Congenital Talipes Research Articles

Динамика восстановления силы мышц стоп у детей с рецидивами врожденной эквиноварусной косолапости после хирургического лечения по методике Понсети

Актуальность. В случае рецидивов врожденной эквиноварусной косолапости (ВЭВК) у детей в возрасте 3–10 лет подходы к лечению значительно отличаются. Так, лечение рецидивов ВЭВК у детей в возрасте 3–10 лет после первичного консервативного лечения по методу Понсети проводится с выполнением транспозиции сухожилия передней большеберцовой мышцы на ІІІ клиновидную кость. Лечение рецидивов ВЭВК у детей 3–10 лет после традиционных методик лечения является более сложным и менее эффективным. Цель: определить особенности восстановления силы групп мышц стопы у детей с рецидивами ВЭВК до и после хирургического лечения по методу Понсети и после традиционных методик лечения. Материалы и методы. Были проведены динамометрические исследования 65 детей с рецидивами ВЭВК. Пациенты были распределены на 2 группы: группа I (33 ребенка) — традиционные методики, которые предусматривали первоначальное хирургическое вмешательство для полного исправления всех компонентов деформации; группа II (32 человека) — метод Понсети. Всем больным проводили динамометрию групп мышц тыльных сгибателей и подошвенных разгибателей стопы. Исследование проводили до лечения, через 6 месяцев после операции и через 1 год. Результаты. Результаты проведенного исследования показали, что у больных, которых лечили по методу Понсети (группа II), сила групп мышц тыльных сгибателей стопы статистически значимо (p = 0,002) увеличивалась уже к 6-му месяцу после оперативного вмешательства. У больных, которых лечили традиционными методами, статистически значимые изменения силы тыльных сгибателей стопы наблюдали только к 12-му месяцу после оперативного вмешательства. У больных I группы статистически значимые увеличения (на уровне р < 0,05) силы групп мышц подошвенных разгибателей стопы наблюдали на всех этапах исследования. У больных, которых лечили по методу Понсети, статистически значимое (p = 0,028) увеличение силы подош-венных разгибателей стопы наблюдали только на первом этапе (до 6 мес.). В дальнейшем увеличение силы мышц подошвенных разгибателей стопы заметно замедлялось и составляло в среднем 0,2±2,3 кг, что не является статистически значимым (p = 0,880). Выводы. У детей I группы увеличение силы мышц происходит более медленно, чем во II группе, и увеличение силы мышц в процентном отношении по сравнению с начальными показателями значительно меньше. Через 12 месяцев после операции у детей практически полностью восстанавливается отношение силы тыльных сгибателей к подошвенным разгибателям, что обосновывает целесообразность использования метода Понсети в качестве первичного метода лечения ВЭВК у детей.

Rational selection of treatment methods in recurrent clubfoot

Objective.Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods.The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results.In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion.In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

Midterm outcome of neglected clubfoot treated by Ponseti method

Background: Mid-term success results by Ponseti method for the treatment of neglected clubfoot can lead to a renewed interest among pediatric orthopedic surgeons. The purpose of this study was to evaluate mid-term effectiveness of Ponseti method for the treatment of neglected congenital idiopathic clubfoot. Methodology: A total of 49 patients (67 clubfeet) were treated by Ponseti method and were studied prospectively up to July 10 (mean follow up period 5 years, minimum follow-up period of 3 years). Age at the initiation of the treatment, gender, bilaterality, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace and CTEV shoes were examined. Passive range of movements and look of club foot are evaluated with mean 5 years follow-up.Results: We applied the Ponseti method and found good to excellent results in 44 patients - 89.79% (58 clubfeet - 86.56%) at mean five year of follow up. Parents of 32 patients (65.30%) accepted the look of the clubfoot nearly normal and parents of 12 patients (24.49%) accepted the look of clubfoot as normal. Of the 49 patients who responded to initial Ponseti casting, 14 patients - 28.57% (19 clubfeet - 28.35%) had relapse at varying age; out of which 9 patients - 64.29% (10 clubfeet - 52.63%) were corrected by Ponseti casting method, while 5 patients - 35.71% (9 clubfeet - 47.37%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint was thought to be the main cause of failure in these patients.Conclusion: Ponseti treatment for neglected CTEV has had encouraging results in terms of attaining a functional and visually acceptable foot and lessening the extent of surgery in cases where full correction is not achieved.

Mapping and Epidemiological analysis of types of Congenital Malformations in a Teaching Hospital

Introduction: The World Health Organization (WHO) defines as congenital malformation, all anomalies triggered by the alteration of normal development resulting in a deficient formation from the initial stage of the fetus still in intrauterine, whose origin occurs before birth, having causes genetic, environmental or unknown, whether structural or functional, these disorders can be seen in prenatal care, childbirth, or even manifested in childhood. Background: To map and analyze epidemiological data on congenital malformations in children at a Teaching Hospital in the interior of the State of São Paulo. Materials and Methods: Data were collected from children with congenital malformations between the years 2010 and 2017, searched through the International Disease Code (ICD 10) with codes from Q00 to Q89. During the analysis of the medical records, 30,309 male and female children with congenital malformations were identified, aged between 1 day and 12 years. Results: 30,309 male and female children with congenital malformations were identified (16,956 male or 54.75% and 13,713 female or 45.25%) aged between 1 day and 12 years (19,587 from 0 to 4 years or 64.63 %; 5,780 from 5 to 8 years or 19.07% and 4,942 from 9 to 12 years or 16.30%). The main types of congenital malformations were found: cardiac and circulatory or 42.32%; spinal cord or 12.34%; congenital clubfoot or 11.07%; male and female genitals and urinary tracts or 8.97% which add up to 74.70%. Conclusion: Congenital malformations are rare anomalies and this study concluded that they are mostly associated with male gender, early age and with a predominance of cardiac and circulatory alterations.

NEW GENES AND DISEASES: EP.304 Early onset lower limp assymmetry: a new clinical phenotype of calsequestrin mutation

Calsequestrin is a protein that handles calcium in sarcoplasmic reticulum (SR),Ca2+ transients are crucial in skeletal muscle excitation-contraction coupling. Synchronous Ca2+ release from the SR terminal cisternae into the cytoplasm and its reuptake into the SR store are granted by a structural and functional unit and their defect causes myopathy. In an 11-year-old girl, affected by lower limb asymmetry (R limb shorter of 3 cm), upper limb hypotrophy and winging scapulae were found; she had high CK:2900 U/l, her sister presented myalgias and CK:1500 U/l, the mother CK 500 U/l and grandmother had both congenital club foot. We investigated the causes of the high CK by EMG that was myopathic, muscle biopsy that showed few atrophic fibres, in ATPase rare 2C fibres, some increased NADH-TR stain at the periphery, increased central nuclei and rare basophilic fibres. We performed immunohistochemistry for dystrophin, caveolin-3, alpha-sarcoglycan, western blot for dysferlin: all normal. The girl was operated at 15 years for elongation of right femur and by epiphysiodesis left femur and the limb asymmetry was reduced to only half a centimeter: however she complained of fatiguability, especially after physical education at school, and high CK (2186 U). She presented with scoliosis, difficulty walking with calf hypertrophy. A search for the causes for hyperCKemia was done with WGS at TIGEM and resulted in detection of a pathogenetic variant of CASQ1 gene (p.ASP244Gly), coding for calsequestrin, which allowed the solution of this puzzling familial case. In 7 members of 4 Italian families with vacuolar myopathy with CASQ1 mutation calsequestrin aggregates and a similar variant was found. In CASQ1 myopathy in several cases hyperCKemia, myalgia or other vague symptoms are present: in 22 CASQ1-mutated patients from 12 families 21 sharing the same variant of our case presented symptoms in the sixth decade with exercise intolerance and myalgias and later developed mild to moderate, slowly progressive proximal weakness with quadriceps atrophy and scapular winging. In the present family, clubfoot, early onset, limb asymmetry were the predominant clinical symptoms, they could be the effect of somatic mosaicism. In this respect our patient presents an early onset and a new clinical phenotype of lower limb asymmetry that is unique. The present familial case expands the clinical phenotype of CASQ1-myopathy.

Clubfoot Cast Simulation Using Pressure Sensors: A Novel Way to Teach the Ponseti Method

The standard of care in treating congenital clubfoot is the Ponseti method. Resident education of this skill traditionally involves direct casting of patients with attending feedback. With increased clinical time demands, mastery of the skill may not be achievable using direct resident - patient interactions. We describe a novel Ponseti cast simulator using pressure sensors to teach this skill. A novel Ponseti cast simulator was constructed using a standardized model and pressure sensors. A pre-training baseline (trial 1) and post education (trial 2) was made and scored using an objective structured assessment of technical skill (OSATS) checklist. Pressure sensors were placed at the first metatarsal and talar head to record cast forces. The study was performed in the Department of Orthopedic Surgery at an academic tertiary care hospital. Study participants included 6 junior orthopedic residents defined as post-graduate year (PGY) 1 to 3, 6 senior orthopedic residents (PGY 4,5), and a board -certified pediatric orthopedic surgeon to serve as a control. Trial 1 OSATS scores were significantly higher in senior residents (9.7 ± 1.5) than junior residents (5.2 ± 1.2) (p = 0.004). Trial 2 OSATS scores were also significantly higher in senior residents than junior residents: 13.7 ± 1.4 vs. 5.8 ± 1.6 (p = 0.003). Additionally, senior residents significantly improved scores between the first 2 trials 9.7 ± 1.5 vs. 13.7 ± 1.4 (p = 0.003), while junior residents did not 5.2 ± 1.2 vs. 5.8 ± 1.6 (p = 0.4566). In addition, there were no significant differences between junior, and senior resident Trial 1 talar head pressures or first metatarsal pressures, or Trial 2 first metatarsal pressures. This is the first casting simulation model to use pressure sensors as a way to objectively measure cast application pressure. This simulator may be useful in an orthopedic training programs to teach Ponseti casting.

Подходы к хирургическому лечению врожденной косолапости у детей

Актуальность. Косолапость является тяжелой деформацией стопы и находится на первом месте среди врожденных заболеваний опорно-двигательного аппарата. Рождаемость детей с врожденной косолапостью составляет 0,1–0,4 %. Начиная с конца 80-х годов, когда во всем мире широкое признание получила методика І. Ponseti, основным является раннее консервативное лечение с использованием этапных гипсовых повязок. Эффективность данной методики достигает 93 % и позволяет значительно уменьшить количество хирургических вмешательств. Однако позднее начало лечения, отсутствие или несоблюдение режима ношения брейсов, сопутствующая неврологическая патология ведут к снижению эффективности консервативного лечения и применению в дальнейшем хирургических методик. Цель — ретроспективный анализ результатов выбранной нами тактики хирургического лечения врожденной косолапости у детей. Материалы и методы. За период с 2009 по 2017 год в ортопедо-травматологическом отделении НДСБ «Охматдет» хирургическое лечение проведено 87 детям (115 стоп) с диагнозом врожденной косолапости. В ходе исследования учитывались возраст, пол, тип деформации, объем оперативного вмешательства, ближайшие результаты оперативного лечения (до 1 года), частота рецидивов. Среди пациентов было 57 мальчиков (78 стоп) и 30 девочек (37 стоп). В том числе у 67 пациентов (83 стопы) операция была первой и у 20 детей (32 стопы) выполнялось повторное хирургическое лечение. Средний возраст пациентов составил 4,5 года. Результаты. Ближайшие результаты лечения через 1 год после оперативного вмешательства показали, что хорошие результаты были у 65 пациентов (74,7 %), удовлетворительные — у 14 (16 %) и неудовлетворительные — у 8 (9,3 %). У 2 (2,3 %) пациентов наблюдались элементы чрезмерной коррекции деформации, что проявлялось пронацией стопы с вальгусной деформацией пятки. Рецидивы, которые проявлялись появлением одного из элементов деформации, отмечались в 8 (9,2 %) случаях. Основной причиной их возникновения у 6 пациентов было несоблюдение рекомендаций на этапах реабилитации и у 2 пациентов — послеоперационные осложнения. Выводы. Ближайшие результаты лечения через 1 год после оперативного вмешательства свидетельствуют о правильности выбранного нами подхода к хирургической реконструкции стопы при косолапости.

Functional outcomes of Ponseti method among children with congenital clubfoot: a healthcare facility-based longitudinal study

Mohammad Jobair Khan, Palash Chandra Banik, Rajib Mondal, Mohammad Forhadul Hoque, Sanjana Zaman, Mohammad Delwer Hossain Hawlader

Bilateral idiopathic club foot in baby of a rheumatoid mother: A rare case report and its management

Congenital clubfoot has a multifaceted etiology, with several hypotheses offered in its etiopathogenesis. The clubfoot has rarely been reported in babies born to women who have rheumatoid arthritis (RA). We present a rare case of a 31-year-old lady with RA on disease-modifying anti-rheumatoid drugs who delivered a child with bilateral congenital clubfoot. She had previously been using Methotrexate, Hydroxychloroquine, and Sulfasalazine regularly, but Methotrexate was stopped seven months before pregnancy. A full-term female baby was born through the cesarean section with bilateral clubfoot deformity and a modified Pirani score of eight out of 10. The deformity correction was done with the Ponseti serial casting method. The final modified Pirani score was two out of ten. In newborns born to rheumatoid arthritis mothers, the club foot deformity was effectively treated with serial Ponseti corrective casts, as was idiopathic clubfoot in babies born to non-rheumatoid mothers. Our findings validate the Ponseti serial casting method for these kinds of patients.

Collection 14 / IV

Dr. A. Gerasimova demonstrated patients with rare congenital deformities, one with spina bifida (meningo-myelo cystocele), paraplegic clubfoot and prolapsus recti, and the other with congenital clubfoot and spontaneous amputations.

Development and Test of a Serious Game for Dorsiflexion and Plantarflexion Exercises of the Feet

Congenital clubfoot is the most common disease of the musculoskeletal system, causing deformities in the musculature of the foot and requiring long-term motor rehabilitation. This article shows the design and development of a serious game to support the process of motor rehabilitation of clubfoot through dorsiflexion and plantarflexion exercises. The game is controlled by a wearable device (Papeteshoes), where the accelerometers are responsible for detecting the movement of the foot. A pilot test was carried out withtwo children with and without clubfoot (Congenital Talipes Equi-novarus-CTE) to examine the feasibility of the game as a therapy instrument. Usability and applicability questionnaires were applied after using the game. The results show that both children reacted in the same way to the proposals, performing the necessary movements for the motor recruitment of the muscles related to the leg and foot and maintaining the range of motion of the ankle joint.

The Impact of the Digital Age and Social Media on Connecting the Clubfoot Community.

BackgroundInternet chat rooms played an important role in the late 1990s promoting the Ponseti method as the preferred initial treatment for congenital clubfoot. The social media boom has created multiple new methods for caregivers to seek support from a global community using a variety of platforms that are now easily available. This study assesses the reach of information shared across social media platforms about congenital clubfoot and analyzes topics most commonly discussed among members in these groups.MethodologyPosts and pages across Facebook, Instagram, Twitter, and TikTok were evaluated to identify the top clubfoot-related hashtags and accounts. In addition, content themes were analyzed for posts across all platforms.ResultsThere were 122 clubfoot-focused Facebook groups for parent support, and the five Facebook groups with the highest number of posts during the study period were found to frequently discuss the following topics: successful treatment stories, questions about casting, bracing, relapse, and commercial items compatible with clubfoot treatment. Twitter pages contained information about live webinars, educational resources for parents and providers, and the impact of the coronavirus disease 2019 pandemic on clubfoot treatment. A search across visual platforms using “#clubfoot” yielded over 59,000 cumulative posts on Instagram and over 34.7 million total views on TikTok.ConclusionsParents of clubfoot patients are increasingly connecting through digital social media platforms, relying on them for information on clubfoot, and utilizing them as a network for social support. Clubfoot physicians should be aware of this content on social media to promote education and discussion that addresses parent concerns, provides accurate information, and guides expectations.

COMPARTIVE STUDY BETWEEN THE RESULTS OF ORIGINAL, ACCELERATED AND DECELERATED PONSETI TECHNIQUES IN TREATMENT OF CONGENITAL TALIPES EQUINOVARUS

Congenital Idiopathic Talipes Equinovarus (CTEV), or clubfoot, is a complex deformity that involves pathological anatomical disorder in the foot with ankle equinus, hindfoot varus, midfoot cavus and forefoot adductus.Ponseti technique has become the gold standard of care for congenital club foot management. It is not only a thorough manipulation and casting process but also prevention and treatment of relapse. The procedure includes a series of plaster casts that have been modified weekly for a period of six weeks, accompanied by a percutaneous tenotomy of the Achilles tendon (PAT), and a further three-week healing castAIM OF THE WORKTo compare the results of original, modified accelerated and modified decelerated Ponseti techniques in treatment of congenital talipes equinovarus (club foot).Patients and MethodsPATIENTSSixty patients with congenital talipes equinovarus were recruited from the Orthopedic Department, Alexandria Main University Hospital (AMUH).The patients were divided randomly by sealed envelope method into three groups.Group I: Included 20 patients (31 feet) that were treated by traditional Ponseti technique using serial casts with one-week intervalGroup II: Included 20 patients (31 feet) that were treated by Modified decelerated Ponseti technique using serial casts with a two-week intervalGroup III: Included 20 patients (31 feet) that were treated by Modified accelerated Ponseti technique using serial casts with a three-day interval

Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot.

Background: Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. Methods: Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). Results: The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked “good” in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an “excellent” interobserver reliability was found but was only “good” in the NPeO cohort. Conclusions: In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.

Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review.

To explore the breadth of pediatric neurological conditions for which neuromuscular electrical stimulation (NMES) has been studied. Databases (PubMed, Google Scholar, Scopus, and Embase) were searched from 2000 to 2020, using the search terms 'neuromuscular electrical stimulation' OR 'functional electrical stimulation' with at least one of the words 'pediatric OR child OR children OR adolescent', and without the words 'dysphagia OR implanted OR enuresis OR constipation'. Articles focused on adults or individuals with cerebral palsy (CP) were excluded. Thirty-five studies met the inclusion criteria, with a total of 353 pediatric participants (293 unique participants; mean age 7y 4mo, range 1wk-38y). NMES was applied in a range of pediatric conditions other than CP, including stroke, spinal cord injury, myelomeningocele, scoliosis, congenital clubfoot, obstetric brachial plexus injury, genetic neuromuscular diseases, and other neuromuscular conditions causing weakness. All 35 studies concluded that NMES was well-tolerated and most studies suggested that NMES could augment traditional therapy methods to improve strength. Outcome measurements were heterogeneous. Further research on NMES with larger, randomized studies will help clarify its potential to improve physiology and mobility in pediatric patients with neuromuscular conditions. What this paper adds Neuromuscular electrical stimulation (NMES) appears to be tolerated by pediatric patients. NMES shows potential for augmenting recovery in pediatric patients with a range of rehabilitation needs.

Management of resistant congenital clubfeet by the new operative procedure (Hussain's procedure): An experience of a fellowship program

Background and Objectives: Pakistan Society for Rehabilitation of the Disabled Orthopedic Hospital is renowned for the correction of orthopedic deformities including foot and ankle deformities. Consultant orthopedic surgeon Afzal Hussain, pioneers the treatment of orthopedic deformities and has developed a new operative technique for congenital clubfoot. This research was planned to report the success of Hussain's Procedure in detecting and managing the anomalous structures.
 Material and Methods: This research was mixed retrospective and prospective research carried out during fellowship of first author in which, operative procedure of the resistant congenital clubfoot associated with anomalous structures viz. anomalous muscles and tarsal coalitions, were performed with the new operative procedure by Dr. Hussain, were assisted by the first author and a minimum of 5 years of follow up of the cases was done by the senior author (Afzal Hussain). Cumming’s modification of Laavag and Ponseti score was applied for the calculation of the results at the follow-ups.
 Results: During the fellowship, 10 cases of clubfeet with muscle anomalies were managed. Similarly 7 clubfeet with tarsal coalitions were managed. There was full correction of the clubfoot deformity. The cases were followed up by the senior author (Afzal Hussain) for at least 5 years. During the minimum of 5 years followup post completion of treatment, Cumming’s modification of Laavag and Ponseti scores of the operated clubfeet were found to be excellent.
 Conclusion: The resistance to management of congenital clubfoot by casting may be because of anomalous structures. New operative procedure by Consultant Afzal Hussain names as Hussain's Procedure was helpful in detecting and managing the anomalous structures.

Clinical examination and classification systems of congenital clubfoot: a narrative review.

Clinical examination of the newborn’s foot is a complex exercise that requires a lot of sensitivity, practice and deep understanding of normal and pathological anatomy, and the clinical assessment of a child with congenital talipes equinovarus, or congenital clubfoot, must be complete and it should not be limited to a simple orthopedic evaluation of the foot; the search for a cause is a pressing concern. This narrative review article aims to provide the key information about clinical examination of children with congenital clubfoot; classification systems are also described. Clinical examination of children with congenital clubfoot is essential. In particular, it is important to evaluate the mental age of the child (developmental milestones), to rule out the presence of a spinal dysraphism, to eliminate a mild form of neurological disease (congenital myopathy or arthrogryposis), as well as to carefully examine the face and hands of the patient. The examination of the foot and the classification of the clubfoot deformity complete the clinical evaluation. In the end, the pediatric orthopedic surgeon must not underestimate any clinical signs, and must act as a pediatrician. This narrative review summarizes the key points in taking a history and performing a comprehensive clinical examination for patients with congenital clubfoot; the review also briefly describes the normal foot anatomy and growth as to give the reader the opportunity to better understand the morphological and functional modifications secondary to congenital clubfoot.

Clubfoot treatment in China before and after the advent of the Ponseti technique: a historical narrative review.

Congenital clubfoot (CF) was first described by Hippocrates in approximately 400 B.C. In ancient China, manipulations were widely used to correct CF, but the outcomes were frequently unsatisfactory with residual deformity even if corrective devices were used. The advent of aseptic surgery and anesthesia has favored the development of different surgical procedures to manage children with CF. Surgical treatment became extremely popular in China during the years 1960–1990 due to the good clinical foot appearance post-surgery. However, the poor mid- to long-term results of surgical treatment facilitated the return of conservative treatment, i.e., the Ponseti technique. Over the past decade, the Ponseti technique has become very popular in China. The Ponseti technique is essentially conservative and it is based on a good understanding of CF pathophysiology. Casts are changed once a week and Achilles tenotomy is performed if equinus persists at the end of treatment. Although highly successful on the short to mid-term, the Ponseti technique is not able to completely eradicate surgery, and recurrence is still possible. As the etiology of CF is still unclear, the first mission for doctors and researchers all over the world is to truly understand the pathogenesis of the deformity. Even though genetics seems to play an important role, successful gene therapy is still a distant goal. This narrative review aims to investigate the history of CF treatment in China, to describe its tortuous process and to potentially inspire new ideas to create new effective methods of treatment.

The 'Hybrid method' for the treatment of congenital clubfoot.

BackgroundThe hybrid method combines the advantages of the Ponseti technique and of the French Physical Therapy method. The main goal of this study is to present our results on 139 consecutive newborns with clubfoot (n=212 feet) treated at our Institution with the hybrid method.MethodsFrom May 2010 until August 2020, 139 consecutive newborns with congenital clubfoot (66 unilateral; 73 bilateral) were treated by the hybrid method protocol and were retrospectively reviewed. All patients were admitted via the maternity ward with their family and personal history records, i.e., parental age, parity, gender, birth weight, involved side and presence/absence of associated medical conditions. At birth, all clubfeet were graded in ascending order of severity according to Dimeglio et al.’s classification system. AP and lateral radiographs of each foot are taken every 5 to 6 months from age 6 months to 2 years, then once a year until age 4 years, to assess divergence between talus and calcaneus on both projectionsResultsThe cohort counted a total of 100 boys (71.9%) and 39 girls (28.1%). Clubfoot was unilateral in 66 patients (47.5%) and bilateral in 73 (52.5%). All but 10 patients had idiopathic clubfoot deformity (92.8%). Mean number of casts per patient was 8 (range: 4–11). One hundred and thirty patients out of 139 underwent percutaneous Achilles tenotomy under general anesthesia (93.5%). Overall, tibialis anterior transfer was performed in 6/212 feet (2.8%), posterior release in 9/212 (4.2%) and medial release in 1/212 foot (0.05%).ConclusionsOur experience with the hybrid method has allowed us to constantly reduce the number of patients requiring surgery over the years, as well as the extent of surgical release. These results are encouraging, but larger cohorts of patients from different institutions and with longer follow up are needed to confirm our findings.

Neglected clubfoot treated by serial casting: a narrative review on how possibility takes over disability.

The Ponseti Method is recognized as the best treatment for congenital idiopathic clubfoot in newborns and its principles became also adopted for treating older children with neglected deformity. This review aims to evaluate the role and effectiveness of serial casting in the treatment of neglected clubfoot, worldwide. Clubfoot is a complex tridimensional congenital foot deformity that can be easily treated after birth by correct manipulation of the foot and serial casting, with a great majority of cases requiring a percutaneous Achilles tenotomy, which can be organized as an ambulatory day procedure, without need for general anesthesia. However, in many low-income countries, treatment is not readily available, and many children grow up with disabling foot deformities. When compared to a newborn’s clubfoot, a neglected clubfoot is different and more challenging to treat, as bones become ossified while malaligned and exposed to abnormal forces. Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The upper age limit for the use of Ponseti Method in clubfoot treatment is yet to be established. Success of clubfoot treatment is mostly defined as a pain-free, aesthetically acceptable plantigrade foot, with no need for extensive surgical tissue release after casting and tenotomy. The results of the Ponseti method for the treatment of clubfoot in children after the walking age are encouraging, with more than 80% of success in achieving initial correction and 18–62.5% of relapses. If Ponseti casting is not successful, any further interventions should be carefully selected and planned, in order to maintain the length of the foot and avoid intracapsular scarring or bony fusions.