Abstract：
OBJECTIVE: To describe a conservative treatment algorithm to manage Congenital Metatarsus Varus.
BACKGROUND: Congenital Metatarsus Varus is a congenital disorder with an estimated incidence of 1/1000 newborns. Despite the deformity being mostly an aesthetic problem, residual and incorrect forms may be responsible for abnormal in-toe gait and shoe-wearing issues. No consensus has still been gathered regarding its correct treatment algorithm.
METHODS: Between May 2019 and September 2020, 2156 newborn patients underwent an orthopedic examination at birth. Patients affected by Congenital Metatarsus Varus were classified according to Bleck\'s classification as flexible, semi-flexible or non-flexible deformity. A conservative treatment algorithm was followed, based on the application of manipulations, Bebax-type braces or plaster cast. All patient were followed until the clinical resolution of the deformity. Complications were also recorded.
RESULTS: One-hundred twenty-four patients were diagnosed Congenital Metatarsus Varus, with an overall prevalence of 5/1000. One-hundred twenty-two patients presented with a flexible or semi-flexible foot deformity and were firstly treated with manipulations: 52 patients reported good results, while 70 required additional treatment with Bebax-type braces for achieving correction. Two patients presented a non-flexible deformity at birth: one required plaster cast due to a non-flexible deformity, and one patient was firstly managed with Bebax-type braces due to a severe semi-flexible deformity. Only two patients presented superficial skin ulcerations, healed within a week. Two patients were lost during the follow-up.
CONCLUSIONS: An early diagnosis allowed by an orthopedic examination in all newborns may be a valid instrument to avoid Congenital Metatarsus Varus misdiagnosis. Early treatment with manipulation and orthosis resulted in good clinical outcome, with only few complications.
BACKGROUND: Congenital Metatarsus Varus is a congenital disorder with an estimated incidence of 1/1000 newborns. Despite the deformity being mostly an aesthetic problem, residual and incorrect forms may be responsible for abnormal in-toe gait and shoe-wearing issues. No consensus has still been gathered regarding its correct treatment algorithm.
METHODS: Between May 2019 and September 2020, 2156 newborn patients underwent an orthopedic examination at birth. Patients affected by Congenital Metatarsus Varus were classified according to Bleck\'s classification as flexible, semi-flexible or non-flexible deformity. A conservative treatment algorithm was followed, based on the application of manipulations, Bebax-type braces or plaster cast. All patient were followed until the clinical resolution of the deformity. Complications were also recorded.
RESULTS: One-hundred twenty-four patients were diagnosed Congenital Metatarsus Varus, with an overall prevalence of 5/1000. One-hundred twenty-two patients presented with a flexible or semi-flexible foot deformity and were firstly treated with manipulations: 52 patients reported good results, while 70 required additional treatment with Bebax-type braces for achieving correction. Two patients presented a non-flexible deformity at birth: one required plaster cast due to a non-flexible deformity, and one patient was firstly managed with Bebax-type braces due to a severe semi-flexible deformity. Only two patients presented superficial skin ulcerations, healed within a week. Two patients were lost during the follow-up.
CONCLUSIONS: An early diagnosis allowed by an orthopedic examination in all newborns may be a valid instrument to avoid Congenital Metatarsus Varus misdiagnosis. Early treatment with manipulation and orthosis resulted in good clinical outcome, with only few complications.
摘要：
目的：描述一种保守的治疗方法来处理先天性跖骨内翻。
背景：先天性跖骨内翻是一种先天性疾病，估计发病率为1/1000新生儿。尽管畸形主要是一个美学问题，残留和不正确的形式可能是导致脚趾步态异常和穿鞋问题的原因。关于其正确的治疗算法尚未达成共识。
方法：在2019年5月至2020年9月之间，2156名新生儿患者在出生时接受了骨科检查。受先天性跖骨内翻影响的患者根据Bleck分类为柔性，半柔性或非柔性畸形。遵循保守治疗算法，基于操作的应用，Bebax型牙套或石膏模型。随访所有患者，直到畸形的临床解决。并发症也被记录。
结果：一百二十四例患者被诊断为先天性跖骨内翻，总体患病率为5/1000。一百二十二例患者表现为柔性或半柔性足部畸形，并首先接受了手术治疗：52例患者报告了良好的效果，而70需要使用Bebax型牙套进行额外治疗以实现矫正。两名患者在出生时表现出非柔性畸形：一名患者因非柔性畸形而需要石膏石膏，由于严重的半柔性畸形，一名患者首先接受了Bebax型支架治疗。只有两名患者出现浅表皮肤溃疡，一周内痊愈。两名患者在随访期间失联。
结论：对所有新生儿进行骨科检查的早期诊断可能是避免先天性跖骨内翻误诊的有效手段。早期治疗的手法和矫形器导致良好的临床效果。只有很少的并发症。
背景：先天性跖骨内翻是一种先天性疾病，估计发病率为1/1000新生儿。尽管畸形主要是一个美学问题，残留和不正确的形式可能是导致脚趾步态异常和穿鞋问题的原因。关于其正确的治疗算法尚未达成共识。
方法：在2019年5月至2020年9月之间，2156名新生儿患者在出生时接受了骨科检查。受先天性跖骨内翻影响的患者根据Bleck分类为柔性，半柔性或非柔性畸形。遵循保守治疗算法，基于操作的应用，Bebax型牙套或石膏模型。随访所有患者，直到畸形的临床解决。并发症也被记录。
结果：一百二十四例患者被诊断为先天性跖骨内翻，总体患病率为5/1000。一百二十二例患者表现为柔性或半柔性足部畸形，并首先接受了手术治疗：52例患者报告了良好的效果，而70需要使用Bebax型牙套进行额外治疗以实现矫正。两名患者在出生时表现出非柔性畸形：一名患者因非柔性畸形而需要石膏石膏，由于严重的半柔性畸形，一名患者首先接受了Bebax型支架治疗。只有两名患者出现浅表皮肤溃疡，一周内痊愈。两名患者在随访期间失联。
结论：对所有新生儿进行骨科检查的早期诊断可能是避免先天性跖骨内翻误诊的有效手段。早期治疗的手法和矫形器导致良好的临床效果。只有很少的并发症。
