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NEWS AND VIEWS Table of Contents   
Year : 2003  |  Volume : 37  |  Issue : 2  |  Page : 14
Role of Indore shoe in the maintenance of club foot correction


Deptt. of Orthopaedics & Traumatology, MGM Medical College , Indore, India

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How to cite this article:
Sonkar D, Taneja D K, Ajmera A, Choudhury C N. Role of Indore shoe in the maintenance of club foot correction. Indian J Orthop 2003;37:14

How to cite this URL:
Sonkar D, Taneja D K, Ajmera A, Choudhury C N. Role of Indore shoe in the maintenance of club foot correction. Indian J Orthop [serial online] 2003 [cited 2019 Dec 9];37:14. Available from: http://www.ijoonline.com/text.asp?2003/37/2/14/48512
Clubfoot has continued to plaque the medical profession since the days of Hippocrates. Both the treating surgeon and the parents of the child are obsessed in attaining a plantigrade foot but once achieved very little importance is contributed in maintaining the correction. The different Maintenance devices like Dennis Browne Shoes [1] , Orfit splint (low temperature thermoplastic material) and Pronator shoes, all lack in their efficiency of maintaining correction is some aspect or the other.

Indore shoe:

A modified pronator shoe ( Indore shoe) has been designed indigenously at our Artificial Limb Fitting Centre of Maharaja Yashwant Rao Hospital, Indore.

Features of the shoe: [Figure 1], and [Figure 2]

  • Medial border has been made dead straight.
  • Anterior and Lateral raise have been given inside the shoe.
  • Shoe is kept open both anteriorly and posteriorly so as to allow inspection of the position of the foot within the shoe.
  • Anterior strap is incorporated to check the tendency towards forefoot adduction and varus.
  • Posterior strap is incorporated to check the tendency towards hind foot equinus.


We have followed 80 patients with 112 feet, treated with different modalities and maintained in Indore shoe for two to 4 years. The parents of all the children were taught regarding the way the shoe has to be put on and the fastening of the anterior and posterior straps and shoe laces to maintain the correction in a proper manner. The foot may go into a deformed position within the shoe which won't be visible from outside in the traditional shoes. The active participation is of utmost importance to ensure a regular follow up.

Recurrence of the deformity was encountered in 11% of case. The commonest deformity to recurr was adduction of the forefoot followed by varus of the hind foot. The main reasons for the recurrence in the study were low socioeconomic status and illiteracy, neglect on the part of the parents for regular follow-up, continuing to wear a worn out shoe, which has lost all its properties of maintaining correction and very small foot.

The cause of recurrence of corrected club foot is multifactorial. Going into the depth of the causes we found that one of the most important causes at our clinic was the lack of proper maintenance device for maintaining the correction of the corrected clubfoot. The fact that led us to make modification in the traditional pronator shoes was that there was no way to control the occurrence of the deformity within the shoe and also if such a deformity was occurring, it wasn't visible from outside.

This modified pronator shoe has the added advantage that it can be used in a slightly deformed foot which is supple. Shoes were prescribed at an average age of 7 months when a very few children are able to stand erect and ambulate with full weight bearing. More over at an age group of less than 8 months the small size of the foot made it difficult to maintain compared to when shoes were given at a higher age group like those treated with JESS. JESS was applied in a higher age group and shoes were prescribed on an average age of 30 months when the foot is large enough so that the straps can hold on the foot very nicely. Moreover adequate soft tissue stretching and good correction which is achieved in all cases was responsible for the least recurrence rate. Patient in which a CSTR was done had a lower recurrence rate than PMR due to the better initial correction that is achieved on table due to release of the lateral side of the foot and the subtalar joint was freed. Our recurrence with the application of Indore shoe has reduced to 11 % from 43.4 % before introduction of modified CTEV shoes.

To summarize we can say that Indore shoe which provides dynamic and static maintenance of correction can bring down the recurrence rate of corrected clubfoot.[2]

 
   References Top

1.Browne D. Splinting for controlled movement. Clin Orthop 1956; 8: 91.  Back to cited text no. 1  [PUBMED]  
2.Taneja DK. Sojourn with clubfoot- 35 years experience. Ind J Orthop 2002; 36: 72-79.  Back to cited text no. 2    

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Correspondence Address:
D K Taneja
MGM Medical College, Deptt. of Orthopaedics & Traumatology, MYHospital, Indore 452001
India
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Source of Support: None, Conflict of Interest: None


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