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Ambulatory status is the other major determinate, with more severe deformity in the non-ambulatory patients.
About one tenth develop a more aggressive variant leading to a more severe deformity of the spine and thorax [ 2].
Furthermore, correlations between HV angle and SF-36v2® subscales suggest that in our sample HV participants with more severe deformity experienced less bodily pain and better social functioning.
The multivariate regression analysis showed that patients with more severe deformity had higher adherence to prescribed footwear maybe because these patients have no other choice than to wear custom-made footwear or because they are more aware of its benefits.
While we are all anecdotally aware that lesser deformity is treated with distal osteotomies and more severe deformity with a proximal osteotomy, we are aware of only limited data in the literature that verifies this.
Across the SF-36v2® subscales, low correlations were found between HV angle and bodily pain (rho = 0.39, p = 0.04) and social functioning (rho = 0.49, p = 0.01), indicating that in our sample, HV subjects with more severe deformity reported less bodily pain and better overall social functioning.
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Although introduced for correction of mild to moderate deformities, many studies have recently demonstrated that chevron osteotomy, associated with a soft-tissue procedure with or without the Akin procedure, can allow correction of more severe deformities [7].
Nevertheless early reports about re-casting with the Ponseti technique seem encouraging, extending the opportunity for nonsurgical or less-invasive surgical procedures (i.e., Achilles tendon lengthening) in older children and in cases of relapse and more severe deformities.
Recent studies have demonstrated that chevron osteotomy, associated with a distal soft-tissue procedure with or without the Akin procedure, can increase the amount of correction, making this combination appropriate for more severe deformities [3].
The long plantar arm of the osteotomy makes it possible to obtain greater correction of the IMA, with the result that this technique is appropriate for more severe deformities too.
Excessive growth of the lateral column of the foot compared with the medial column, that is shorter as a consequence of tissues retraction and joint dislocation, produces a more severe equinovarus deformity.
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more severe type
more severe fibrosis
more severe dehydration
more angular deformity
more severe injury
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more severe disease
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more severe morbidity
more substantial deformity
more severe comorbidity
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