exhibit odd behaviour are involved. Even after numerous surgeries and in unusual situations, like this one, resistant/rigid club foot, a frequent orthopaedic issue, continues to be unresolved. This is especially true when we encounter abnormalities in older children, teenagers, or adults. This case had a distinct pathoanatomy because of congenital conditions, advancing age, and recurrent disease despite two prior surgeries. It was crucial to identify the true aetiology, or the particular patho- anatomy, before organising a new surgery. Due to this particular pathoanatomy, several other surgical approaches were not anticipated to produce the desired outcome. The concept of this research was founded on pathoanatomy and its complete correction, and the author has long been involved in club foot research. In order to make this research process effective in all resistant club feet at any age, including adolescents and adults, numerous need-based modifications have been made from time to time, based on applied interpretations of pathoanatomy. These modifications have been used in a sizable series with adequate follow-up in the past 25 to 30 years, with satisfying results. The groundbreaking changes include: giving the general term "obstinate club foot" to every conceivable rigid club foot of any age as a replacement for multiple names found in the literature; renaming the surgical procedure as the "Dolarz technique," which incorporates Z-plasties in the dorsolateral rotation skin flap (DOLAR); and revising an earlier method that had already been reported in the literature and was not likely to be successful. In addition to the skin flap, subtotal subtalar release also includes modified extended deeper extensive soft tissue and osseous releases (SSR). The current instance was handled using the Dolarz method, albeit with some more recent adjustments. Each stage took longer and involved more detail, focusing on triple plus dislocations and incorporating an innovative cuboid sliding osteotomy for complete restoration. Being aware of the diagnosis and conducting careful preoperative planning were essential for a satisfying outcome. Clubfoot that is rigid and recurrently obstinate, Dolarz procedure, subtotal subtalar release Subtotal subtalar release refers to the modified extended deeper extensive soft tissue and osseous release in addition to the skin flap (SSR). The Dolarz approach was used to treat the current instance, although with some more recent alterations. Each phase was longer and more thorough, concentrating on triple plus dislocations, and included an original cuboid sliding osteotomy for full repair. For a satisfying outcome, awareness of the diagnosis and thorough preoperative planning were necessary.
Author(s) Details:
Rattan Lal Mittal,
Department of Orthopedics, Government Medical College Patiala, Punjab, India.
Please see the link here: https://stm.bookpi.org/CIMMS-V1/article/view/8105
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