Clubfoot Research Articles

Outcomes of clubfoot conservative treatment using the Ponseti technique in an academic hospital in Saudi Arabia

Objectives: Congenital talipes equinovarus (CTEV), commonly known as clubfoot, affects 1–4/1000 births, predominantly males. Without intervention, children face mobility limitations and deformities. Conservative treatment, particularly the Ponseti technique, which boasts a success rate exceeding 90%, is favored despite potential complications. Methods: This study aimed to assess the efficacy of the Ponseti technique through a retrospective analysis of idiopathic CTEV cases. Data on pre- and post-treatment Pirani scores were analyzed across variables including age, sex, number of casts, Achilles tenotomy, surgical intervention, and complications. Participants were categorized based on treatment outcomes to identify contributing factors. Results: Among 42 participants (69 feet), 62% were male, presenting at an average age of 9 weeks and receiving an average of 5.26 casts per patient. Pre-treatment Pirani scores averaged 4.52, significantly decreasing to 0.88 post-treatment. Feet managed without surgery demonstrated greater improvement in Pirani scores (mean change 3.888) compared to those requiring surgery (mean change 2.364), a statistically significant difference (P < 0.001). Acceptable outcomes were observed in 84.06% of feet. Percutaneous Achilles tenotomy was performed in 84% of cases. Surgical intervention was necessary in 15.94% of feet. Casting complications occurred in 14.49% of feet. Conclusion: This study confirms the Ponseti technique’s effectiveness in managing idiopathic CTEV, emphasizing early detection and initiation of conservative treatment. The early findings establish the Ponseti technique as the preferred initial approach for CTEV management.

Inertial measurement units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients: a feasibility study

IntroductionThis study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.MethodsPatients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram.Results20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80).DiscussionIMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

Effects of educational material among children with clubfoot during bracing stage of treatment by Ponseti method

Aims: To identify effects of educational material among children with clubfoot during bracing stage of treatment by Ponseti method. Methods: This study was a quantitative type quasi-experimental research design. Actually, it was an experiment among specific groups and usual groups. Exercises applied with educational material to the material group or experiment group and only usual exercises applied to the non-material group or the control group. A pre-test (before exercises provided by educational material) and post-test (after exercises provided by educational material) was administered with each subject of both groups to compare the effects on children with clubfoot during bracing stage of treatment by Ponseti method. Results: The mean Pirani score before providing exercises with educational material for right feet among the clubfoot babies were 0.56 ± 0.33 (material group) and after providing exercises with educational material for right feet among the clubfoot babies were 0.43 ± 0.41 (material group). Statistically it was found highly significant (t = 2.99, p greater 0.0003). So, it was concluded that exercises with educational material had significant influence on Pirani score reduction for right feet among the clubfoot babies. The mean Pirani score before providing usual exercises for left feet among the clubfoot babies were 0.5 ± 0.15 (non-material group) and after providing usual exercises for left feet among the clubfoot babies were 0.53 ± 0.48 (non-material group). Statistically it was found significant (t = –0.059, p greater 0.056). So, it was concluded that usual exercises without educational material had influence on Pirani score increased for left feet among the clubfoot babies. Conclusion: The modern treatment of clubfoot is Ponseti method which is very effective, outcome oriented, and less invasive surgical procedure. This study was concluded that exercises with educational material had significant influence on Pirani score reduction among the children with club foot. So, there was significant importance of exercises with educational material rather than usual exercises by verbal instructions.

Parental Management Choices and Discordant Ultrasound Findings in Referrals for Fetal Spina Bifida.

The severity of spina bifida aperta can be assessed prenatally by ultrasound. Morphological findings assist parents in choosing between management options. We aimed to document those management choices since the introduction of fetal surgery, and compare initial ultrasound findings prior to referral to findings in a fetal surgery center. Single center cohort study of 245 consecutive fetuses with a second-trimester diagnosis of SBA. Data included nature of referral (for assessment or for surgery), condition-specific findings on ultrasound, and further management. We compared the reported findings on the initial ultrasound to ours for the presence of hindbrain herniation, lesion level, ventricular width, kyphosis, leg movement, and club feet. Seventy-two percent (n=177) of fetuses met the eligibility criteria for surgery; in 60% (n=106) parents opted for fetal surgery. Of 136 patients specifically referred for surgery, 27 were ineligible (20%). Of the others, 93 proceeded with surgery. In up to 28% (n=30) of surgery referrals, eligibility criteria such as lesion level (n=30, 28%) or leg movement (72%, n=78) as severity indicators were not reported. Fetal surgery uptake was high in patients referred for surgery. Second assessment in a fetal surgery center often reveals additional relevant information.

Review of Ayurveda and Modern Perspectives on Congenital Anomalies or Anatomical Abnormalities

Ayurveda is the fundamental science of medicine that covers all aspects of human life. It describes many diseases and classifies them into different categories based on their symptoms and origin. In this regard, Adibala Pravritta and Janmabala Pravritta are categorized under Garbhajanya vikriti, mainly arising from maternal or paternal problems and defects in progeny. The faulty diet and lifestyle of the mother are also considered responsible for congenital birth defects. Defects in Beeja & Beejabhaga play an important role in the pathogenesis of such diseases. Similar to Ayurveda, modern science also mentions structural anomalies and developmental issues like heart defects, spina bifida and club foot as common anatomical abnormalities. Ayurveda scholars mention various factors – Matrija, Pitrija, Aatmaja, Rasaja, Satmyaja and Sattvaja – as Shad Garbhkarabhavas that play a vital role in healthy progeny. Factors such as awful conduct, abnormalities in Shad Garbhkarabhavas and genetic predisposition trigger the pathogenesis of Garbhajanya vikriti.

Meningocele manqué. Case report of a rare disorder

A case of meningocele manqué with its management is presented and the literature of this rarely reported condition is reviewed. A one-year-old child was admitted with a small sac like lesion in the upper dorsal region with a soft swelling in the dorso lumbar region, was also associated with congenital bilateral talipes equinovarus which was being treated by a paediatric orthopedic surgeon. Methods. Craniospinal MRI was suggestive of dorso lumbar lipomyelomeningocele, and corresponding to the dorsal sinus/sac at DV3/DV4 level there was another tethering seen on the MRI due to a band and associated with syrinx of the dorsal cord below that, s/o meningocele manqué. Treatment. This patient underwent in 1st stage, DV2 to DV5 laminoplasty, excision of the sinus, durotomy, dissection of the multiple arachnoid cysts, and cutting of the dorsal band. In second stage will undergo surgery for Lipomyelomeningocele Conclusion: Meningocele Manque is rare, it can present in isolation or associated with other spinal dysraphism. With other spinal dysraphism they can be either at the same or at another location, as was seen in our case. Before operating all cases of spinal dysraphism it is of paramount importance to MRI screen the entire neuraxis and study images thoroughly. In our case along with the dorso lumbar lipomyelomeningocele, there was a Meningocele manqué at DV3/DV4 level. It is essential that the meningocele manqué be addressed first; if not the returning/recoiling cord after de-tethering at the lower level can get tugged/sheared at the tethered meningocele manqué causing deficits.

The Management of Congenital Idiopathic Clubfoot Deformity: An Observational Study

Background: Club feet are a frequent birth defect, and congenital club foot is one of the most prevalent. Patients with this condition are often treated with surgery. A congenital club foot is a complicated joint malformation that may take many different forms. Objective: To observe the management of congenital idiopathic clubfoot deformity. Methodology: This research was conducted between January 2007 and December 2008 at the orthopaedic department of Bangabanghu Sheikh Mujib Medical University in Shahbag, Dhaka. Group-I included 13 patients with 19 feet who had surgery using Mckay's process, and Group-II included 12 patients with 17 feet who underwent surgery using Turco's technique, for a total of 25 patients with 36 feet. There was complete observance of all ethical norms. Medical history, physical exams, and specific tests all pointed to a positive diagnosis. Two groups then had surgery, one through the Turco incision and the other via the Cincinnati one. SPSS (Statistical Package for the Social Science) was used for the statistical analysis. Results: The next most common age range was between 12 and 17 years old. McKay's method had a success rate of 23.07%, whereas Turco's method achieved a success rate of 25.0%. There were around 75% males and 25% females in the Turco group. There were more men than women in McKay's group (61.53% vs. 38.46%). Four patients included their right foot (21.05%), three their left foot (15.80%), and six their both feet (63.15%) during McKay surgery. Of McKay's patients who had the treatment, just 10.54 percent had negative results, while the remaining 89.46 percent performed well. Conclusion: Everyone agrees that a congenital clubfoot abnormality should be surgically corrected. Bias was not a possibility. It may be advantageous for our people if this prospective research evaluating the results of the Turco and McKay surgical procedures for treating congenital clubfoot is completed.

Anterior or Posterior Tibial Tendon Transfer to the Peroneus Tertius for Equinovarus Deformity.

Equinovarus deformity correction was performed by soft tissue release and bone deformity correction, and tendon transfer to maintain deformity correction. Because of the high complication rate of tendon fixation methods, partial or total anterior tibial tendon or posterior tibial tendon transfer to the peroneus tertius tendon was reported. The purpose of this study was (i) to review the results of this tendon transfer technique after release and correction of talipes equinovarus, and (ii) to analyze the complication of this technique. Between February 2017 and May 2022, 176 patients (210 feet) with equinus and/or varus foot and ankle deformities underwent anterior or posterior tibial tendon transfer to the peroneus tertius in our institute. Preoperative and postoperative foot and ankle range of motion (passive and active) were checked. The postoperative radiographic assessment included antero-posterior (AP), lateral, and hindfoot alignment radiographs. Preoperative and postoperative lateral tibio-talar, talo-calcaneal, talo-first metatarsal, tibial-sole angles, hindfoot alignment, and anterior subluxation of the talus were checked. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and visual analog scale (VAS) were used to assess pain. Paired Student's t-test was used to compare the clinical scores and radiographic angles before the operation and at the last follow-up. The mean age of the patients was 23.27 ± 13.44 years (range, 3-69 years). The mean follow-up time was 25.56 ± 16.37 months (range, 12-68 months). There were significant differences between the preoperative and postoperative measurements of the lateral tibio-talar angle, lateral talo-calcaneal angle, lateral talo-first metatarsal angle, lateral tibial-sole angle, and hindfoot alignment (p < 0.001). There was significant difference between the preoperative and postoperative AOFAS and VAS scores (p < 0.001). The early complications included infection in one patient, skin necrosis in two patients, and plantar numbness in three patients. The late complications included pin infection in three patients, tibio-talar joint compression in four patients, forefoot pain in two patients, toe flexion in two patients, and plantar numbness in one patient. There were three cases of complications (1.43%) related to the transferred tendons. Tibialis anterior or posterior tendon transfer to the peroneus tertius is a safe and effective method for equinovarus deformity correction. It yielded excellent outcomes that produced high patient satisfaction and few complications.

Painful Ankle due to Impingement Between the Medial Malleolus and Navicular

Introduction: A plethora of pathologies can cause medial ankle pain. Material and methods: We present a case of 66-year-old male with medial ankle pain. Result: Bilateral CTEV (Congenital talipes equino varus) with impingement between the navicular and medial malleolus was present, which was contributing to medial ankle pain. Conclusion: One needs to be aware of this rare form of impingement in patients with medial ankle pain.

Autosomal Recessive Spastic Paraplegia Type 51 Caused by Homozygous Mutation of the AP4E1 Gene: A Case Report of a 17-Years-Old Boy

Autosomal recessive spastic paraplegia-51 (SPG51) is a rare neurodevelopmental disorder caused by a homozygous mutation in the AP4E1 gene, located on chromosome 15q21. Spastic paraplegia-51 (SPG51) is an extremely rare autosomal recessive neurodevelopmental disorder characterized by neonatal hypotonia that progresses to hypertonia and spasticity. Mutations in the AP-4E1 gene on chromosome 15q21.2, which is part of the AP-4 complex, can lead to autosomal recessive spastic paraplegia 51 (SPG51). Different mutations in this gene have been identified in affected individuals, leading to disruption of the AP4 complex and vesicular trafficking processes. The specific characteristics of SPG51 are, due to only few cases, not well understood due to limited reports of affected families. Affected individuals also have global developmental delay with impaired intellectual development and poor or absent speech. Studies linked to an additive symptom of persistent stuttering. Affected individuals typically present with hypotonia in the neonatal period, which progresses to muscular hypertonia, especially in the lower limbs. They may also exhibit contractures, talipes equinovarus, decreased muscle mass, short stature, and microcephaly. Severe mental retardation, absent speech, and dysmorphic facial features are common. Some patients may experience seizures. Neurological examination often reveals spastic paraplegia of the lower limbs, and brain imaging may show atrophy of the cerebellar vermis and cortical atrophy. We present an extremely rare case of a 17 years-old boy with autosomal recessive spastic paraplegia type 51.

Campomelic dysplasia: a case report

Campomelic dysplasia is a rare, lethal, and autosomal dominant inherited disorder with reversal of sex in genotypic male in two third cases. An eight-month-old phenotypic female infant was admitted with respiratory distress and failure to thrive. She had facial dysmorphism, cleft in soft palate, pectus excavatum deformity, bowing of lower limbs, dimpling at right knee area and bilateral congenital talipes equinovarus deformity. Radiographs shows 11 pairs of ribs, hypoplastic scapula, bowing of bilateral tibia and hypoplastic bilateral fibula. Karyotyping was 46XYchromosome and whole exome sequencing reveals autosomal dominant affecting SOX9 (NM_000346.4) gene, pathogenic variant of c.583C&gt;T (p.Gin195Ter) which is stop gained variant. She was managed according to hospital protocol and discharged. Prenatal diagnosis, genetic counselling and multidisciplinary approach for management of survival cases is important to reduce mortality.

Comparative Study of the Surgical Treatment of Congenital Club Foot between McKay and Turco Procedure

Background: Congenital clubfoot is one of the common congenital disorders. Surgery plays an important role in the treatment of patients with this deformity. Comparative studies after surgical treatment might be beneficial. Hypothesis: Surgical treatment of congenital idiopathic club foot by McKay procedure gives better results than Turco procedure. Objectives: To compare the outcome of surgical treatment of congenital idiopathic club foot between McKay procedure and Turco procedure. Methods: This is a prospective interventional study carried out at Orthopaedic Department of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, during the period of January 2007 to December 2008. 25 patients with 36 feet were selected in which Group-I consisted of 13 patients with 19 feet treated with surgery by Mckay's procedure and Group- II consisted of 12 patients with 17 feet treated with surgery by Turco's procedure. All the ethical considerations were fulfilled. A questionnaire was designed and prepared by the researcher himself. Diagnosis was confirmed by detailed medical history, clinical examinations and relevant investigations. Then through Turco or cincinnati incision surgery was done in two groups. Statistical analysis were done by SPSS (Statistical Package for the Social Science). Results: There were satisfactory results (Excellent + Good) in 17 feet (89.47%) and unsatisfactory results (fair + poor) were in 2 feet (10.53%) in Mckay's procedure. Where as satisfactory results (Excellent + Good) were in 9 feet (52.94%) and unsatisfactory results (fair + poor) were in 8 feet (47.06%) in Turco's procedure. Conclusion: Operative treatment of congenital clubfoot deformity is always an accepted method of treatment. The final outcome of the results shows that in Mckay's procedure satisfactory results was found in 89.47% which is more than Turco's procedure 52.94%.

Hereditary sensory autonomic neuropathy type VI in the age of genetic testing

AbstractBackgroundHereditary sensory and autonomic neuropathy type VI (HSAN VI) is a rare recessive genetic disorder caused by mutations in the human dystonin (DST) gene. We report a novel homozygous alternate transcript mutation in the DST gene causing a severe neonatal form of HSAN VI.Patient DescriptionThis baby boy was born with severe hypotonia, respiratory distress, dysmorphic features, and bilateral club feet. Imaging, karyotyping, Prader–Willi assay, spinal muscular atrophy genetic panel and myotonic dystrophy genetic panel were all negative. A comprehensive neuropathy panel detected a homozygous pathogenic variant in the DST gene—alternate transcript NM_015546.4:c.1357G&gt;A (p.Trp4525*). Nerve conduction studies revealed mixed axonal and demyelinating sensorimotor neuropathy, suggesting the possibility of motor involvement in severe forms of this rare condition. The infant ultimately developed sepsis and died from cardiorespiratory arrest. Neuropathological findings of focal and mild spinal nerve axonal degeneration were nonspecific.ConclusionCollective analysis of these patients would help to further characterize the spectrum of disease pathology and could provide insight into the neurophysiology and neuropathology of this rare condition.

Atypical Variants of Spinal Dysraphism: A Case Series

Abstract The aim of this study is to present and discuss atypical instances of spina bifida (SB) within a Nigerian paediatric cohort, highlighting their distinctive clinicoradiological features. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Additionally, a brief literature review is provided to contextualise these congenital anomalies. This case series comprises eight rare cases of SB managed in a Nigerian neurosurgical facility. Amongst these, four cases exhibited segmental spinal dysgenesis (SSD; one thoracolumbar, one lumbar, and two sacral). Each of these cases demonstrated diverse associated musculoskeletal, cutaneous, and perineal anomalies, accompanied by varying degrees of neurological dysfunction. Other cases included lipomyelomeningocele (LMMC), human tail (HT), membranous meningocele, and myeloschisis (MSS). Autonomic dysfunction was a common feature in all of the cases, whilst two of the patients presented with congenital kyphotic spinal deformity. Lower limb anomalies varied, including congenital talipes equinovarus deformity, pes planus, congenital calcaneovagus deformity, rocker bottom feet, clinodactyly, and tetrapolydactyly. Remarkably, none of the patients exhibited clinical features indicative of hydrocephalus. SSD, LMMC, HT, membranous meningocele, and MSS represent atypical forms of SB in the Nigerian paediatric population. Early neuroimaging of patients with suspected spinal dysraphism is crucial, as it may reveal a spectrum of diverse vertebral anomalies associated with this neurological condition within the African population.

Prevalence and pattern of congenital clubfoot among less than 5-year-old children in Ethiopia; cross-sectional based study

BackgroundClubfoot is one of the most common congenital malformations, but it is also one of the most neglected public health problems among less than five-year-old children, mainly in middle- and low-income countries. Approximately 80% of clubfoot cases are found in low- and middle-income countries. In this study setting, no epidemiological studies have been conducted to assess clubfoot deformity. Due to this gap, the study aimed to assess prevalence, and pattern of congenital club foot among less than 5-year-old children.Materials and methodsAn institutional-based cross-sectional study was carried out at Black Lion Specialized Hospital at the pediatric orthopedic clinic. The sample size was 261 to determine the prevalence and pattern of congenital clubfoot. Terms like frequency, percentage, and mean were used for data presentation.ResultA total of 36,303 pediatric patients visited Black Lion Specialized Hospital during the study period, and clubfoot prevalence was 7.2 per 1000. The largest subclassification of congenital clubfoot was idiopathic clubfoot, which accounted for 6.2 per 1000, whereas syndromic clubfoot was 0.3 per 1000, and neuropathic clubfoot was shared at 0.36 per 1000. Most of the cases in this study were bilateral clubfoot, with males having more dominance.ConclusionIn the area under investigation, a significant prevalence of congenital clubfoot was observed, especially among male children. The majority of cases were bilateral, with idiopathic clubfoot being the dominant form.

Prenatal olanzapine exposure and congenital talipes equinovarus (clubfoot): a case report and review of emerging evidence

Recently, concerns have emerged about the potential teratogenic effects of olanzapine, particularly its association with congenital malformations such as congenital talipes equinovarus (clubfoot). Evidence from a large Finnish study, which reported a 2.5-fold increase in musculoskeletal anomalies, as well as various case reports, suggests a significant link between in-utero exposure to olanzapine and these anomalies. This case report aims to add to the growing body of evidence by detailing a new instance of clubfoot following prenatal olanzapine exposure. A 25-year-old woman suffering from bipolar I disorder with psychotic features was treated with olanzapine during pregnancy, resulting in the birth of a male infant with clubfoot but no other malformations. This case underscores the importance of careful risk assessment and monitoring for pregnant women undergoing psychiatric treatment with olanzapine. Potential mechanisms, such as disrupted fetal musculoskeletal development due to olanzapine’s pharmacological effects, warrant further investigation. Comparative analysis with other cases highlights consistent patterns, emphasizing the need for further research to elucidate the mechanisms and risk factors involved.

Continuous nursing for infants with congenital talipes equinovarus undergoing Ponseti therapy and telehealth education for their parents via WeChat: a single center retrospective study.

This study aimed to evaluate the impact of continuous nursing and telehealth education via WeChat in infants with congenital talipes equinovarus (CTEV) undergoing Ponseti therapy on reducing complications, care burden, and improving the quality of life for parents. This is a single-center retrospective study. From July 2021 to December 2022, 44 CTEV children who undergoing Ponseti treatment in our hospital who received continuous nursing and telehealth education via WeChat (experimental group). In addition, during January 2020 to June 2021, 44 children with CTEV treated with Ponseti in our hospital who received routine nursing and traditional health education were selected as the control group. The incidence of complications, parental care burden and parental quality of life were compared between the two groups. There was no significant difference in the demographic characteristics of patients and parents between the two groups, and the groups were comparable (p > 0.05). The incidence of complications including plaster loosens, plaster falling off, pressure ulcer was significantly lower in the intervention group compared to the control group (p < 0.05). Parents in the intervention group experienced significantly lower care burdens compared to those in the control group (p < 0.05). The quality of life of parents in the intervention group was significantly higher than that for the control group (p < 0.05). There were significant differences in the incidence of complications, the care burden of parents and the quality of life of parents between the two groups. This study found that continuous nursing and telehealth education via WeChat group during Ponsetis treatment of children with CTEV can effectively reduce complications, reduce the care burden of parents and improve the quality of life of parents. This method is simple and convenient, especially worthy of application and promotion in medically underdeveloped areas.

Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study.

Clubfoot, or congenital talipes equinovarus, is a widely recognized cause of disability and congenital deformity worldwide, which significantly impacts the quality of life. Effective management of clubfoot requires long-term, multidisciplinary intervention. It is important to understand how common this condition is in order to assess its impact on the population. Unfortunately, few studies have investigated the prevalence of clubfoot in Saudi Arabia. To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital (KFUH). This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions. Of the 7792 births between 2015 to 2023 that were included in the analysis, 42 patients were diagnosed with clubfoot, resulting in a prevalence of 5.3 per 1000 live births at KFUH. The observed prevalence of clubfoot was significantly higher than both global and local estimates, indicating a substantial burden in the study population.

Assessment of Gross Motor Skills in Ponseti-treated Children With Idiopathic Clubfoot at 3 Years Old: Insights from the Peabody Developmental Motor Scale 2.

Congenital talipes equinovarus, or clubfoot, can lead to lifelong functional impairments, including diminished gross motor skills (GMS), if left untreated. The Ponseti method corrects idiopathic clubfoot through casting and bracing. Given the importance of GMS in childhood development, this technique must be optimized to support childhood and long-term health outcomes. This study examined immediate posttreatment GMS in 3-year-old children treated with Ponseti, hypothesizing that they would perform on par with their nonclubfoot peers. Data from 45 children (33 to 46mo of age) treated for idiopathic clubfoot were analyzed. The Peabody Developmental Motor Scales, 2nd edition, was used to assess GMS, and logistic regression identified factors influencing Gross Motor Quotient (GMQ) scores. Approximately half (n=22) of the patients exhibited below-average GMS (11th to 25th percentile), with 11 scoring below the 10th percentile. Initial deformity severity, gender, and cast numbers did not impact GMQ. Repeat percutaneous tenotomy was associated with lower GMQs. Brace compliance significantly reduced odds of low GMQs by up to 80%. Age at testing and additional surgery were also linked to below-average and poor GMQs. GMS appeared to be impaired in almost half of the 3-year-old patients treated for idiopathic clubfoot, so our hypothesis was disproven. Repeat percutaneous tenotomy was associated with lower GMS, necessitating future recognition of patients who might be at risk of relapse. Brace noncompliance emerged as a significant risk factor, emphasizing early identification of these patients and education for their parents. This study offers a benchmark for clinicians and parents, but research on long-term outcomes is needed. Level II, prospective cohort study.

Innovative Recycled PET 3-D Printed Foot Abduction Orthosis for Infant Clubfoot Treatment

This paper presents the development of an innovative and cost-effective 3-D printed Foot Abduction Orthosis (FAO) for the treatment of infant clubfoot, specifically addressing the challenges faced in resource-constrained regions such as Ethiopia. The Ponseti technique of treating clubfoot, also known as congenital talipes equinovarus, necessitates the use of FAOs, which are often prohibitively expensive in low-resource settings.