Correction Of Congenital Talipes Equinovarus Research Articles

A study on accelerated Ponseti method for correction of congenital talipes equinovarus and evaluation of results

A study on accelerated Ponseti method for correction of congenital talipes equinovarus and evaluation of results

Does Revision Surgery Peak after Extensive Joint Surgical Correction of Congenital Talipes Equinovarus?

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Severe congenital talipes equinovarus (also known as clubfoot) that resists conservative treatments is managed with extensive surgical soft-tissue release and bony procedures. Residual clubfoot deformity, or relapse after a primary intervention may also warrant an open surgery. While the high relapse rate of primary and secondary invasive surgical methods has been widely reported in the literature, the question if this curve will reach a peak in time remains open. This systematic review examines the tendency of required revision surgery in management of talipes equinovarus and statistically extrapolates the result to locate a pivot point. Methods: A comprehensive search was conducted of PubMed, CINAHL, Web of Science, and Cochrane from inception to December 2020 to identify literature on clubfoot. Using PRISMA guidelines, the search terms clubfoot OR clubfeet OR clubbed foot OR clubbed feet OR talipes equinovarus were used. Articles containing more than three human subjects were included. The database was searched for longitudinal studies of clubfoot management by extensive surgical procedures for pediatric, idiopathic, resistant, residual, or relapsed deformity. Retrospective studies of primary and revision surgery performed on children up to ten years old with reported mean follow up of at least one year were included. Outcomes were evaluated according to scoring systems Laaveg-Ponseti, Dimeglio-Bensahel, and Magone based on clinical examination of foot function, radiographic studies, or patient satisfaction questionnaires. Relapse was defined as revision surgery needed to manage residual deformities, mobility, pain, or other complications. Probability of less than 0.05 is considered statistically significant. Results: The initial search yielded 2907 articles, of which 23 relevant articles, were included. The number of treated clubfeet was 1646, and the average age at operation was 13.1 (1 - 120) months. The most common surgical procedures included posterior medial and lateral soft tissue release such as Turco's posteromedial release (PMR), subtalar release, and tibialis anterior tendon transfer. Initial correction outcome was commonly evaluated clinically by physical examination with high satisfaction, evidenced by often long lapses to first revision surgery when needed. The mean follow-up period was 17.2 years (1 - 47). For very long follow- up periods, relapse rate was as high as 89% (mean 37%). There was a strong positive correlation between mean follow-up and rate of relapse (R = 0.5023, p = 0.0073). Conclusion: The high rate of complications that warranted revision surgery (37%) was consistent with the literature, but of more concern was the consistent statistically positive slope that continued to climb even with follow-up periods as long as five decades. The absence of a peak in relapse is most consistent with the postulations that relapse was due to muscle-bone balancing dynamics evolving with growth and activities, damage from repeated surgeries, or severity of deformity at birth that is permanently incurable. Since clinical evidence and statistical assessment indicated persistent high rate of relapse, revision surgery should be limited in managing relapsed clubfoot.

LOW TEMPERATURE THERMOPLASTIC SPLINTING IN THE MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS

Congenital talipes equinovarus (CTEV) is one of the most common congenital deformities. Treatment of clubfoot should begin at the earliest to have the best outcome. The goal of treatment is to eliminate all deformities of CTEV so that patient has a functional, pain free, plantigrade foot with good mobility within minimum time duration. Treatment includes non-surgical and surgical methods. Conventionally Plaster of Paris (POP) is used for splinting though leather, polypropylene and rubber are also used. Objective of this study is to evaluate the effectiveness of low temperature thermoplastic (LTTP) splinting in CTEV management. This is an on observational study over a period of one year in Thirty-two CTEV patients with Pirani score of less than three. Effectiveness of LTTP splinting was evaluated in detail. It was found that LTTP splinting was cost effective, cosmetically better, reusable, demoldable, and easier to apply. It was of light weight, and required lesser time. It avoids the need for repetitive casting and same splint can be used as maintenance splint also. Pirani score lowered from 3 to 0 after 6 months of splinting. Conclusion –The compliance in donning the splint was high and acceptable among the children studied. Parental satisfaction regarding the splint wearing time and correction of deformity factor was high. Skin complications associated with POP casting were absent in the study population. Hence correction of CTEV with LTTP splinting was more effective than conventional POP casting.

Comparison of the outcome of management of congenital idiopathic clubfoot treated by ponseti method with modified technique

Background: Ponseti's technique has become the standard and most effective treatment modality for correction of Congenital Talipes Equinovarus (CTEV) in newborn. With time, little modification has been done in the classic technique.
 Objective: Our objective in this study was to compare the outcome in the recent years (modified Ponseti technique) with the results of our previous study (classic Ponseti technique).
 Methods: A total number of 976 patients (1553 feet) of Congenital Talipes Equino Varus were treated from October 2009 to February 2019 in Khulna Medical College Hospital and in private hospitals. In this retrospective study (based on convenient sampling), there were two groups. In group A, a total 621 patients (with a total 1033 feet) were treated from October 2009 to August, 2015. In group B, 355 patients (520 feet) were treated from November 2015 to February 2019.
 Results: In this study, in group A, approximately 88.6% was in 0-6 months age group. 64.9% was male patients. 3.7% patients had positive family history. In group B, majority of the patients (301, 84.8%) was in 0-6 months age group. 211 patients (59.4%) was male child. In approximately 3.1% (11) patients family history was positive. Approximately in 95.9% (991 out of total 1033) and 96.5% (502 out of total 520) feet respectively in group A and B, tenotomy was required. Dropout rates were 7.6% and 4.1% in respective groups. Minor bleeding was observed in approximately 1.5% (15) and 1.4% (7) feet in respective groups, followed by plaster related complications in approximately 2.2% (23) and 1.0% (5) feet in group A and B. Patients' compliance was found significantly higher in group B in contrast to group A. In group B, it was over 90%, whereas in group A, it was approximately 64.1 %.
 Conclusion: The ultimate outcome of Ponseti repair is improving by less requirement of total number of plaster, resistant cases and reduction in overall dropout rate by the newer modification.
 Bang Med J (Khulna) 2019; 52 : 7-11

Evaluation of Ponseti method in correction of congenital talipes equinovarus

<p class="abstract"><strong>Background:</strong> Congenital idiopathic clubfoot is a complex foot deformity often requires many months of treatment and frequently resulted in incomplete or defective correction by older methods. Deformity can be corrected with serial manipulation and casting with minimal or no surgery as reported by Ponseti. This study is an attempt to evaluate the effectiveness of Ponseti technique in treatment of idiopathic congenital talipes equino varus.</p><p class="abstract"><strong>Methods:</strong> 30 patients between age group of 01 to 24 weeks with 48 feet having congenital idiopathic clubfoot were treated using Ponseti technique. The guidelines for treatment were followed as per the Ponseti method of serial manipulation and casting at weekly intervals.<strong></strong></p><p class="abstract"><strong>Results:</strong> 43 (89.58%) cases were treated successfully by using Ponseti technique without need of extensive surgery. 42 feet required tenotomy. 38 (79.16%) feet had an excellent outcome, 5 (10.42%) feet had a fair outcome and 05 feet (10.42%) had poor outcome as measured by the Pirani scoring system. 7 (14.58%) patients had cast related complications.</p><p><strong>Conclusions:</strong> The Ponseti method is a safe, effective and reproducible method for correction of idiopathic congenital talipes equinovarus which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot.</p>

Functional outcome of serial cast correction of congenital talipes equinovarus by ponseti method

Vast number of children are born with congenital clubfoot every year. Incidence of CTEV being one per 1000 live births. Most of these are kids born in countries where they remain untreated or poorly treated reducing their quality of life. CTEV has been existent and known since time immemorial to mankind and so are the controversies it carries within itself. Many research has been done on these subjects and they all have contributed understanding the pathoanatomy and deciding upon the appropriate treatment. Still the literature states that treatment of club-foot is in general one of unvarying success. In our study we have recorded the functional outcome of serial cast correction of CTEV by Ponseti method.

Quantification of the ossification of the lateral cuneiform in the feet of young children with unilateral congenital talipes equinovarus

After the initial correction of congenital talipes equinovarus (CTEV) using the Ponseti method, a subsequent dynamic deformity is often managed by transfer of the tendon of tibialis anterior (TATT) to the lateral cuneiform. Many surgeons believe the lateral cuneiform should be ossified before surgery is undertaken. This study quantifies the ossification process of the lateral cuneiform in children with CTEV between one and three years of age. The length, width and height of the lateral cuneiform were measured in 43 consecutive patients with unilateral CTEV who had been treated using the Ponseti method. Measurements were taken by two independent observers on standardised anteroposterior and lateral radiographs of both feet taken at one, two and three years of age. All dimensions of the lateral cuneiform on the affected side increased annually but remained smaller than the corresponding dimensions of the unaffected foot (p < 0.01). The lateral cuneiform resembled a 9 mm cube at two years and an 11 mm cube at three years. At one and two years, the ossification centre of the lateral cuneiform may not be large enough to accommodate a drill hole for tendon transfer. However, by three years, it has undergone sufficient ossification to do so. Cite this article: Bone Joint J 2017;99-B:1109-14.

Transfer of technology regarding correction of congenital talipesequinovarus by ponseti method of treatment to doctors working at peripheral hospitals of eastern region of Nepal covered by BPKIHS, Dharan.

Background: Ponseti method of manipulation and casting has been standard non operative method of treatment for idiopathic clubfoot. We have conducted this study to find out whether Ponseti method of correction can be taught to doctors working at district hospital.Objective: To assess the knowledge, familiarize the Ponseti method of correction and to decrease the need of surgery regarding the congenital talipesequinovarus.Method: We conducted prospective study among doctors working in the district hospitals of eastern Nepal. We assessed knowledge and practice regarding clubfoot management before and after the intervention by questionnaire based method. The data were analyzed using before and after difference for magnitude and paired t test for significance.Result: 13 doctors were included in the study. Among 13 participants, one (7.69%) had formal orthopedic training. Only 30% of the participants had more than 60% correct response regarding questionnaires regarding knowledge of clubfoot. 40% of participants had done referral of cases to orthopedic centre. One (7.69%) of the participants had applied Ponseti cast. 61% percent of the participants responded more than 60% correctly at the final follow up at one year.Conclusion: The study shows that the knowledge and practice regarding Clubfoot correction is inadequate and hence teaching of Ponseti method was useful in the district hospital.Health Renaissance 2015;13(2): 144-152

Long-Term Outcome Evaluation in Young Adults Following Clubfoot Surgical Release

The aim of this study was to evaluate the long-term outcome of a comprehensive surgical release for congenital talipes equinovarus (CTEV). Gait, strength, segmental foot motion, and outcomes questionnaire data were collected on 24 adults (21.8+/-2.3 y) who were surgically treated for CTEV as infants. These data were statistically compared with of 48-age group matched controls (23.2+/-2.4 y). The clubfoot group was functional in activities of daily living, although most patients did experience foot pain after a day of typical activities, such as walking, standing, using stairs and doing exercise. Lower extremity gait kinematics was similar to the control group. There were differences in segmental foot motion with the hindfoot in a more plantarflexed position relative to the tibia and the forefoot dorsiflexed, and adducted relative to the hindfoot. Ankle plantarflexion and inversion strength and range of motion was reduced in the clubfoot group in association with an increase in hip power generation during the preswing and initial swing phases of the gait cycle. Surgical correction of CTEV was successful in providing a functional plantigrade foot as the patients reached adulthood. However, limitations included foot pain, limited foot range of motion, and weakness. Level III.

Comparison of the effects of epidural and intravenous ketamine on the duration of epidural analgesia in children

Abstract Nineteen children undergoing surgical correction of congenital talipes equinovarus were randomly allocated to receive one of two analgesic regimens. Group IV received 1 ml/kg −1 of bupivacaine 0.25% epidurally and ketamine 0.5 mg/kg −1 intravenously and Group C received 1 ml/kg −1 of bupivacaine 0.25% with ketamine 0.5 mg/kg −1 epidurally. Venous blood was taken at intervals after the administration of ketamine and assayed for ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 4.5 hours in Group IV compared with 6 hours in Group C (p max ) was not measured in Group IV and was 0.35 μg/ml −1 (range 0.17–0.96 μg/ml −1 ) in Group C. The median time taken to attain C max (T max ) was not measured in Group IV and was 45 minutes (range 5–50 minutes) in Group C. The terminal elimination half life was 11.3 hours in both groups. There were no differences between the groups in the time taken to recover from anaesthesia.

The accessory soleus muscle in congenital talipes equinovarus

Accessory soleus muscle is seen not infrequently at surgical correction of congenital talipes equinovarus. However this association has rarely been reported in the world literature, and not at all in the British literature. This abnormal muscle is thought to contribute significantly to the hindfoot deformity in these cases, and must be recognised if a successful correction is to be achieved. Abnormal musculature may be an indicator of poor prognosis. We describe three types of accessory soleus muscle.

SIXTY-SIXTH REPORT OF PROGRESS IN ORTHOPEDIC SURGERY

CONGENITAL DEFORMITIES Premature Ossification of Lower Epiphysis of the Tibia Following Forcible Correction of Clubfeet. —Riedel1observed five patients who showed premature ossification of the lower tibial epiphyses following forcible manipulation for the correction of congenital talipes equinovarus. Each patient came under observation because of a persistent tendency toward recurrence of the deformity. In all cases, roentgen-ray examination showed that the lower tibial epiphyses had closed, while the lower epiphyses of the fibula were still open. The tibiae had stopped growing, while the fibulae were still elongating, and the asymmetrical growth resulted in tilting the astragalus and supinating the os calcis and the whole tarsus. In all of the cases the original manipulation had been forcible, the wrench having been used. Presumably the epyphyses had been injured during the procedure. Riedel believed that many cases of recurring clubfoot are to be explained in this manner. He stated that he