Idiopathic Clubfoot Research Articles

Early clubfoot recurrence can lead to more frequent and earlier second recurrences.

The frequency of multiple clubfoot recurrences following Ponseti casting and the effect on final outcomes have not been well studied. This study aims to evaluate the effect of early recurrence (during the first 2 years) on the timing and rate of subsequent recurrences. A retrospective review was conducted of children treated with Ponseti casting at a single institution from 2002 to 2023 with minimum follow-up until age 5. Patients who required comprehensive soft tissue surgery to obtain initial correction were excluded. Patient-Reported Outcomes Measurement Information System data were collected when available. A total of 86 patients were included; 69.8% (60) had idiopathic clubfoot. Average follow-up was 5.8 years. Early recurrence (recurrence before age 2) occurred in 26.7% (23). The rate of late recurrence (recurrence after age 2) was higher in the early recurrence group, 73.9% (17) vs. 39.7% (25), P = 0.005. Survival analysis revealed that patients with early recurrence experience late recurrence at a younger age of 3.9 vs. 6.7 years, P ≤ 0.001. The early recurrence group experienced more frequent recurrences, with a median of 3 [interquartile range (IQR): 1-5] total recurrences vs. 0 (IQR: 0-1), P ≤ 0.001. Patients with early recurrence had lower final mobility scores, 40.83 ± 10.88 vs. 48.00 ± 10.60, P = 0.029. In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Spina Bifida.

While the Ponseti method is the primary treatment for idiopathic clubfoot, its application in treating myelodysplastic clubfeet is less certain. Myelodysplastic clubfoot tends to be more severe and difficult to treat. Although the Ponseti method can initially correct these cases, there is conflicting evidence about recurrence rates and the need for additional treatment. This study aims to assess the effectiveness of the Ponseti method in treating myelodysplastic clubfeet compared with idiopathic clubfeet over a 20-year period. The study conducted a retrospective review of medical records from patients treated for clubfoot at a single institution (2002 to 2021), comparing children with myelodysplastic and idiopathic clubfoot. Included patients were under 18, initially treated with Ponseti-casting, and had a minimum 2-year follow-up. Data on demographics, treatment details, recurrence, and Patient-reported Outcomes Measurement Information System (PROMIS) scores were analyzed. Forty-nine myelodysplastic and 512 idiopathic clubfeet in 366 patients met the inclusion criteria. Myelodysplastic cases had a median age of 5 months at presentation versus 2 months for idiopathic cases ( P =0.002). Initial correction was achieved in 95% of idiopathic and 87.8% of myelodysplastic feet ( P =0.185). Recurrence rates were higher in the myelodysplastic cohort, 65.3% versus 44.1% ( P =0.005). Surgery was necessary to treat recurrence in 59.2% of myelodysplastic and 37.7% of idiopathic cases, P =0.003. Follow-up was 3.9±1.8 years for myelodysplastic and 3.3±1.5 years for idiopathic feet, P =0.030. Myelodysplastic feet had lower PROMIS mobility scores; 31.94±7.56 versus 49.21±8.64, P <0.001. To the best of our knowledge, we report the largest series of myelodysplastic clubfeet treated by Ponseti casting and the first to assess PROMIS data. Overall, the Ponseti method is as effective in obtaining initial correction in myelodysplastic clubfoot as it is in idiopathic clubfoot. However, myelodysplastic clubfeet has a higher risk of relapse and increased need for surgical interventions. Children with spina bifida may need closer follow-ups and more stringent adherence to bracing. Level III-therapeutic studies-investigating the results of treatment.

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.

Psychosocial Impacts of Idiopathic Clubfoot on Parents and Children: A Scoping Review Protocol.

Idiopathic clubfoot is a complex pediatric foot deformity. The Ponseti technique is widely regarded as the standard for correcting deformities, and treatment compliance is essential for preventing relapse. Examining psychosocial effects on parents and/or children during clubfoot treatment provides valuable insights for improving compliance. This scoping review will map the existing literature on the psychological and social effects experienced by parents and/or children with idiopathic clubfoot. It also aims to examine the assessment tools used to measure these impacts and identify factors influencing treatment compliance. This review will adhere to the Joanna Briggs Institute (JBI) guidelines for scoping reviews. The search will include databases such as Scopus, Web of Science, EBSCOhost, MEDLINE, and PsycINFO and focus on studies published in the last 10 years. This review will include quantitative, qualitative, and mixed-method studies that investigate the psychological and social effects experienced by parents or affected children of any age with idiopathic clubfoot. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension guidelines. The screening and data extraction process will involve two independent reviewers. The analysis will be descriptive and qualitative. The findings will be presented in tables and a narrative summary. This review may guide health practitioners in developing evidence-based interventions to improve treatment adherence.

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%.

Percutaneous Achilles tendon tenotomy in clubfoot with a blade or a needle: a single-centre randomized controlled noninferiority trial.

The gold standard for percutaneous Achilles tendon tenotomy during the Ponseti treatment for idiopathic clubfoot is a tenotomy with a No. 15 blade. This trial aims to establish the technique where the tenotomy is performed with a large-bore needle as noninferior to the gold standard. We randomized feet from children aged below 36 months with idiopathic clubfoot on a 1:1 basis in either the blade or needle group. Follow-up was conducted at three weeks and three months postoperatively, where dorsiflexion range, Pirani scores, and complications were recorded. The noninferiority margin was set at 4° difference in dorsiflexion range at three months postoperatively. The blade group had more dorsiflexion at both follow-up consultations: 18.36° versus 18.03° (p = 0.115) at three weeks and 18.96° versus 18.26° (p = 0.001) at three months. The difference of the mean at three months 0.7° is well below the noninferiority margin of 4°. There was no significant difference in Pirani scores. The blade group had more extensive scar marks at three months than the needle group (8 vs 2). No major complications were recorded. The needle tenotomy is noninferior to the blade tenotomy for usage in Ponseti treatment for idiopathic clubfoot in children aged below 36 months.

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.

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.

Pitfalls and complications in the treatment of clubfoot by the Ponseti method: A literature review

BACKGROUND: At every step of clubfoot treatment using the Ponseti method, pitfalls leading to complications, both minor and potentially dangerous, may occur. Any doctor involved in the treatment of clubfoot may encounter similar difficulties in their practice; however, publications devoted to this problem are limited, and in some cases, experts cannot reach a consensus regarding the interpretation of actions that entail undesirable consequences. AIM: This study aimed to analyze pitfalls and complications associated with the Ponseti method for the treatment of clubfoot using modern literature data. MATERIALS AND METHODS: Articles were searched for in PubMed, Science Direct, Google Scholar, and eLibrary databases using the following keywords: idiopathic clubfoot, Ponseti method, serial casting, bracing, Achilles tenotomy, pitfalls, and complications. The search was performed without language restrictions. Most of the studies included were published no more than 10 years ago. RESULTS: Current literature data present on the pitfalls and complications encountered in the treatment of clubfoot using the Ponseti method. The review also covered associated complications and unfavorable prognostic factors. The restrictive measures during the COVID-19 pandemic have affected the treatment of clubfoot. CONCLUSIONS: Analysis of the causes of pitfalls and complications and control of unfavorable prognostic factors will help reduce complications of clubfoot treatment using the Ponseti method and optimize orthopedic care for children.

The Core outcome Clubfoot (CoCo) study: relapse, with poorer clinical and quality of life outcomes, affects 37% of idiopathic clubfoot patients.

There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse. A total of 11 international centres participated in this institutional review board-approved observational study. Data including demographics, information regarding presentation, treatment, and details of subsequent relapse and management were collected between 1 June 2022 and 30 June 2023 from consecutive clinic patients who had a minimum five-year follow-up. The clubfoot COS incorporating 31 parameters was used. A regression model assessed relationships between baseline variables and outcomes (clinical/QoL). Overall, 293 patients (432 feet) with a median age of 89 months (interquartile range 72 to 113) were included. The relapse rate was 37%, with repeated relapse in 14%. Treatment considered a standard part of the Ponseti journey (recasting, repeat tenotomy, and tibialis anterior tendon transfer) was performed in 35% of cases, with soft-tissue release and osteotomies in 5% and 2% of cases, respectively. Predictors of relapse included duration of follow-up, higher initial Pirani score, and poor Evertor muscle activity. Relapse was associated with poorer outcomes. This is the first multicentre study using a standardized COS following clubfoot treatment. It distinguishes patients with and without relapse in terms of clinical outcomes and QoL, with poorer outcomes in the relapse group. This tool allows comparison of treatment methods and outcomes, facilitates information sharing, and sets family expectations. Predictors of relapse encourage us to create appropriate treatment pathways to reduce relapse and improve outcome.

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level. Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless." Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.

Assessment of functional outcome after ponseti method for congenital idiopathic clubfoot

Assessment of functional outcome after ponseti method for congenital idiopathic clubfoot

Early Radiographic Characteristics of the Lateral Talocalcaneal Angle and its Predictive Significance for Relapse in Patients With Idiopathic Clubfoot Treated With the Ponseti Method

In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants' feet were classified into three groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92±1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57°±12.05° and 39.37°±12.55°, respectively, while Group C was 49.61°±9.11°. A significant difference was found among the three groups of patients (F=31.48, P<0.001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse. LEVEL OF EVIDENCE: III.

Prevalence and Associations of Depression in Parents of Children With Congenital Talipes Equinovarus: A Single-Centre Study.

Congenital talipes equinovarus (CTEV) is a congenital deformity that requires weekly visits to the hospital for manipulation and corrective cast application, followed by an intensive bracing regimen requiring multiple visits to the hospital spread over the years. Parents of children with clubfoot are known to undergo a range of negative emotions. The objective of this study was to identify the prevalence of depression and the factors associated with depression in parents of children with idiopathic CTEV. This cross-sectional study consecutively enrolled 190 parents of children with idiopathic CTEV undergoing treatment at King George Medical University. Parents with conditions that preclude the assessment of mental status were not included. These conditions include a history of head injury or psychiatric illness, parents with ongoing treatment of psychiatric illness, ongoing chronic illness, chronic neurological disease, and parents with clinically established intellectual disability. Information was recorded on certain parent-related characteristics and certain child-related characteristics. Parent-related information included age and sex of the parent, religion, area of residence, number of children in the family, degree of perceived social support (using the Multidimensional Scale of Perceived Social Support, MSPSS), level of education, socio-economic status, depression subscale score of DASS 21 (Depression, Depression Anxiety, and Stress Scale -21), chronic pain (visual analogue scale, VAS), family history of clubfoot or depression, and level of stress caused by a major life event during the past year using the Presumptive Stressful Life Event Scale (PSLES). Child-related information included the sex of the child, phase of treatment (casting or bracing), limb involvement (unilateral or bilateral), relapse of the deformity, and Pirani score of the deformity. Bivariate analysis and logistic regression were used to identify factors associated with a score ≥10 on the depression subscale of DASS 21. One hundred forty-five subjects were males (76.3%). The mean age of the enrolled parents was 28.47±4.89 years. The mean score on the depression subscale of DASS-21 was 4.87±6.3. Thirty-two parents (16.8%) had a score of ≥10 on the depression subscale of the DASS-21. On bivariate analysis, female sex, being Hindu, having studied up to class 12th, relapse, MSPSSscore, and PSLES score were found to be associated with a score ≥10 on the depression subscale of the DASS-21. On logistic regression, female sex, lack of graduate education and above, and MSPSS scores were found to be significantly associated with a score of ≥10 on the depression subscale of the DASS 21 score. The prevalence of depression in parents of children with idiopathic clubfoot was 16.8%. Female gender, lack of college education, and the level of perceived social support (MSPSS) are independently associated with a score ≥10 on the depression subscale of DASS 21. We recommend screening parents of children with clubfoot and referring those with abnormal scores to a psychiatrist for a confirmed diagnosis.

Parent reported outcomes for idiopathic clubfoot children treated with the Ponseti technique: An analysis of 140 feet followed minimum 5 years

ObjectiveThe treated clubfoot children are often evaluated clinically during follow-up. However, patient reported outcomes (PROM) are seldom analysed for these children. We investigated 87 idiopathic clubfoot children (140 feet) treated by the Ponseti method and followed minimum 5 years to study their clinical outcomes and PROM. Material and methodsThis was a cross-sectional study, based on evaluating treated clubfoot children clinically (Pirani score) and PROM (Oxford Ankle and Foot Questionnaire – Parent Version) and comparing them with the age-matched healthy controls (n = 60). The questionnaire has four main domains related to the child's physical, school and play, emotional and footwear profile. The children having persistent deformity (residual/relapse) were specifically studied for their PROM scores. ResultsThe mean child age at initial treatment was 2.3 months and the mean follow-up duration was 6.9 years. The PROM score of clubfoot children was statistically lower than the healthy controls (p < 0.001). Of the individual domains, the physical domain was the most affected. On calculating the Pirani scores, 10 out of 140 feet (7 %) had some form of persistent deformity. The children with persistent deformity had lower Oxford scores than healthy children or those with corrected feet. The physical domain followed by the emotional domain scored low when persistent deformity was present. ConclusionsMost children (98 %) had a plantigrade foot following Ponseti treatment at follow-up. However, PROM score of the clubfoot children did not correspond to the clinical outcome. Persistent deformity, even minor, was a cause of parental concern and resulted in a low PROM score.

Assessing the Influence of Age, Weight, and Pirani Score on the Number of Casts During the Initial Phase of Clubfoot Treatment Using the Ponseti Method: A Prospective Study.

Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment. A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction. The majority of participants were male infants aged 4-6months, with a median age of 4.5months. Half of them weighed between 3.00 and 4.99kg at their first hospital visit, with a median weight of 3.20kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0-3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3-9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts. The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy.

Management outcome of congenital talipes equinovarus (clubfoot) using Ponseti protocol at Lagos University Teaching Hospital.

Idiopathic clubfoot occurs commonly in children with a prevalence of 1 in 1000. The Pirani scoring system, which consists of a midfoot contracture score and hindfoot contracture score, is traditionally used in assessing the severity of clubfoot deformity. Ponseti protocol is used in the management of clubfoot deformity. The study aimed to evaluate the outcome of the management of clubfoot using the Ponseti protocol and to correlate the outcome with the initial Pirani score. Eighty-two children aged 1 week-2 years with 128 idiopathic clubfeet were recruited into the study. The severity of their clubfoot deformities was scored using the Pirani scoring system on recruitment. They were managed with weekly serial manipulation and cast application with or without tendon-Achilles tenotomy according to Ponseti protocol. The average initial Pirani score was 3.6 ± 0.9. The average number of casts used was 5.9 ± 1.3 (range: 4-9 casts). Tenotomy was done in 51.56% of the feet. The group that required tenotomy required more casts and as such longer duration of treatment than the "no tenotomy" group. There was a relapse rate of 2% in the feet of the compliant group, whereas the relapse rate was 69% in the group that was not compliant with the use of foot-abduction brace. The success rate at 6 months follow-up was 84.4%. Ponseti protocol is an excellent method of management of idiopathic clubfoot, and the Pirani scoring system was useful in assessing the initial severity and the outcome. The initial Pirani score correlates with the duration of treatment.

Comparison of kinematics and pedobarography findings between the unaffected foot of patients with unilateral clubfoot and controls.

Idiopathic clubfoot (ICF) involves structural abnormalities in the lower extremities. Approximately half of patients have unilateral ICF, which could be due to differences in limb formation. The contralateral unaffected foot may have subclinical ICF. The objectives were to compare ankle and foot kinematics and pedobarography findings between the unaffected foot of patients with unilateral ICF and controls. Eleven children with unilateral ICF (11 unaffected feet, 11.7 ± 3.8years) and 15 age-matched controls (30 control feet, 11.1 ± 3.0years) were enroled. Five complete gait trials were performed. Data were collected using ten cameras and a twom long Footscan system and compared between groups using the Wilcoxon rank sum test. All children with ICF underwent the selective soft tissue release procedure. The unaffected feet showed limited ranges in inversion-eversion and dorsiflexion-plantar flexion on kinematic analysis. There was a delay in landing time in all regions of the foot during heel rise and propulsion. The peak time was achieved significantly later in the unaffected feet compared to the controls. Although plantar pressure parameters were comparable, unaffected feet showed a larger contact area in the midfoot region. Gait data on the unaffected foot in unilateral ICF patients do not correspond to those of controls despite an indistinguishable clinical appearance. This could be due to the effect of treatment, the process of foot development, or a combination. The relationship between genetics and gait deviation in patients with unilateral ICF needs further evaluation. The unaffected foot should receive similar attention during follow-up.

Combined Cuboid-Cuneiform Osteotomy For Correction Of Residual Forefoot Adduction Deformity In Idiopathic Clubfoot

Combined Cuboid-Cuneiform Osteotomy For Correction Of Residual Forefoot Adduction Deformity In Idiopathic Clubfoot

Routine ultrasound screening for hip dysplasia in children with clubfoot is not supported.

Despite the existence of guidelines for screening for developmental dysplasia of the hip (DDH), there remains controversy regarding the need for routine ultrasound screening for DDH in patients with clubfoot due to an unclear correlation between the two conditions. The purpose of this study is to determine whether ultrasound screening for DDH in this population improved the diagnostic accuracy of DDH over standard assessment for patient risk factors and physical exam. This is a retrospective cross-sectional review of infants diagnosed with idiopathic clubfoot who underwent hip ultrasounds to assess for DDH as identified by keyword search in an institutional radiological database at a tertiary care paediatric hospital. Patient demographics, risk factors for DDH, physical exam findings, and ultrasound results were recorded. Of the 120 patients who met the inclusion criteria between 2003 and 2018, 8 had hip dysplasia confirmed on ultrasound (6.7%). All these patients either had known risk factors for hip dysplasia or had an abnormal physical exam finding suggestive of hip instability or dislocation as performed by an orthopaedic surgeon on their initial consultation. A detailed history to determine risk factors and a thorough physical exam are adequate to determine the need for hip ultrasound in infants with idiopathic clubfoot. Routine ultrasound screening of all patients with clubfoot is likely unnecessary and may pose a significant burden on the health care system.