Treatment of the idiopathic and complex congenital talipes equinovarus with Ponseti method
0
Citation
18
Reference
10
Related Paper
Abstract:
Abstract: Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application. Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized as short, stubby foot, having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.Keywords:
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Pes cavus
Foot (prosody)
Cite
Introduction: Congenital talipes equinovarus (CTEV) is the commonest musculoskeletal deformity worldwide. The Ponseti technique is the goal standard for clubfoot treatment. During the correction phase, the provider’s right hand manipulates the right foot and the left hand, left foot. Often, one foot is ready for Achilles tenotomy before the other in bilateral clubfoot. Objective: To determine the effect of the provider’s hand dominance would have on bilateral clubfoot treated with the Ponseti technique. Method: This was a prospective cross-sectional study that analyzed idiopathic bilateral clubfoot patients aged 0 - 5 years and treated using the Ponseti technique at FMC Umuahia from October 2019 to September 2020. Informed consent and ethical clearance were obtained. The Pirani scores were obtained and compared at presentation and at each clinic visit. All trained manipulators were right-handed. Two-tailed t-test was used and a p-value less than 0.05 was deemed significant. Results: Forty-seven patients participated in the study with an M:F of 2.6:1 and mean age of 13.79 ± 13.39 months. Thirty-six patients (76.6%) had the same Pirani score on both feet at presentation, while the right and left feet were more severely affected in 8 and 3 cases respectively. The mean number of casts before readiness for tenotomy was 4.95 on the right and 5.28 on the left with p-value of 0.042. Conclusion: Though the right foot had a worse mean Pirani score on presentation, however, it required fewer casts before readiness for tenotomy than the left.
Tenotomy
Ponseti Method
Congenital talipes equinovarus
Foot (prosody)
Presentation (obstetrics)
Cite
Citations (2)
Clubfoot also called as congenital tailpipes equinovarus is a complex ankle and foot deformity characterized by forefoot adduction and supination, midfoot cavus and hindfoot varus and equinus. It is estimated that more than 100,000 babies are born each year worldwide with clubfoot, and 80% are seen in developing nations. Different scoring systems are used for grading the severity of deformity or monitoring the natural history of clubfoot. The Pirani scoring system is now routinely used in most clubfoot clinics, including Cure Ethiopia, Children's Hospital.A facility based retrospective study was conducted on 278 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani system between September 2013/14 to September 2017/2018. Age at presentation, number of casts required, need for percutaneous Achilles tenotomy, casting effects were recorded.A total of 287 clinical folders of children were retrieved (424 feet). The mean (±SD) number of casts required for correction of the deformity was 5.54 ± 1.63. The number of cast required for correction is significantly, and positively correlated with initial severity of Pirani score (r = 0.62 for right foot; r = 0.675 for left foot). There is a significant difference on the overall initial Pirani score between tenotomy and non- tenotomy group (P value < 0.001).The study revealed that severity of initial Pirani score can be used to estimate the number of Ponseti cast required for correction of clubfoot deformity and the need for tenotomy. Besides, the number of Ponseti cast required may not be affected by age of a child at the commencement of treatment.
Tenotomy
Ponseti Method
Congenital talipes equinovarus
Foot (prosody)
Cite
Citations (13)
Background: Congenital clubfoot is a common deformity characterized by an abnormal development of the foot. The etiology is multifactorial and genetic causes have been related. The Ponseti method is a conservative treatment for the clubfoot, mostly used in idiopathic cases. This method involves serial plaster cast changes, tenotomy of the Achilles tendon and use of braces to prevent relapses. This study was designed to identify the characteristics of the patients diagnosed with congenital clubfoot who were treated with the Ponseti method and the main outcomes of this treatment in children under five years.Method: A retrospective study was conducted in Fundación Ruth Paz in San Pedro Sula, Honduras, since June 1st 2015 to May 31th 2017. This study included patients under five years who were diagnosed with congenital clubfoot and treated with Ponseti method. The data were collected from the clinical files of the identified cases.Results: Congenital clubfoot was more common among males (66.3%) and the localization of the deformity was more commonly bilateral (51.8%). The cases of idiopathic clubfoot represent 91.6% of all the cases. The tenotomy of the Achilles tendon was performed in 51.8% of the patients. Complete treatment was identified in 90.4% of the cases and relapses were reported in 12% of the children who completed treatment.Conclusions: Ponseti method was effective for treat children under five years diagnosed with clubfoot (idiopathic and non-idiopathic) and a significant decrease of the Pirani scoring after treatment was identified in all the cases. A correct use of braces is necessary to avoid relapses.
Ponseti Method
Tenotomy
Etiology
Congenital talipes equinovarus
Cite
Citations (0)
Aim: Since long Clubfoot has been an unsolved clinical challenge for the orthopaedic surgeons. It is one of the commonest congenital deformities in children. More than 1,00,000 babies are born worldwide each year with congenital clubfoot. Around 80% of the cases occur in developing nations like India. We wish to study results and effectiveness of ponseti method in treatment of clubfoot because this method has become famous after the author reported successful correction in 85% - 90% cases without need for posteromedial release. Materials and methods: 96 feet in 65 children were treated by ponseti method from June 2015 to June 2016 (31 of them have bilateral CTEV). A prospective follow up for mean duration of 18.6 months( range 6-24 months) was undertaken. All the patients were clinically evaluated by pirani scoring system at each visit with proper counselling of parents. Results: The average pirani scoring was 5.3/6. The mean number of casts given before Achilles tenotomy was 6.4. 93.75% patients needed tenotomy for full correction. There were 15(15.6%) cases with residual deformity, while 7(7.29%) feet show relapse after completion of treatment. Almost all of them have non compliance for foot abduction brace. Conclusion: The treatment of idiopathic congenital clubfoot by ponseti method is very effective and shows reproducible results. It is very cost beneficial in developing countries like India. Proper counselling and adherence to brace is highly recommended to prevent relapse.
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Cite
Citations (1)
Objectives: The purpose of this study was to evaluate our result in patients with congenital clubfoot deformity who had been treated with Ponseti's technique. Materials and methods: The study included 28 patients (18 males, 10 females, mean age 2.2 months; range 6 days to 5 months). All patients had Dimeglio grade II, III, and IV deformities. All patients had manipulation and casting according to the Ponseti's technique. Achilles tenotomy was performed in the persistent equines. Maintenance of correction was obtained with the use of foot abduction orthosis. Mean follow-up period was 17 months (range 6-36 months). Results: Forty-one feet of 28 patients were treated according to the Ponseti's technique. Achilles tenotomy was performed in 31 feet (81%). Posterior release was not performed in any patient. Although, correction was maintained in all feet at the beginning, 14 feet (31%) were relapsed. The relapses were due to decreased compliance to foot abduction orthoses. Conclusion: Ponseti technique is an effective, and reliable in correction of idiopatic congenital clubfoot deformity. The results also suggest that the role of family education to enhance compliance to brace application and experienced orthotist are important to prevent relapses.
Ponseti Method
Cite
Citations (0)
Objective Hyperextension of the big toe is described here as a simple and reliable sign to predict undercorrection of cavus deformity of clubfoot in the Ponseti Method. Materials & Methods This retrospective study was conducted on children with clubfoot who were treated successfully by Ponseti Method in the King Fahad Hospital, Saudi Arabia, and Emam Reza Hospital, Mashad, Iran, from 2003 through 2008. The total number of the patients in our study was 191, with 306 affected feet. Of them, 115 children had bilateral clubfeet (230 feet) and 76 had unilateral clubfoot. There were 119 males and 72 females. Hyperextension of the big toe at MTPJ was present in five cases of clubfoot. The average follow-up period was 20 months (range: 8-38 months). Results The authors observed that hyperextension of big toe at MTPJ had a linear relationship with the severity of cavus deformity of clubfoot. On the other hand, the big toe had a normal relationship with other toes after satisfactory treatment of the initial or relapsed cavus deformity by Ponseti Method. Conclusion Hyperextension of the big toe at MTPJ can be regarded as a reliable prognostic sign for detecting the severity, correction, and the number of castings needed for cavus deformity correction in clubfoot treatment in the Ponseti Method.
Ponseti Method
Congenital talipes equinovarus
Pes cavus
Cite
Citations (0)
Objectives: The purpose of this study was to evaluate our result in patients with congenital clubfoot deformity who had been treated with Ponseti’s technique. Materials and methods: The study included 28 patients (18 males, 10 females, mean age 2.2 months; range 6 days to 5 months). All patients had Dimeglio grade II, III, and IV deformities. All patients had manipulation and casting according to the Ponseti’s technique. Achilles tenotomy was performed in the persistent equines. Maintenance of correction was obtained with the use of foot abduction orthosis. Mean follow-up period was 17 months (range 6-36 months). Results: Forty-one feet of 28 patients were treated according to the Ponseti’s technique. Achilles tenotomy was performed in 31 feet (81%). Posterior release was not performed in any patient. Although, correction was maintained in all feet at the beginning, 14 feet (31%) were relapsed. The relapses were due to decreased compliance to foot abduction orthoses. Conclusion: Ponseti technique is an effective, and reliable in correction of idiopatic congenital clubfoot deformity. The results also suggest that the role of family education to enhance compliance to brace application and experienced orthotist are important to prevent relapses.
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Foot (prosody)
Cite
Citations (0)
Background and purpose — Neglected clubfoot deformity is a major cause of disability in low-income countries. Most children with clubfoot have little access to treatment in these countries, and they are often inadequately treated. We evaluated the effectiveness of Ponseti's technique in neglected clubfoot in children in a rural setting in Ethiopia. Patients and methods — A prospective study was conducted from June 2007 through July 2010. 22 consecutive children aged 2–10 years (32 feet) with neglected clubfoot were treated by the Ponseti method. The deformity was assessed using the Pirani scoring system. The average follow-up time was 3 years. Results — A plantigrade functional foot was obtained in all patients by Ponseti casting and limited surgical intervention. 2 patients (4 feet) had recurrent deformity. They required re-manipulation and re-tenotomy of the Achilles tendon and 1 other patient required tibialis anterior transfer for dynamic supination deformity of the foot. Interpretation — This study shows that the Ponseti method with some additional surgery can be used successfully as the primary treatment in neglected clubfoot, and that it minimizes the need for extensive corrective surgery.
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Foot (prosody)
Foot deformity
Cite
Citations (44)
The preferred conservative treatment for congenital idiopathic clubfoot deformity remains a controversial issue.To compare the outcomes of two groups of CICF patients who underwent two different treatment protocols.The study cohort included 72 infants treated in our hospital from August 1998 to December 2002. Group 1 comprised 40 infants (61 clubfeet) who were treated by a traditional method (a modification of the Kite and Lovell technique), and group 2 consisted of 32 infants (48 clubfeet) treated with the Ponseti technique. Both groups were similar in age, gender and severity of the deformity (Dimeglio scoring system).After an average follow-up of 54.9 months (range 44-68), 35 (57%) clubfeet in group 1 required surgical intervention and 27 (44%) clubfeet had a residual deformity at last follow-up. In the Ponseti group, 45 (94%) clubfeet were fully corrected at last follow-up (average 29.2 months, range 16-45) while 3 (6%) clubfeet had residual deformity and required surgery. Achilles tendon tenotomy was performed with no complications in 47 clubfeet (in group 2) at an average age of 2.4 months (range 2-4 months).Even after a relatively short follow-up period, our success rate with the Ponseti approach already appears to be significantly higher and to bear fewer complications than the traditional treatment, in agreement with the results published by other medical centers. We now endorse the Ponseti technique of conservative manipulative treatment for congenital idiopathic clubfoot in our department.
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Conservative Treatment
Cite
Citations (80)
Idiopathic clubfoot or congenital talipes equinovarus is the commonest congenital foot deformities having 1 in every 1000 children born worldwide. Around 80% of the cases occur in developing nations. It remains the most difficult to treat. The most widely used treatment is the Ponseti method of manipulation and serial plaster followed by an Achilles tenotomy. This method is effective in 90% of all cases. The objective of this study was to evaluate the outcomes of the Ponseti manipulation and casting method in the management of idiopathic clubfoot. This is a prospective study of 80 feet in 52 children treated by the Ponseti method in the department of Orthopedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, and Jharkhand. Evaluation of the deformity was done by Pirani score before and after the treatment and the results were assessed. The average number of castings used to correct the deformity was 6.5 times (range: 4 to 12). Tenotomy was performed in 66 (82.5%) of the feet. In all patients, plantigrade foot was achieved. The patients with bilateral clubfeet, higher Pirani score and higher age had inferior final outcome compared to those with unilateral clubfoot, lower Pirani score and lower age. 11 (13.75%) feet had skin excoriation secondary to cast problems and four patients had pain and tenderness at the site of the tenotomy. Recurrence was seen in three cases. 90.38% of parents were completely satisfied with their child’s gait and foot appearance.
Ponseti Method
Tenotomy
Congenital talipes equinovarus
Foot (prosody)
Cite
Citations (3)