Idiopathic Congenital Talipes Equinovarus Research Articles

Clinical and Sonographic Evaluation of Percutaneous Achilles Tendon Tenotomy in Idiopathic Clubfoot: A Prospective Study

Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical and sonographic outcomes of percutaneous Achilles tendon tenotomy in children with idiopathic clubfoot who underwent the Ponseti procedure. Methods: A prospective study was conducted at the JIPMER Department of Orthopaedics, involving 41 feet with residual equinus deformity following Ponseti treatment. Infants with idiopathic clubfoot were included. Clinical and sonographic evaluations were performed, percutaneous Achilles tendon tenotomy was performed. Parameters were measured, Data were statistically analyzed using Kolmogorov-Smirnov tests, paired t-tests, ANOVA, and correlation analysis. Results: 29 infants (41 feet), primarily boys (89.7%) were studied. Following percutaneous tenotomy, clinical improvement was observed, with a mean increase in dorsiflexion of 20-25 degrees. Sonographic parameters showed significant improvement in tibio calcaneal distance, talocalcaneal divergence, and metaphyseal-talocalcaneal angle post-tenotomy (p<0.05). Positive correlations were found between clinical and sonographic improvements. Conclusion: Clinical improvement of hindfoot deformity following percutaneous Achilles tendon tenotomy in idiopathic clubfeet correlates with the sonological improvement of talo calcaneal, tibio calcaneal angles and tibio calcaneal distance.

A ‘Hub and Spoke’ Shared Care initiative for CTEV Ponseti service

AimsThe Ponseti method is the gold standard treatment for congenital talipes equinovarus (CTEV), with the British Consensus Statement providing a benchmark for standard of care. Meeting these standards and providing expert care while maintaining geographical accessibility can pose a service delivery challenge. A novel ‘Hub and Spoke’ Shared Care model was initiated to deliver Ponseti treatment for CTEV, while addressing standard of care and resource allocation. The aim of this study was to assess feasibility and outcomes of the corrective phase of Ponseti service delivery using this model.MethodsPatients with idiopathic CTEV were seen in their local hospitals (‘Spokes’) for initial diagnosis and casting, followed by referral to the tertiary hospital (‘Hub’) for tenotomy. Non-idiopathic CTEV was managed solely by the Hub. Primary and secondary outcomes were achieving primary correction, and complication rates resulting in early transfer to the Hub, respectively. Consecutive data were prospectively collected and compared between patients allocated to Hub or Spokes. Mann-Whitney U test, Wilcoxon signed-rank test, or chi-squared tests were used for analysis (alpha-priori = 0.05, two-tailed significance).ResultsBetween 1 March 2020 and 31 March 2023, 92 patients (139 feet) were treated at the service (Hub 50%, n = 46; Spokes 50%, n = 46), of whom nine were non-idiopathic. All patients (n = 92), regardless of allocation, ultimately achieved primary correction, with idiopathic patients at the Hub requiring fewer casts than the Spokes (mean 4.0 (SD 1.4) vs 6.9 (SD 4.4); p < 0.001). Overall, 60.9% of Spokes’ patients (n = 28/46) required transfer to the Hub due to complications (cast slips Hub n = 2; Spokes n = 17; p < 0.001). These patients ultimately achieved full correction at the Hub.ConclusionThe Shared Care model was found to be feasible in terms of providing primary correction to all patients, with results comparable to other published services. Complication rates were higher at the Spokes, although these were correctable. Future research is needed to assess long-term outcomes, parents’ satisfaction, and cost-effectiveness.Cite this article: Bone Jt Open 2023;4(11):865–872.

Accelerated versus standard Ponseti cast in the management of idiopathic congenital talipes equinovarus at a tertiary care centre in North India: a comparative study

Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle. With a male dominance pattern, this deformity is bilateral in around 50% cases. It is characterized across varying degrees and severity of components manifesting with: forefoot adductus, midfoot cavus, hindfoot varus and hindfoot equinus. Severity is accessed using Pirani score (0 to 6). Insights into the basic patho-anatomy of this complex 3-dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in foot-ankle orthosis initially for 23 hours day for 3 months and then 12 hours a day for 3 years. Parental counselling regarding the importance of compliance with maintenance braces remains the most important component of treatment. Methods: This was a double blinded randomized prospective study including 40 patients with 61 feet of only idiopathic clubfoot, conducted in the department of orthopaedics, government medical college, Jammu over a period of 01 year. Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p<0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0). Conclusions: The clubfoot in developing countries has social stigma, the early and the promising result of the accelerated method of Ponseti casting has a dramatic impact on both parents and the treating orthopaedician. The accelerated Ponseti casting has remarkably reduced the overall duration of the treatment of Ponseti casting without any complication.

Factors Related to Relapse of Congenital Talipes Equinovarus (CTEV) After the Ponseti Method.

Congenital talipes equinovarus (CTEV) is one of the common congenital disorders in pediatric orthopedic practice that affects a large group of children.It is a combination of four parts of deformity that affect either a single foot or both feet. Our aim in this study is to estimate the prevalence and incidence of CTEV and to evaluate the risk factors that lead to relapse in some children to avoid relapse in future and complex surgical interventions, as well as to improve the final outcome. A retrospective cohort study for the cases of CTEV was conducted to estimate the prevalence of relapse in children with CTEV after management by the Ponseti method and to evaluate the risk factors that lead to recurrence. The study includes 103 patients with CTEV, and only 22 patients had relapse. The prevalence rate of relapsed cases was 20.4%, and the incidence was 42 per thousand. The average number of casts applied was 4.05 ± 1.37. The average severity of the deformity that was measured by the Pirani score was 4.97 ± 1.21. The most common atypical presentation of CTEV was associated with developmental dysplasia of the hip (DDH), followed by myelomeningocele (MMC). The only significant factors in the study were the Pirani score and non-compliance of the brace with p < 0.05. There was not any significance in the correction of the deformity by Ponseti between idiopathic and non-idiopathic CTEV based on the number of casts and the Pirani score. The dynamic foot brace can be the solution for the high recurrence rate, yet more studies are needed in the future.

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 &lt;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

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.

Anterior Distal Tibial Guided Growth for recurrent equinus deformity in idiopathic Congenital Talipes Equinovarus treated with the Ponseti method

IntroductionDistal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment. MethodsPatients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles' tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity. ResultsWe identified 22 feet in 16 patients, with an average follow-up was 25 (8.8–47.3) months. The mean aDTA changed from 88.9 (82.3–94.5) to 77.0 (65.0–83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot. ConclusionThis procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment. Level of EvidenceTherapeutic Level IV.

Genetic Role in Recurrence of Idiopathic CTEV: A Systematic Review.

Congenital Talipes Equinovarus (CTEV) is a multitude of deformities involving equinus, varus, adductus, and cavus deformities. Clubfoot affects 1 in every 1000 infants born worldwide, with various incidences according to geographical areas. It has been previously hypothesized that the possible genetic role in Idiopathic CTEV (ICTEV) might have a treatment-resistant phenotype. However, the genetic involvement in recurrent ICTEV cases is yet to be determined. To systematically review existing literature regarding the discovery of genetic involvement in recurrent ICTEV to date to further understand the etiology of relapse. A comprehensive search was performed on medical databases, and the review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed on several medical databases: PubMed (MEDLINE), Scopus, the Cochrane Library, and European PMC on May 10, 2022. We included studies reporting patients with recurring idiopathic CTEV or CTEV of unknown cause after treatment, reporting whole-genetic sequencing, whole-exome sequencing, Polymerase Chain Reaction, or Western blot analysis as methods of genetic analysis (intervention) and providing results of idiopathic CTEV genetic involvement. Non-English studies, literature reviews, and irrelevant articles were excluded. Quality and risk of bias assessments were performed using Newcastle-Ottawa Quality Assessment Scale for non-randomized studies where appropriate. The authors discussed data extracted with the primary outcome of gene(s) frequency being reported of their involvement in recurrent ICTEV cases. Three pieces of literature were included in this review. Two studies analyzed the genetic involvement in CTEV occurrence, while one analyzed the protein types found. With included studies of less than five, we could not perform other forms of analysis apart from qualitatively. The rarity of literature exploring the genetic etiology of recurrent ICTEV cases has been reflected in this systematic review, giving opportunities for future research.

BRACING COMPLICATIONS IN IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS

Specific brace-fitting complications in idiopathic congenital talipes equinovarus (CTEV) have been rarely described in published series, and usually focus on non-compliance. Our primary aim was to compare the rate of persistent pressure sores in patients fitted with Markell boots and Mitchell boots. Our additional aims were to describe the frequency of other brace fitting complications and identify age trends in these complications. A retrospective analysis of medical files of 247 idiopathic CTEV patients born between 01/01/2010 - 01/01/2021 was performed. Data was collected using a REDCap database.Pressure sores of sufficient severity for clinician to recommend time out of brace occurred in 22.9% of Mitchell boot and 12.6% of Markell boot patients (X2 =6.9, p=0.009). The overall rate of bracing complications was 51.4%. 33.2% of parents admitted to bracing non-compliance and 31.2% of patients required re-casting during the bracing period for relapse. For patients with a minimum follow-up of age 6 years, 44.2% required tibialis anterior tendon transfer. Parents admitting to non-compliance were significantly more likely to have a child who required tibialis anterior tendon transfer (X2=5.71, p=0.017). Overall rate of capsular release (posteromedial release or posterior release) was 2.0%.Neither medium nor longterm results of Ponseti treatment in the Australian and New Zealand clubfoot have been published. Globally, few publications describe specific bracing complications in clubfoot, despite this being a notable challenge for clinicians and families. Recurrent pressure sores is a persistent complication with the Mitchell boots for patients in our center. In our population of Australian clubfoot patients, tibialis anterior tendon transfer for relapse is common, consistent with the upper limit of tibialis anterior tendon transfer rates reported globally.

A Systematic Review and Single Center Experience With Percutaneous Needle Tenotomy in Congenital Talipes Equinovarus (CTEV).

Percutaneous scalpel tenotomy is frequently performed as part of congenital talipes equinovarus (CTEV) to correct the equinus deformity. The use of a scalpel is associated with complications such as neurovascular bundle damage and pseudoaneurysms. In the literature, a percutaneous large-bore needle has been found to be a safer alternative to a scalpel for performing tenotomies. The goal of this study was to conduct a systematic review and report a single-center case series on the use of percutaneous needle tenotomy in the treatment of CTEV. A Preferred Reporting Items of Systematic Review and Meta-analysis (PRISMA)-compliant literature search was conducted to identify studies describing the use of a percutaneous needle tenotomy in the treatment of idiopathic CTEV. A retrospective case series of patients with idiopathic CTEV treated with percutaneous needle tenotomy over a seven-year period from a single center were also conducted. The patients' demographics, the location of the clubfoot, and the Pirani score were all recorded. An analysis of descriptive statistics was carried out. Continuous data were expressed as mean and SD, whereas categorical variables were expressed as absolute numbers and percentages (%). The systematic review included eight papers with a total of 1026 feet and a mean age of 10.4 weeks (SD 5.9). There were 47 (0.04%) complications across all studies, with a pooled success rate of 95%. Eleven patients (16 feet) were included in the single-center case study. The patients' initial Pirani score was 4.8 (SD 1.5), with a final score of 0. (SD 0). Four complications occurred in the patient's cohort - one minor bleeding and three recurrences as a result of poor compliance with the post-tenotomy foot abduction brace.In conclusion, the percutaneous Achilles tenotomy of a CTEV foot with a large bore needle is a safe and effective alternative.

TO STUDY THE CORRELATION BETWEEN CLINICAL AND RADIOLOGICAL (USG) ASSESSMENT IN MANAGEMENT OF TYPICAL CTEV USING PONSETI TECHNIQUE

Congenital talipes equinovarus (clubfoot) is a joint deformity of the foot in children, which affects one in every 1000 live births. Our study aims to correlate Pirani score and ultrasound in assessing the correction of clubfoot in neonates treated by the Ponseti method. A total of 44 infants with idiopathic congenital talipes equinovarus deformity were prospectively treated by the Ponseti method. Pirani score and ultrasound parameters were measured during every visit, i.e., every week till the completion of treatment. The sonographic evaluation was done in the affected foot's posterior, medial and lateral aspects. Following sonographic parameters were calculated: Tibio-calcaneal distance (TC), Medial Malleolar Navicular distance (MMN) &amp; Calcaneo-cuboid angle (CC angle). The correlation between ultrasound parameters and Pirani score was evaluated using paired t-test. Ultrasound effectively depicts the pathoanatomy in clubfoot. Ultrasound being non-invasive, easily available, and radiation-free, can be safely used for infants to assess the effectiveness of clubfoot treatment. Pirani score and ultrasound correlation were done, and p values for respective parameters were calculated during the treatment.

Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age.

The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV. The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children's Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results. The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached 'consensus in', no statements reached 'consensus out', and 18 reached 'no consensus'. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached 'consensus in', no statements reached 'consensus out', and three reached 'no consensus' and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages. We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: Bone Joint J2022;104-B(6):758-764.

Comparison Between the Outcome of the Standard and Accelerated Ponseti Casting Methods for Correcting Congenital Talipes Equinovarus Deformity

Background: Congenital talipes equinovarus (CTEV) is a prevalent congenital foot deformity. The Ponseti Method is a non-surgical treatment for clubfoot, which entails a sequence of casts and braces. The accelerated Ponseti method is a modified version of the standard Ponseti method, involving more frequent cast changes. Materials and Methods: A total of 60 patients with idiopathic CTEV under the age of one were carefully chosen and assigned to either group A (Standard) or group B (Accelerated). The Pirani score was used to evaluate each clubfoot before applying a cast. In group A, above-knee casting was performed once a week, while in group B, it was done twice a week Results: The study involved sixty children, accounting for a total of seventy feet. The results indicated a shorter treatment duration with the accelerated Ponseti method, while the occurrence of skin complications was comparable between the two methods. Conclusion: In conclusion, both the accelerated and standard Ponseti methods are equally effective in correcting clubfoot. The accelerated method offers the advantage of reducing the overall treatment duration and has clear benefits, while there is no notable difference in skin complications between the two methods.

The outcomes of idiopathic congenital talipes equinovarus : a core outcome set for research and treatment.

AimsTo 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).MethodsA list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected from patients and families through a questionnaire and interview process. The combined list, as well as the appropriate follow-up timepoint, was rated for importance in a two-round Delphi process that included an international group of orthopaedic surgeons, physiotherapists, nurse practitioners, patients, and families. Outcomes that reached no consensus during the Delphi process were further discussed and scored for inclusion/exclusion in a final consensus meeting involving international stakeholder representatives of practitioners, families, and patient charities.ResultsIn total, 39 OMTs were included from the systematic review. Two additional OMTs were identified from the interviews and questionnaires, and four were added after round one Delphi. Overall, 22 OMTs reached ‘consensus in’ during the Delphi and two reached ‘consensus out’; 21 OMTs reached ‘no consensus’ and were included in the final consensus meeting. In all, 21 participants attended the consensus meeting, including a wide diversity of clubfoot practitioners, parent/patient representative, and an independent chair. A total of 21 outcomes were discussed and voted upon; six were voted ‘in’ and 15 were voted ‘out’. The final COS document includes nine OMTs and two existing outcome scores with a total of 31 outcome parameters to be collected after a minimum follow-up of five years. It incorporates static and dynamic clinical findings, patient-reported outcome measures, and a definition of CTEV relapse.ConclusionWe have defined a minimum set of outcomes to draw comparisons between centres and studies in the treatment of CTEV. With the use of these outcomes, we hope to allow more meaningful research and a better clinical management of CTEV.Cite this article: Bone Jt Open 2022;3(1):98–106.

Standard and accelerated ponseti technique in management of idiopathic congenital talipes equinovarus: A comparative study

Introduction: Congenital talipes equinovarus (CTEV) is one of the most common deformities of foot and ankle. Incidence of CTEV is around 1 in every 1000 live births. Males are affected twice as often as females. Bilateral deformities occur in 50% of cases and in unilateral cases, right foot has predominance. Components of Congenital talipes equinovarus are cavus, forefoot adduction, hindfoot varus, ankle equinus. Goal of clubfoot management is to produce and maintain a painless, functional, mobile and callosity free, normal shoeable foot. In an accelerated ponseti technique, cast is applied twice weekly on fixed days instead of one week. This study compares the results of Standard Ponseti technique with Accelerated Ponseti technique in management of idiopathic CTEV. Materials and Methods: A hospital based prospective randomized comparative study was conducted in the Dept. of Orthopaedics of Silchar Medical College,Silchar, Assam from 1stJune 2020 to 31st may 2021. Total of 50 cases were selected randomly, randomization was done, 25 were treated by Standard Ponseti and 25 were treated by Accelerated Ponseti technique. Results: Mean Pirani score at presentation in standard Ponseti group was 5.25±0.76, and in accelerated Ponseti group it was 5.37±0.65, with p-value indicating that two groups did not have significant difference. In standard Ponseti group, the treatment time in plaster ranged from 28-56 days, and in accelerated Ponseti group it ranged from 14-31 days. Discussion: Modification in frequency of casting has shown that the efficacy remains unchanged but correction of deformity occurs in a shorter span of time. Reduction in duration of treatment will help to improve compliance among parents. Conclusion: Ponseti method has shown good results in idiopathic as well as syndromic CTEV. This Study shows that Accelerated Ponseti method is equally effective as Standard Ponseti method in treatment of idiopathic CTEV with the benefit of reduction in treatment time.

Ponseti method for treatment of idiopathic congenital talipes equinovarus at tertiary care center in India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Different treatment methods were tried with variable success rates but Ponseti method of serial casting and manipulation stood apart due to better understanding of foot biomechanics and became accepted choice of treatment worldwide.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 50 patients were enrolled in the study out of which 40 were available for final follow-up. We studied 40 cases during October 2018 to December 2020 at Government Medical College, Aurangabad. Out of 40 cases 31 were male and 9 were female. 25 were unilateral and 15 were bilateral. All cases were idiopathic. 4 inches Plaster of Paris (POP) bandages were cut into half and such 2 inches POP bandages were used for casting. Tenotomies were performed under controlled environment of Operation Theater with general anaesthesia. Number 12 surgical blade was used. Dennis-Browne splint was used for maintenance of correction.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of total 55 feet studied, 10 feet (18.18%) required tendo Achilles tenotomy and 45 feet (81.82%) were treated with casting alone. There were 8 cases of relapses (20%). All relapsed cases were treated with repeat casting as per Ponseti protocol and none of them required repeat tenotomy. Complications related to plaster were minimal and there were no incidence of rocker bottom deformity.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that in a low income developing country like India where case load is very high; Ponseti method is effective, inexpensive form of treatment with minimal complications. Need for extensive soft tissue procedures vastly reduced with this method.&lt;/p&gt;

Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment.

Idiopathic congenital talipes equinovarus is the most commonly encountered congenital deformity of the foot. Ponseti technique of manipulation is the treatment of choice. The Pirani classification is a reliable scoring system for clinical evaluation of clubfeet. The role of radiographic parameters in the evaluation and treatment of clubfeet is still controversial. The aim of this study was to evaluate the correlation of radiological parameters with clinical correction in patients with idiopathic clubfeet undergoing correction using Ponseti method. Between March 2018 and March 2019, 42 feet in 27 patients with idiopathic clubfeet were treated in our hospital. We used the Pirani scoring system for clinical evaluation. Anteroposterior and lateral views of the feet were taken before and after correction and at the last follow-up. The anteroposterior view was evaluated for the talocalcaneal angle and talo-first metatarsal angle, while the lateral view was only evaluated for the talocalcaneal angle. Twelve were boys (44.4%), and 15 were girls (55.6%). The deformity was bilateral in 15 patients (55.6%) and unilateral in 12 patients (44.4%). The average age was threemonths. According to the Pirani score, the mean Pirani Total score was 4.4 before correction and reduced to 0.4 after correction. The mean talocalcaneal angle in anteroposterior and lateral views was 15.1° and 7.8° before correction, increased to 32.7° and 31.8° after correction, respectively. The mean talocalcaneal index increased from 23.2 before correction to 64.5 after correction. The mean talo-first metatarsal angle in anteroposterior view improved from 25.7° before correction to - 1.6° after correction. The relation between the differences in Pirani scores before and after correction and the differences in measured radiographic parameters before and after correction revealed a statistically significant correlation. Radiographic parameters showed a statistically significant correlation with the clinical outcome. Thus, evaluation of clubfeet correction treated by Ponseti technique can rely mainly on clinical scores with limited utilization of radiological assessment.

EVALUATION OF RESULTS OF GRADUAL DISTRACTION TECHNIQUE FOR CORRECTION AND FUNCTIONAL RECOVERY OF NEGLECTED CTEV

INTRODUCTION: Congenital talipes equinovarus (CTEV) or clubfoot is commonest congenital foot deformity. The incidence of Congenital Idiopathic Clubfoot ranges from 0.36/1000 to 6.8/1000 in some populations and about 1.2/1000 births among Caucasians including Indians, with a 1 much higher occurrence in the affected families . More common in male (2:1). Bilateral cases account for about 50%. In unilateral cases right side affected more. The term talipes is derived from talus (ankle bone) and pes (foot). AIMS &amp; OBJECTIVES:To assess the efcacy of gradual differential distraction with JESS as a method of treatment in neglected CTEV. Evaluation of functional recovery of neglected CTEVusing this technique. To assess the morbidity &amp; complication of the technique. MATERIALS AND METHODS: Study area: - The study was institution based, conducted at the Orthopaedics department of I.P.G.M.E.R.&amp; S.S.K.M. Hospital, Kolkata, a tertiary care centre catering to people of West Bengal and adjacent states of Eastern India Study population: Patients attending Orthopedics' O.P.D. of IPGMER &amp; SSKM Hospital. Study period: From May 2016 to Oct 2017 (18 months duration) Sample size: 20 patients (24 feet) Sample design: Patient selection: RESULTS AND ANALYSIS: 2(8.3%) patients exion deformity of toes. 1(4.2%) Persitant cavus, 1(4.2%) had liniar skin necrosis, 1(4.2%) patients had pressure sore, 1(4.2%) had oedema of feet, 1(4.2%) persistent all deformity, 2(8.3%) patients had persistan tequinus, 5(20.8%) patients had persistant heel varus, 2(8.3%) patients had forfoot adduction, 3(12.5%) patients had pin tract infection and 11(45.8%) had no complication. 4(16.7%) patients had excellent functional outcome, 8(33.3%) patients had good functional outcome, 8(33.3%) patients had moderate functional outcome and 4(16.7%) patients had poor functional outcome. CONCLUSION: In our study 12(82.3%) feet had excellent to moderate result, only 4(16.7%) had poor result with limited complication. Few patients left with one or more persistent deformity but the nal outcome was functionally satisfactory. JESS is an excellent technique in the management of neglected cases of CTEV especially when it is done at an early age. Differential distraction by JESS xator for the correction of neglected idiopathic CTEV is an effective and patient-friendly method of management. Therefore the differential distraction with JESS can be considered as a treatment modality for the neglected CTEV.

Association Between TPM1 Gene Polymorphisms and Idiopathic Congenital Talipes Equinovarus Risk in a Chinese Population.

Background: Idiopathic congenital talipes equinovarus (ICTEV) is one of the most common congenital deformities of children, and dysplasia of the striated muscle may be one of the causes of ICTEV. Previous studies have shown that polymorphisms of the rs4075583 SNP in the tropomyosin gene 1 (TPM1) were associated with ICTEV in Caucasian children. However, there are no studies investigating the correlations of TPM gene polymorphisms with the risk of ICTEV in Chinese children. Methods: We conducted a case-control study, including 430 children with ICTEV and 891 ICTEV-free children. We explored the potential correlations of three TPM gene polymorphisms (TPM1/rs4075583 G>A, tropomyosin gene 2 (TPM2)/rs2145925 C>T, and TPM2/rs2025126 G>A) with ICTEV risk. The three single nucleotide polymorphisms (SNPs) were genotyped using a TaqMan method. We calculated the odds ratios (ORs) and adjusted ORs and their 95% confidence intervals (CIs) to explore the associations between these selected SNP polymorphisms and ICTEV. Results: TPM1 rs4075583 A was found to be associated with an increased ICTEV risk (AA vs. GG: adjusted OR = 1.70, 95% CI = 1.15-2.49, p = 0.007; and GG/GA vs. AA: adjusted OR = 1.62, 95% CI = 1.14-2.31, p = 0.0071) after adjusting for age and sex. In addition, a risk effect of rs4075583 GA/AA with ICETV was observed for patients with affected right feet (adjusted OR = 1.62, 95% CI = 1.10-2.39, p = 0.014) in the stratified analysis. However, there were no significant differences in the risk for ICTEV associated with the rs2145925 and rs2025126 polymorphisms. Conclusion: These results indicate that the TPM1 rs4075583 G > A polymorphism is associated with ICTEV risk in a southern Chinese population; however, this finding needs to be confirmed in larger studies and through mechanistic studies.