Management Of Clubfoot Research Articles

The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana.

Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.

Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study.

Clubfoot, or congenital talipes equinovarus, is a widely recognized cause of disability and congenital deformity worldwide, which significantly impacts the quality of life. Effective management of clubfoot requires long-term, multidisciplinary intervention. It is important to understand how common this condition is in order to assess its impact on the population. Unfortunately, few studies have investigated the prevalence of clubfoot in Saudi Arabia. To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital (KFUH). This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions. Of the 7792 births between 2015 to 2023 that were included in the analysis, 42 patients were diagnosed with clubfoot, resulting in a prevalence of 5.3 per 1000 live births at KFUH. The observed prevalence of clubfoot was significantly higher than both global and local estimates, indicating a substantial burden in the study population.

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.

Multiple Serial Casting for Recurrent Clubfoot in Arthrogryposis Corrects Deformity With Diminishing Returns.

Arthrogryposis multiplex congenita (AMC) consists of more than 400 conditions involving severe joint contractures of at least two or more body regions. Management of clubfoot in patients with AMC is notoriously challenging, with a higher likelihood of recurrence than idiopathic clubfoot, which can be treated using the Ponseti technique to avoid or delay more invasive procedures. The purpose of this study is to determine the utility of multiple serial casting as a treatment of clubfoot in AMC using Pirani scores as an objective measure of deformity. Pirani scores were retrospectively collected from 17 AMC patients with a total of 30 clubfeet and two years follow-up from initiation of treatment. Patients with a minimum of three casting series were included. Pre-treatment and post-treatment deformity scores were examined across casting series using analysis of variance (ANOVA) statistical analysis. The first series pre-treatment Pirani score improved from 4.80±1.54 to 1.68±1.48 (p<0.001). The second series improved from 4.23±1.03 to 2.72±0.916 (p<0.001). The third series had the smallest improvement from 3.87±1.07 to 2.82±1.02 (p<0.001). Change in Pirani scores showed a significant decrease from the first series to the second (p=0.001) and third (p<0.001). In addition, the number of casting days was found to significantly affect the change in scores during the third series (p=0.038). The Ponseti technique can improve clubfoot in AMC as measured by the Pirani score. Data shows that early intervention yields better results, with a diminished yet effective ability to elicit change over time.

The Efficacy of the Ponseti Method in the Management of Clubfoot: A Systematic Review.

Clubfoot is a congenital abnormality of the lower extremities, and it may be unilateralor bilateral. Left untreated, it may lead to issues with walking. Additionally, inappropriate treatment or the lack of treatment can result in functional damage. The goal of clubfoot treatment is to correct the deformities of the involved components. The Ponseti method has been regarded as the gold standard for the treatment of clubfoot as it is safe and effective. In this review, we aimed to assess thesuccess of the Ponseti method in the treatment of clubfootby reviewing the previous studieson this subject. We searched electronic databases, including PubMed, Scopus, Science Direct, and Google Scholar, for relevant articlesspanning the period from2018 to2023. The keywords used in the search were"Ponseti method, Treatment, Outcomes, Success, Relapse, Failure, and Rates."Theinclusion criteria were original articles in Englishonclubfoot patients treated with the Ponseti method. While our search yielded a total of 1,037articles, only ninewere deemed eligible for analysis based on the inclusion criteria. The articles involved a total of 537 feet of 358 patients and the age of the patients ranged from one day to five years.Thesuccess rate ranged between 55% and 100%, and the relapse rate ranged between 3.2% and 34.2%. Based on our findings, the Ponseti methodhas a high success rate in the treatment of idiopathic clubfoot, and hence it isan excellent conservative methodof treatment. However, there are additional factors that may affect the treatment outcomes, which need to be taken into account.

Outcomes of Management of Severe Clubfoot among Children by Ilizarov External Fixator.

Clubfoot remains the most common birth defect involving the musculoskeletal system. There are various surgical and non-surgical treatment options available for the management of clubfoot. Using the minimally invasive Ilizarov external fixator method has been reported to have good success rates and fewer complications. This study aimed at analysing the morphological and functional outcomes of treating severe clubfoot by Ilizarov external fixator among children from July 2017 to March 2020. Thirty-two children who had either failed Ponseti / surgery or neglected with 44 clubfeet of Dieglio type III and type IV were included in the study. A short-leg walking cast was applied for an additional six weeks after removing of Ilizarov frame and additionally followed by an orthosis for another six weeks. Outcomes were measured by the functional rating system by Laaveg and Ponseti and interpretation done at 1 month and 12 months after the ankle-foot arthrosis. About 86.4% of the patients had good or excellent outcome scores. Pre and post-Demeglio scores and functional rating scores were statistically significant (p<0.001) by using Paired t-test. Complications included superficial pin site infections in 13 feet (29.54%), 5 feet (11.36%) had claw toes, 3 feet (6.81%) had linear skin necrosis and 2 feet (4.54%) had calcaneal fractures which were manageable with minor interventions. The study findings highlighted that the Ilizarov external fixator method can correct complex foot deformities of severe clubfoot with minimum morbidity. Further larger and long-term studies are needed to investigate the effects of the stiff hindfoot and possible degenerative changes on the function and symptoms of these patients as adults.

The impact of the 2023 Kahramanmaras (Turkey) earthquake on clubfoot management: A retrospective, observational study

Background/Aim: Clubfoot is the most common congenital foot deformity. Although the etiology and pathoanatomy of clubfoot are not fully understood, dysplasia is present in all musculoskeletal structures below the knee at varying rates. The aim of any treatment regimen is to obtain a pain-free, properly positioned foot that has functional use. The objective of this investigation was to evaluate difficulties in the follow-up and treatment of patients with clubfoot treated in our clinic after the 2023 Kahramanmaras earthquake. Methods: Data from patients with clubfoot treated with the Ponseti method at the Orthopedics and Traumatology Outpatient Clinic of Gaziantep Metropolitan Municipality Inayet Topcuoglu Hospital in Turkey between December 2022 and July 2023 were obtained from the hospital's electronic registry system. Patient demographics, the number of plaster casts made before the earthquake, the total number of plaster casts made, time delays in treatment due to the earthquake, and costs were all analyzed. The Dimeglio score was used for the morphological classification of clubfoot. We analyzed patient data from three time periods: the time of the initial treatment, the period before the earthquake, and the period after the earthquake. Results: The study included 31 feet (16 left and 15 right) of 20 patients (11 males, 9 females). The mean age of the cohort was 3.5 months (standard deviation: 1.6 months). The median and minimum/maximum Dimeglio scores were 11 (9, 13), 6 (4, 8), and 9 (7, 11) at first admission, before the earthquake, and after the earthquake, respectively (P&lt;0.001). The number of casts before the earthquake was 4.32 (0.32), and the total number of casts was 9.39 (1.38). The average time delay until retreatment after the earthquake was 12 weeks (range: 8–15 weeks). There was a significant positive correlation between the duration of the delay and the Dimeglio score measured after the earthquake (r=0.392, P=0.029). The additional cost per patient due to the delay was calculated to be 8290.8 ± 5033.761 TRY (308.78 ± 187.43 USD). Conclusion: The 2023 Kahramanmaras earthquake had a significant impact on the management of clubfoot and other elective procedures. Dealing with the consequences of an unprecedented natural disaster is certainly challenging. However, by adopting carefully designed protocols and therapeutic approaches that are based on the unique characteristics of an illness, we can successfully alleviate the repercussions of such events.

Neglected Clubfoot- a Community Health Challenge in Rural Odisha, India.

Neglected clubfoot deformities are very rigid & stiff that need surgical correction. Unlike countries like china, Uganda, and Malawi, no dedicated National program has been implemented for clubfoot management in India. The burden of disability from untreated or partly treated clubfoot is relatively high. With the existing issues, it has been observed that untreated clubfoot is a public health problem in most low and middle-income countries. To conduct an observational analysis of the community approach to the correction of neglected clubfoot by corrective rehabilitation surgery camps. The study included the retrospective data of all the neglected clubfoot children who had undergone clubfoot corrective surgery in 13 different remote districts of Odisha, held every year between February 2014 to October 2022 except during covid 19 pandemic period (2020 and 2021). A total of 993 clubfeet of 731 children were corrected through community approach-based corrective camp surgery. Follow-up was done for all the operated children with post-op plaster and orthosis till they returned back to the community. About 46.78% of study participants were within the age group of 5years. Male presentation [454 males (62.10%)] was reportedly found 1.6 times higher than the female [277 females (37.89%)]. Most of them belonged to minor communities, socially and economically backward classes from various rural districts of eastern India. The Association of different socially backward categories of clubfoot children with the district they belonged to, was found significant statistically (p value < 0.001). When gender distribution was compared among the district where surgical camps were conducted, the association was statistically not significant (p value = 0.676). Neglected clubfoot in rural areas can be managed by camp approach. The establishment of a robust standard operating procedure for the conduction of community-based surgical camps may be required to reduce the morbidity level in children with neglected clubfoot.

"…with the third eye we can detect mistakes and correct them…'' Supportive supervision and the management of Clubfoot by Ponseti method: Qualitative experiences from Mwanza, Tanzania.

Supportive supervision is the key to health programs in the provision of quality care. Clubfoot or Congenital Talipes Equinovarus remains among the prevalent congenital musculoskeletal birth defects in Tanzania. In 2015, Tanzania introduced supportive supervision guidelines for clubfoot treatment. However, little is known about how supportive supervision helps maintain the skills of providers. To analyze the supportive supervision in maintaining the clinical skills of healthcare workers in clubfoot management in Mwanza, Tanzania. An exploratory qualitative case study employing in-depth interviews (IDIs) with healthcare providers, supervisors, and parents of children with clubfoot was conducted in Mwanza, Tanzania. Data were collected from 3 purposefully selected hospitals and 32 IDI were conducted with the selected participants between April and May 2021. A semi-structured interview guide was used to conduct the IDIs. Qualitative content analysis was used to analyze the data. Two categories were identified in this study. First "the contribution of supportive supervision" attributed by its purpose and the success brought by the supportive supervision. Second, "the maintenance of healthcare workers' skills was attributed to their willingness to learn and actively engage in supportive supervision, cooperation with clinics and clubfoot programmes, and material support. The findings of this study underscore the contribution of supportive supervision to maintaining skills in the management of clubfoot in Tanzania. The findings of this study highlight the importance of joint efforts to maintain quality service skills.

An Insight on Current Clubfoot Management: A Reported Data From Lebanon.

Clubfoot, which has been reported in the literature since the time of Hippocrates in 400 BC, is regarded as one of the most difficult congenital orthopedic anomalies, with a high relapse incidence of 16.87 infants per 10,000 births. The Lebanese region holds limited data concerning the evolution of clubfoot management. Herein, we aim to present novel findings in the treatment of clubfoot without surgical intervention. This single-center, cross-sectional research included 300 patients with virgin idiopathic clubfoot treated at our facility from 2015 to 2020. The Pirani and DiMeglio Scores were used to determine the severity of the illness prior to treatment, and the DiMeglio Score was used to determine the severity of the disease after treatment. For data analysis, the Statistical Package for Social Sciences (SPSS, IBM-Version 26; IBM Corp., Armonk, NY) was used and results with p-value < 0.05were considered statistically significant. Our study included 300 patients, with 188 boys (62.7%) and 112 girls (37.3%). The mean age of the patients' onset was 32 days. We recorded an average initial Pirani score of 4.27 ± 0.65 and an average initial DiMeglio scoreof 11.58 ± 2.56 (62 out of 300) while the average final DiMeglio score was 2.17 ± 1.82. The mean number of casts was 5 ± 0.8, with a minimum of four and a maximum of six casts. The prevalence of relapse was 20.7%. Clubfoot remains a challenging deformity with a high rate of treatment failure and recurrence. While the superiority of Ponseti's technique in terms of success rate could not be disputed, tailored therapy based on the patient's socioeconomic status is considered critical for compliance and treatment success.

Management of complex idiopathic clubfoot using modified Ponseti method

Clubfeet with rigid equinus, severe plantarflexion of all the metatarsals, a transverse crease in the sole of the foot, short and hyperextended great toe, forefoot adduction and supination and a deep posterior crease are categorized under the heading of complex clubfeet, which do not respond to the conventional Ponseti technique. Rather treatment of such feet with conventional Ponseti method results in the development of secondary deformities and thus failure of treatment. Hence modification of the technique is warranted for optimal correction of these feet as described by Ponseti. The aim of our study was to evaluate effectiveness of Modified Ponseti technique in the management of complex clubfoot. Thirty two complex clubfeet in 19 patients were managed by Modified Ponseti technique through the study period. Four patients with 7 complex clubfeet were lost to follow-up. At the end of study 15 patients with 25 complex clubfeet were available for final follow up assessment and evaluation. Pirani and Dimeglio score was allotted to each foot at every visit. There after each foot was manipulated and casted as per the Modified Ponseti technique at an interval of one week. Average number of casts required for deformity correction was 7.68. Tendo-achilles tenotomy was obligatory in 23 (93.33 %) feet. The mean follow-up duration was 12.35 months (Range 8-21 months). The mean pre-treatment Pirani score (initial PS) was 5.60±0.54 and mean post-treatment Pirani score (PS at SFAB) was 0.70±0.38. The change in mean score post intervention was found to be statistically significant. The mean pre-treatment Dimeglio score (initial DS) was 15.80±2.02 and mean post-treatment Dimeglio score (DS at SFAB) was 3.68±1.35. The change in mean score post intervention was found to be statistically significant. Relapse rate was 4% (n=1), which responded to re-casting with modified Ponseti technique and re-tenotomy of the tendo-achilles. Based on our study results and existing literature we recommend modified Ponseti technique as the first line initial treatment for these complex feet. However such feet require higher number of plaster casts with higher rate of tendo-achilles tenotomy, with high relapse rate than their classical idiopathic counterparts, nonetheless the eventual outcome is reasonable correction of deformity, negating the necessity of multifaceted operating procedures.

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.

Current Clubfoot Practices: POSNA Membership Survey

Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years' experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell-Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications.

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.

Assessment of Treatment Outcomes in the Management of Club foot using the Ponseti Technique: A cross-sectional study.

The Ponseti technique remains the preferred method for club foot treatment. Although measures of treatment outcomes have been well documented, there is no consensus on the determinants of those outcomes. This study aims to assess treatment outcomes and the factors which can influence treatment outcomes. This is a cross-sectional study. A total of 472 children representing 748 feet in total were recruited. Patient characteristics such as age at presentation, gender, tenotomy, walking with or without deformity, parental educational status and occupation were documented. Outcomes of care were assessed using indictors such as parents' satisfaction with the outcome of treatment and the patients' ambulation without deformity. The relationships between the determinant factors and these outcomes were explored using multivariable binary logistic regression. Most of the children (69.1%) were aged below 2 years. Brace compliance was very high (89.9%). The pre-treatment average Pirani scores were 3.9 ± 1.8 and 4.3 ± 1.8 for the right and left feet, respectively. Majority (88.3%) of the children achieved ambulation without deformity, whereas most (87%) of the parents were satisfied with the treatment outcomes. In total, parental satisfaction with child's treatment outcomes was lower in parents who were not formally educated odds ratio (OR) = 0.19 (95% confidence interval [CI] 0.08-0.43), but parental satisfaction was lower if the child had higher Pirani score OR = 0.77 (95% CI 0.62-0.96). Children who had more casts applied to the affected foot were more likely to walk without deformity OR = 1.24 (95% CI 1.01-1.52). This study revealed that treatment outcomes in children with club foot can be determined by some sociodemographic and treatment-related factors.

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.

Management of idiopathic clubfoot by ponseti method: Prospective study

Objective: To analyse the Functional outcome of serial cast correction of congenital idiopathic club foot by using Ponseti method.Background: One of the most common deformity in children is club foot. It is complex deformity difficult to manage. Ponseti method used in our department of orthopaedics in Raja Muthiah Medical College, Chidambaram (Government Cuddalore Medical College, Chidambaram. We Aim to analyse management of idiopathic club foot by using ponseti method. Methods: 22 cases selected from CTEV clinic with clubfoot were studied in the Department of Orthopaedics, Rajah Muthiah Medical College and Hospital (Government Cuddalore Medical College) Chidambaram, from March 2021 to October 2022. Detailed history regarding age, sex, mode of delivery, address and others recorded. General examination carried to rule out any other congenital anomalies. Deformity scored according to pirani scoring system. Cast changed every week, case followed up for 1 year. Results: In 1 year follow up by ponseti method we achieved 90% excellent result 9.67% good result and

Prospects of Long Term Relapse after Management of Pediatric Clubfoot with the Ponseti Method: A Systematic Review

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Ponseti method of serial casting has been recognized as the gold standard for management of idiopathic clubfoot, a very common congenital foot deformity. While the short to midterm success of the method has been widely confirmed in the literature, there are very limited published studies of the longer term trend of relapse. Dr. Ponseti's own definitive assessment of the long term result has not been decisively reevaluated by the literature. This systematic review examines the long-term functional outcomes and evaluates the relapse rates of the Ponseti method. Methods: A comprehensive search was conducted of PubMed, CINAHL, Web of Science, and Cochrane from inception to December 2020 to identify literature on clubfoot. Using PRISMA guidelines, the search terms clubfoot OR clubfeet OR clubbed foot OR clubbed feet OR talipes equinovarus were used. Articles containing more than three human subjects, were included. The database was searched for longitudinal studies of pediatric, idiopathic clubfoot management with the Ponseti method. Retrospective studies of primary Ponseti management performed on neonates and children up to twenty four months old and with reported mean follow-up of two years or longer were included. Evaluation reported according to different scoring systems based on clinical examination of foot function, radiographic studies, or patient satisfaction questionnaires were dichotomized as success (good to satisfactory results) or failure (residual or relapse that requires corrective management or surgery). Probability of less than 0.05 is considered statistically significant. Results: The search yielded 20 articles following 2782 treated idiopathic clubfeet for 6.4 (2.6 - 19) years. The rate of successful initial correction was 97% (86.6% - 100%), satisfactory functional outcomes at last follow-up was 90% (63.4% - 100%), relapse was 21% (5.3% - 68%), and surgery needed to correct relapse was 9% (2.5% - 24%). Functional outcomes were inversely correlated with follow-up to 9 years (R= -0.5300, p= 0.0173), then became insignificantly associated when following up to 19 years (R= - 0.2480, p= 0.1458). Relapse rate was strongly correlated with follow-up to 9 years (R= 0.5540, p= 0.0129), then subsided thereafter to 19 years (R= 0.3792, p= 0.0495). The frequency of surgical release correlated with follow-up in a similar pattern, strongly up to 9 years (R= 0.6204, p= 0.0052), subsiding thereafter to 19 years (R= 0.3142, p= 0.0887). Conclusion: The short-term trends were consistent with literature findings that the rate of relapse increased during the first ten years, leading to lower patient satisfaction and higher rate of surgical correction. However, our new findings of weak long-term correlation and declining deformity relapse after nine years supported Dr. Ponseti's own assessment that late relapses were exceptions. The trend was consistent with uncommon returning relapses after a secondary corrective management or surgery. This trend also supports the postulation that the cause of relapse was non-compliance with foot abduction bracing, rather than clinicians' learning curves, age at presentation, or deformity severity.

The Impact of Treatment Method and Timing on the Long Term Outcomes of Pediatric Clubfoot Management

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Ponseti method of serial casting has been widely accepted as the new gold standard for management of idiopathic clubfoot, replacing joint invasive surgery, once the method-of-choice. While the short to midterm advantages of the method have been widely confirmed in the literature, there are limited comparative studies of the longer term outcomes. Dr. Ponseti's own definitive assessment of the long term result has not been decisively reevaluated by the literature. This systematic review compares the long-term functional outcomes of the two pediatric clubfoot management methods across different ages at treatment. Methods: A comprehensive search was conducted of PubMed, CINAHL, Web of Science, and Cochrane from inception to December 2020 to identify literature on clubfoot. Using PRISMA guidelines, the search terms clubfoot OR clubfeet OR clubbed foot OR clubbed feet OR talipes equinovarus were used. Articles containing more than three human subjects, were included. The database was searched for longitudinal studies of pediatric, idiopathic clubfoot management with the Ponseti method or joint invasive surgery. Retrospective studies of primary Ponseti treatment with serial casting or invasive soft tissue release and joint surgery that was performed on newly born and children up to twenty four months old and with reported mean follow-up of two years or longer were included. Evaluation reported according to different scoring systems were dichotomized as success (good to satisfactory results) or failure (residual or relapse that requires corrective management). Probability of less than 0.05 is considered statistically significant. Results: The initial search yielded 2907 articles, of which 29 articles reporting 2597 pediatric idiopathic clubfeet were included in this review, managed with either Ponseti casting, (group P = 1545 feet), or other surgical techniques, (group S = 1052 feet). The outcomes of 684 feet from group P with a mean long term follow up of 21+-13years were significantly superior to 1028 feet from group S with a mean follow up of 16+-5 years (p = 0.0002, odds ratio = 1.478). Multivariate analysis on 1310 feet from group P with mean age of 4.4 months (Range 1 - 8.9) against 794 feet from group S with mean age of 10.8 months (Range 1 - 22) detects no significant dependency on age (p = 0.128). Conclusion: The Ponseti method of serial casting resulted in significantly higher long term satisfaction outcomes compared with invasive surgical techniques in treatment of congenital clubfoot when performed within the first year of life. The findings supported Dr. Ponseti's own assessment regarding the high long term satisfaction rate (8+ years). Age was not found to be a significant contributor to the success of Ponseti casting over invasive surgery even though casting often started much earlier than surgery.

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

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