Idiopathic Clubfoot Research Articles

CLINICO- RADIOLOGICAL OUTCOME OF IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS FOLLOWING PONSETI TECHNIQUE

Introduction: Idiopathic clubfoot or congenital talipes equinovarus is the most common orthopedic congenital deformity. Club foot affects roughly one in every 1000 live births, and it is bilateral in about half of the cases. The four components of a congenital club foot are cavus, adduction, varus, and equinus. The treatment's purpose is to address four abnormalities and keep them corrected so that the patient can have a functional, pain-free plantigrade foot. Aims: To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: The present study was a Observational study. This Study was conducted from 03/08/2005 to 02/08/2007 at Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences. Total 37 patients were included in this study. Result: we found that a relatively low clinical outcome as compared to ndings by other authors who have reported excellent treatment outcomes that have ranged from 82.4% to 97% and In this study 62.6% of the patients reported no pain, an evidence of good functional outcomes associated with the Ponseti conservative method of treatment compared to the surgical soft tissue release. Conclusion: The functional outcomes are equally good with the majority of patients reporting no pain, being able to wear shoes of their liking and having no limitation during walking or running. This is a sign of an improved life style and quality of life and correlates with good patient and caregiver satisfaction.

A PROSPECTIVE STUDY OF TREATMENT OF IDIOPATHIC CLUBFOOT (CTEV) USING PONSETI METHOD

Background: Congenital talipes equina varus (CTEV) or clubfoot is one of the commonest orthopedic problems seen in infants. CTEV is the term used to describe as a deformity involving in utero malalignment of the calcaneo-talar-navicular complex of the foot. The incidence is 1 in 1000 live births with male to female ratio is 3:1 and is bilateral in 50% of the infants. Idiopathic congenital talipes equinovarus (clubfoot) is a complex deformity that is difcult to correct. The deformity has four components - cavus, adductus, varus equinus and internal tibial torsion. The goal of treatment is to reduce or eliminate these deformities so that the patient has a functional pain-free foot with good mobility and does not need to wear modied shoes. Most orthopaedic surgeons agree that the initial treatment should be non-surgical and should start as soon as possible after birth. Many methods have been described, most of which involve serial manipulation and casting. If left untreated, clubfoot inevitably leads to signicant long-term disability, deformity and pain. Although various surgical techniques are used to correct clubfoot, such as soft tissue releases or bony procedures in older children, currently, conservative management is the preferred option in infants. The technique of gradual and simultaneous correction of all deformities of CTEV using manipulation and casting at weekly interval described by Dr.Ignacio V. Ponseti has gained wide acceptance throughout the world. In this study, we have attempted to analyse the functional outcome of Idiopathic clubfoot using Ponseti's technique in children. To study the outcome following the use of Ponseti technique Objectives: for idiopathic clubfoot. To evaluate the efcacy of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot. Children with congenital Source Of Data: idiopathic clubfoot consulted at Basaweshwar teaching and general hospital; attached to Mahadevappa Rampure Medical College, Kalaburagi. Method Of Collection Of Data: The study proposes to include patients with congenital clubfoot examined according to the protocol. Associated deformities are noted.The severity of foot deformity was assessed according to Pirani scoring system before and after treatment.Serial toe to groin castings will be applied. The number of casts required to obtain correction and the need for tenotomy was also recorded. Patients will be reviewed at weekly intervals till all deformities except equinus are corrected and once in a month following tenotomy and the use of orthotics. Results: Average number of cast applied before equinus correction in 0-6month age group was 6.3 and 7-12month age group was 6.7 average number ofnal cast used in 0-6months of age was 7.3 and in 7-12months it was 7.7 .Average number of cast increases with increase in age and Pirani severity score 98% of patient had no residual deformity at the time of follow up 2% had relapse at the time of nal follow up. There was a signicant reduction in the PSS after each cast and these difference in PSS between before equinus correction and after the last cast were signicant with the p value of <0.001. Ponseti technique of treatment for Clubfoot deformity is very effective, a Interpretation / Conclusion: nd produces painless, mobile, exible, plantigrade and cosmetically acceptable foot without need of any major surgical intervention

Bilateral congenital idiopathic clubfoot treatment with the Ponseti technique in Umuahia: A comparison of individual foot characteristics

Background: Clubfoot is the commonest musculoskeletal congenital deformity affecting the foot. The idiopathic variety is the most common type and worldwide the agreed treatment method is the Ponseti method. In bilateral cases, the feet may have different anthropometric characteristics. These differences were evaluated in this study.Objective: To assess the effect of the differences in the anthropometric parameters of the legs and feet (Calf circumference, foot length, degrees of cavus, adduction and equinus and Pirani score) in a child with bilateral clubfoot on the treatment outcome and recurrence of the deformity.Method: This was a prospective study that analyzed idiopathic bilateral clubfoot patients aged 0-5 years and treated using the Ponseti Technique at Federal Medical Center, Umuahia from October 2019 to September 2020. The Pirani scores, the lengths of the feet, the calf circumferences and degrees of cavus, adduction and equinus were measured at initial presentation, commencement of bracing and 3 months after commencement of treatment. These measurements were then compared.Results: A total of 47 patients participated in the study with a male preponderance. The right calf circumference and length of the right foot were consistently bigger than the left at each measurement; and these differences were statistically significant. The degrees of cavus, adduction and equinus were significantly worse on the right foot at presentation. Thirty-six patients (76.6%) had the same Pirani score on both feet at presentation. The differences in anthropometry parameters did not predict the number of casts needed to correct the deformity, the need for tenotomy nor the recurrence of the deformity.Conclusion: Although there were differences in the lower limb anthropometry of children with bilateral clubfoot, they did not predict deformity correction nor recurrence.

HOW EFFECTIVE IS STEENBEEKS BRACE IN MAINTAINING CORRECTION IN CLUBFOOT AFTER PONSETI TREATMENT

Background: The term clubfoot refers to a variety of related congenital foot deformities. It is used interchangeably to refer to clubfoot deformities that are idiopathic, atypical, syndrome, and postural. Scales designed specifically for clubfoot, like the Pirani and Dimeglio Scales, are frequently used to categorize severity. Therefore, this study is aimed to evaluate the effectiveness of Steenbeek Foot abduction brace (SFAB) to maintain the correction achieved. Methodology: A Cross-sectional study conducted at CTEV Clinic, Department of Orthopaedic, NSCB Medical College, Jabalpur from the period of 1st Jan 2021 to 31st June 2022 with a sample size of 50 estimated through n = z2pq / d2. Study participants include Child age- <=1.5 years and Unilateral / Bilateral Idiopathic Club Foot. Statistical analysis was done through IBM Software SPSS 21.0 and association was found with confidence Interval of 95% and p-value<0.05. Results: Current study concluded that maximum are males (54%) with an age-group of <6 months (64%) presented Bilateral CTEV (60%). Furthermore, treatment effectiveness was highest in number with the significant association between treatment effective and sex (p-value<0.05). Meanwhile, relapse was found in females comparatively to males with no statistically association (p-value>0.05). Conclusion: The desired goal of achieving minimal disability as a result of clubfoot can be assisted in its achievement by enhancing the education and counselling of parents, removing social barriers, strengthening the training of health providers, improving access to affordable braces, and eliminating social barriers.

Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment. Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors. Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed. Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons.

Percutaneous Achilles tendon tenotomy in clubfoot patients with a 22 gauge needle in a low-resource setting.

Ponseti treatment has been well-established as the gold standard for the treatment of idiopathic clubfoot in high-income countries and middle- and low-income countries (LMICs). The tenotomy is usually performed in the clinic using a scalpel blade under local anesthesia. However, we believe that by adapting the technique from Minkowitz et al. to a low-resource setting, we can help address some of the known barriers to Ponseti care. Using a needle instead of a blade makes the procedure less cumbersome easier to learn and easier to understand for the provider, family and the patient. We were able show that the needle tenotomy technique can be implemented in a low-resource setting like Pakistan, and can be performed using only one assistant and materials that are locally and readily available for the same cost This paper and its attached educational videos can help spread the technique among providers in low-resource settings.

Pain behavior of children with bilateral idiopathic clubfoot undergoing Ponseti casting and the effect of non-pharmaceutical pain-relieving agents.

This study prospectively investigated the pain response and physiological parameters [heart rate (HR) and oxygen saturation (SpO2)] during sequential casting in bilateral clubfoot. Additionally, it explored the role of non-nutritive sucking and human care contact on the observed responses during casting. Subjects were allotted to control group (Group A with no intervention) and two intervention groups (Group B: non-nutritive sucking intervention, Group C: human care contact intervention). Neonatal Infant Pain Score (NIPS), heart rate (HR), and oxygen saturation (SpO2) were used to assess the response. The three groups matched in age and gender characteristics of the participants. Pain response was noted across all groups. The left foot demonstrated a statistically significant preexisting tachycardia which rose further during casting (p < 0.01). Intergroup comparisons revealed that the alteration for NIPS during casting was in following sequence (Group A > C > B, p < 0.00001). The effect of interventions offered in Group B and C lasted in the post-cast period as well (B > C). The clubfoot child exhibited moderate pain response during casting of both feet. A tachycardia was noted prior to initiation of second cast which further exaggerated with subsequent cast. Pacifier (non-nutritive sucking) intervention produced better control of pain response than human care contact during casting for both feet.

Does age and start of Ponseti treatment affect the functional outcome in club foot: A comparative study

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct. Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age &lt;1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment. Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant. Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.

A prospective study on the role of foot evertor muscle activity in recurrence of clubfoot

BackgroundEven after corrective casting and bracing, clubfoot recurrence is challenging throughout childhood, with around 14–40 % recurrence rates. Most of the literature on recurrence was attributed to various factors, and minimal research was conducted to know the role of foot evertor muscle activity and its stimulation benefits. This study aimed to assess the role of foot evertor muscle activity in idiopathic congenital clubfoot recurrence by using clinical, sonographic, and electromyographic parameters. MethodsA prospective cohort study was conducted at our tertiary care hospital from 2020 to 2022. The patient’s demographic data, Pirani, Dimeglio, Clinical Evertor Muscle Activity scores, sonographic cross-sectional areas of leg muscle, and evertor motor activity using surface electromyography were recorded in adherence to the pre-defined intervals. ResultsIn total, 51 patients (51 feet) were included in the study, and the overall recurrence rate was 27.5 % (14/51). In this study, around 47 % (24/51) of children had mild or poor clinical evertor activity; among them, 58 % (14/24) children had a recurrence, and the insufficient clinical evertor activity and recurrence were strongly correlated (p = 0.01). Evertor muscle cross-sectional area ratio, motor unit potentials, and recruitment were comparatively less in the recurred group; however, only the cross-sectional area ratio was statistically significant (p = 0.02). ConclusionEarly detection of evertor muscle weakness can help to individualize the treatment plans by predicting recurrence. Therefore, it should be included in routine clinical evaluations. Further research is required to determine the advantages of evertor muscle-strengthening activities in preventing idiopathic clubfoot deformity. Level of Clinical EvidenceA prospective cohort study, Level of evidence-II

Subgroups of Idiopathic Clubfoot Can Predict Short-term Outcomes.

The Pirani scale is used for the assessment of Ponseti-managed clubfoot. Predicting outcomes using the total Pirani scale score has varied results, however, the prognostic value of midfoot and hindfoot components remains unknown. The purpose was to (1) determine the existence of subgroups of Ponseti-managed idiopathic clubfoot based on the trajectory of change in midfoot and hindfoot Pirani scale scores, (2) identify time points, at which subgroups can be distinguished, and (3) determine whether subgroups are associated with the number of casts required for correction and need for Achilles tenotomy. Medical records of 226 children with 335 idiopathic clubfeet, over a 12-year period, were reviewed. Group-based trajectory modeling of the Pirani scale midfoot score and hindfoot score identified subgroups of clubfoot that followed statistically distinct patterns of change during initial Ponseti management. Generalized estimating equations determined the time point, at which subgroups could be distinguished. Comparisons between groups were determined using the Kruskal-Wallis test for the number of casts required for correction and binary logistic regression analysis for the need for tenotomy. Four subgroups were identified based on the rate of midfoot-hindfoot change: (1) fast-steady (61%), (2) steady-steady (19%), (3) fast-nil (7%), and (4) steady-nil (14%). The fast-steady subgroup can be distinguished at the removal of the second cast and all other subgroups can be distinguished at the removal of the fourth cast [ H (3) = 228.76, P < 0.001]. There was a significant statistical, not clinical, difference in the total number of casts required for correction across the 4 subgroups [median number of casts 5 to 6 in all groups, H (3) = 43.82, P < 0.001]. Need for tenotomy was significantly less in the fast-steady (51%) subgroup compared with the steady-steady (80%) subgroup [ H (1) = 16.23, P < 0.001]; tenotomy rates did not differ between the fast-nil (91%) and steady-nil (100%) subgroups [ H (1) = 4.13, P = 0.04]. Four distinct subgroups of idiopathic clubfoot were identified. Tenotomy rate differs between the subgroups highlighting the clinical benefit of subgrouping to predict outcomes in Ponseti-managed idiopathic clubfoot. Level II, prognostic.

Functional Implications of Flat-Topped Talus Following Treatment of Idiopathic Clubfoot Deformity.

Though flatness of the talar dome (TD) is a potential consequence of operative and nonoperative clubfoot management, the functional impact of this deformity is not well understood. This study analyzes the relationship between TD morphology and ankle function at skeletal maturity in patients treated for idiopathic clubfoot during infancy. 33 skeletally mature patients (average age 17.9 years) with 48 idiopathic clubfeet were identified. Weightbearing radiographs, gait analysis, and patient-reported outcomes using the Pediatric Orthopaedic Data Collection Instrument (PODCI) were obtained. Radius of curvature (ROC) of the TD and tibial plafond were measured along with other parameters of talar and calcaneal morphology. All measurements were correlated to PODCI scores and gait analysis data. Patients demonstrated marked variability in ROC of the TD (mean 30.8 mm, SD 13.6 mm), TD radius to talar length (R/L) ratio (mean 0.56, SD 0.28), opening angle of the TD (alpha angle) (mean 89.6°, SD 28.4°), and tibiotalar incongruity index (mean 0.18, SD 0.16). Increased tibiotalar incongruity index correlated with decreased maximum plantar flexion (r = ‒0.325, P = .02). A less acute alpha angle of the talar dome correlated with increased maximum ankle power generation (r = 0.321, P = .03) as did increased length of the talar neck (r = 0.358, P = .013). Increased tibiotalar incongruity index correlated negatively with PODCI global function domain scores (r = ‒0.490, P = .04; r = ‒0.381, P = .03, respectively), whereas length of the talar body correlated with higher global function scores (r = 0.376, P = .03) and lower pain scores (r = 0.350, P = .046). At skeletal maturity, flattening of the talar dome and tibiotalar incongruity on plain radiographs correlate modestly with gait changes, whereas tibiotalar incongruity and length of the talar body, not flatness of the talar dome, correlate with decreased patient-reported outcome scores. Level III, prognostic.

PONSETI VERSUS KITE'S METHOD OF TREATMENT FOR IDIOPATHIC CLUBFOOT.

Introduction : Idiopatic congenital talipes equinovarus deformities in infants are difcult to treat due to its complicated pathoanatomy of the growing foot. As clubfoot deformities are pliable in the early weeks of life, treatment preserved is always conservative. Both manipulation and casting methods of Kite and Ponseti are commonly used with good outcomes 1. Though most orthopaedicians prioritize using Ponseti method, advantages and disadvantages of both treatment should be taken into consideration when selecting the treatment. So, we have decide to carry out a comparative study between Kite's and Ponseti method in the treatment of idiopathic clubfoot. 33 patients (48 feets) having idiopathic CTEV were randomized and divided into Materials and methods : two groups. 18 infants (26 feet) were selected and treated by Ponseti method and 15 infants (22 feet) were treated by Kite's method. The results of both group were compared based on Pirani score, time and number of casts required for correction, relapse and percentage of feet corrected. Ponseti Results : method had higher satisfactory correction rate (91.67% versus 80.95%), required less number of casts ( 7.57 versus 11.76), less duration of cast ( 53 days versus 82.35 days) and lesser percentage of relapse ( 8.33 % versus 9.52%). The relapse were corrected by remanipulation in both the groups. In case of bilateral idiopathic CTEV mean Pirani score decreased faster in the Ponseti group compared to Kite's group. The difference was statistically signicant 3rd week onwards in left sided CTEV and 4th week onwards in right sided CTEV. In case of unilateral idiopathic CTEV, the mean Pirani score in Ponseti group decreased faster in Ponseti group compared to Kite's group and the difference was statistically signicant 3rd week onwards. Both Ponseti and Kite's method of casting are effe Conclusion : ctive in correcting idiopathic CTEV deformities. Though correction rate was almost similar in both methods, Ponseti method proved slightly better than Kite's in correcting deformities faster with relatively lesser number and duration of casts. The Kite's method had an advantage of not needing any minor surgical procedure for the correction of deformity.

What exactly is "foot abduction" during management of idiopathic clubfoot in clinical practice?

There is however gross ambiguity regarding the use of term "foot abduction" in clubfoot treatment. We measured below defined angles at different stages of clubfoot treatment to decipher their precise interpretation. In a prospective evaluation of 25 unilateral clubfeet in infants' age less than sixmonths treated with Ponseti technique, clinical leg foot and thigh foot angle were measured at talar head reduction (LHT0), pre-tenotomy, and post-tenotomy stage. A "normal" reference was available in the form of measurements of contralateral limb. Talar head (LHT0) was reduced at mean leg foot angle of 26 degrees. The corresponding pre- and post-tenotomy angles were 42.6 and 50.0 degrees, respectively. The reference leg foot angles for contralateral limb were 49.8 degrees. The thigh foot angle for LHT0, pre-tenotomy, post-tenotomy, and contralateral side were, respectively, 39.2, 56, 68, and 65.6 degrees. There was an additional tibial external rotation component of mean 13.4 degrees (SD 4.5) in the thigh foot angle when compared to the leg foot angle at tenotomy. This increased to 18 degrees (SD 3.4) post-tenotomy. The study suggested that the foot abduction described in the "Ponseti Manual" probably intends thigh foot rather than leg foot angles. There was a significant difference in the angles when talar head reduced and tenotomy was decided. The foot abduction is an ambiguous term which should be replaced by the more specific leg or thigh foot abduction angle.

Percutaneous Achilles Tenotomy in Idiopathic Clubfoot treatment

Introduction; Percutaneous Achilles tenotomy is a standard procedure in most clubfoot patients treated with Ponseti method as the most widely use method of conservative clubfoot treatment. To our knowledge, there are not studies published in Albanian literature about this technique. Our goal is to present results of conservative treatment of idiopathic clubfoot where this technique was performed.&#x0D; Material and Method. This is a prospective study of all idiopathic clubfoot patients treated in our Institution with Ponseti Method. We performed this technique under sedation anesthesia in operation room, not in clinic. We measured age of patient at time of presentation, gravity according to Pirani score, number of casting, need for Achilles tenotomy).&#x0D; We measured the degree of angle of dorsiflexion before and after this procedure, the gravity and need for a second procedure.&#x0D; Results: Out 400 clubfeet treated during 2005-2010 we included in our study 372 case that needed the percutaneous Achilles tenotomy performed. Average age at presentation was 3 weeks. Average Pirani score was 5.5. The number of weekly serial cast needed before the tenotomy was 8. Dorsiflexion angle after this procedure was improved by 45 degree (range from 30 to 90 degree). Only 2 cases needed reoperation due to non-compliance with foot abduction bar and physiotherapy&#x0D; Conclusion: The percutaneous Achilles tenotomy is used in 93% of case with idiopathic clubfoot serie of patient. It is an easy technique performed with sedation anesthesia in operation room not with local anesthesia. Achilles tenotomy is an important element to avoid recurrence This supports other studies that have used this method.

Common Errors in the Management of Idiopathic Clubfeet Using the Ponseti Method: A Review of the Literature.

Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: "Idiopathic Clubfoot" (All Fields) AND "Management" OR "Outcomes" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0-12 months). A full-text review of these articles was then performed looking for "complications" or "errors" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients.

The outcome of ponseti method for the treatment of clubfoot; a systematic review

Clubfoot is one of the most common congenital orthopedic disorders that is characterized by four structural deformities. The treatment of clubfoot could be conservative or surgical; however, conservative modalities should be the initial option for the management of clubfoot. Ponseti method is a conservative modality. Thus, this review was conducted to assess the outcomes of the ponseti method in the treatment of clubfoot by reviewing the previous studies conducted on this subject. Google Scholar and PubMed databases were explored for scientific articles using different keywords, including &amp;quot;clubfoot, treatment, management, outcomes and ponseti method.&amp;quot; Original articles focused on the treatment of clubfoot by the ponseti method that were in English and available full-text articles were eligible for the analysis. After refining the findings, only nine articles were found eligible as per the inclusion criteria. The nine studies included a total number of 884 children. It was found that children were suffering from idiopathic clubfoot, neglected clubfoot, idiopathic and flexible clubfoot, complex clubfoot, or undefined clubfoot. Ponseti method is found effective and safe for the management of clubfoot, even for neglected clubfoot in older children with few complications and decreased rate of relapse.

Ponseti Treatment of Bilateral Idiopathic Clubfoot: Does the Hand Dominance of the Provider Make a Difference?

Introduction: Congenital talipes equinovarus (CTEV) is the commonest musculoskeletal deformity worldwide. The Ponseti technique is the goal standard for clubfoot treatment. During the correction phase, the provider’s right hand manipulates the right foot and the left hand, left foot. Often, one foot is ready for Achilles tenotomy before the other in bilateral clubfoot. Objective: To determine the effect of the provider’s hand dominance would have on bilateral clubfoot treated with the Ponseti technique. Method: This was a prospective cross-sectional study that analyzed idiopathic bilateral clubfoot patients aged 0 - 5 years and treated using the Ponseti technique at FMC Umuahia from October 2019 to September 2020. Informed consent and ethical clearance were obtained. The Pirani scores were obtained and compared at presentation and at each clinic visit. All trained manipulators were right-handed. Two-tailed t-test was used and a p-value less than 0.05 was deemed significant. Results: Forty-seven patients participated in the study with an M:F of 2.6:1 and mean age of 13.79 ± 13.39 months. Thirty-six patients (76.6%) had the same Pirani score on both feet at presentation, while the right and left feet were more severely affected in 8 and 3 cases respectively. The mean number of casts before readiness for tenotomy was 4.95 on the right and 5.28 on the left with p-value of 0.042. Conclusion: Though the right foot had a worse mean Pirani score on presentation, however, it required fewer casts before readiness for tenotomy than the left.

Experience with accelerated ponseti technique for treatment of idiopathic clubfoot in a regional orthopaedic hospital in Nigeria.

Idiopathic talipes equinovarus (ITEV) 'aka clubfoot' is the most common foot deformity in children. Ponseti technique had been accepted as a standard method for correction. The traditional Ponseti technique for correction is well known. Accelerated Ponseti technique is said to offer some advantages over the standard technique. The aim of this study was to determine and document the efficiency and success rate of accelerated Ponseti technique. This was a prospective interventional study which lasted 26 months from February 2017 to April 2019. Twenty-eight patients with 42 feets who met the inclusion criteria were recruited. They had serial manipulation and casting twice every week till percutaneous tenotomy was done as indicated. Final cast usually applied after tenotomy and left for 3weeks. Each patient was followed up for a year corresponding to 9 months after the commencement of night bracing. Data were analysed using SPSS version 20. The mean age was 8.1 months with a range of 1-36 months. The mean Pirani score recorded was 4.4, while the mean number of casting sessions was 3.6 and the mean duration of treatment was 12.4 days. The tenotomy rate recorded was 42.9%. Pre-bracing assessment of Pirani score, passive ankle dorsiflexion and foot abduction done and repeated after a year revealed optimal correction. The relapsed rate at 1 year was 4.8%. The only complication observed was pressure sore in a patient. The accelerated Ponseti technique is an efficient method of treatment of ITEV in a much shorter time with a higher success rate. It facilitates compliance with treatment.

Factors Predictive of Tenotomy After Ponseti Casting for Idiopathic Clubfoot: A Tertiary Care Center Study.

Parents of children with clubfoot are likely to inquire about the need for tenotomy and about any factors that may be predictive. The present study was done to identify factors that may help predict the need for tenotomy in children undergoing Ponseti treatment for idiopathic clubfoot. A prospective observational study was conducted on patients under 5 years of age with idiopathic clubfoot and no previous treatment history treated at Hospital and Rehabilitation Centre for Disabled Children. The relationship between the Pirani score, Dimeglio score, age, and passive ankle dorsiflexion (DF) and the need for heel cord tenotomy was analyzed using appropriate statistical methods. Of 83 patients (125 feet) with a mean age of 6 months, 93 feet (74.4%) required a percutaneous tenotomy. The mean initial Pirani and Dimeglio score for 125 club feet was 4.5 (SD=1.68) and 13.5 (SD=6.1), respectively. The mean initial passive ankle DF was -40.4 (SD=22.31). The Dimeglio ( P =0.000), Pirani scores ( P =0 .000), and passive ankle DF ( P =0.000) showed significant association with the need for tenotomy. This study shows a strong association between initial Pirani and Demiglio scores and initial passive ankle DF as predictive of a heel cord tenotomy. However, age, sex, and laterality were not associated with the need for tenotomy.

Symmetry of Shoe Size and Calf Girth in Children With Treated Idiopathic Clubfoot: A Longitudinal Study.

Symmetry of Shoe Size and Calf Girth in Children With Treated Idiopathic Clubfoot: A Longitudinal Study.