Management Of Congenital Clubfoot Research Articles

Results of Ponseti Method in the Management of the Congenital Clubfoot

Background: Clubfoot is a debilitating pathology and a source of abnormal gait in children. Treatment with the Ponseti method is the treatment used in the management of congenital clubfoot in children under 9 years old. This study aims to identify the proportion of children with clubfoot supported by the Ponseti method and to evaluate their effectiveness. Materials and Method: A multicenter retrospective descriptive study for six (06) months from June 1st to November 30th, 2019 concerning the evaluation of the Ponseti method in the management of clubfoot in Madagascar was conducted. Results: One hundred ninety-one (191) children with club feet were screened during the study period. One hundred and fifty children, or 226 congenital equine varus clubfoot were treated with the Ponseti method during the study period. The male gender was the most affected compared to the female gender with a sex ratio of 1.75. The clubfoot was bilateral in 50.66% of cases and idiopathic in 92.66%. The initial Pirani score was on average (±SD) 5.04/4.98 (±1.22/1.20). A proportion of 23.33% of cases of recurrence was recorded at 3 months of use of brace abduction splint. Conclusion: In Madagascar, the incidence of congenital clubfoot remains relatively low but clubfoot is still the main limitation of walking and a lack of footwear in children. Ponseti method is the gold standard in the management of this pathology. However, it requires a long-term follow-up.

A study on management of congenital clubfoot by Ponsetti technique in a rural medical college in India

<p class="abstract"><strong>Background:</strong> Congenital clubfoot also known as CTEV (congenital talipus equinovarus) is a common and debilitating congenital musculoskeletal anamoly affecting the children across the world with a slight preponderence in third world countries. The Ponseti technique of casting has now become the mainstay of treatment of this condition. This method is especially effective in rural and underdeveloped areas with limited health care facilities. The purpose of this study was to evaluate the effectiveness of the Ponsetti technique in the correction of this deformity, thorough the assessment of modified Pirani score.</p><p class="abstract"><strong>Methods:</strong> This was a prospective observational study conducted on 75 patients of either sex with 100 feet, with an average age of 3.6 months presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between September 2015 and September 2017, with a diagnosis of congenital clubfoot. All the patients were treated with Ponsetti technique and the results were analysed through the assessment of modified Pirani score. The patients were followed up for a peroid of 1 year after attainment of correction.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority of the patients obtained full correction with this method. The mean value of the modified Pirani score improved from the pre-treatment value of 5.30 to 0.36 at the final follow up. The average number of casts required for full correction was 7.32.</p><p><strong>Conclusions:</strong> Thus results of our study demonstrate that the Ponsetti method is a safe and effective method of treatment for congenital clubfoot, especially in rural and underdeveloped regions. </p>

CAUSES OF NON-OPTIMAL CONSERVATIVE TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

Introduction. Ponseti method commonly accepted as the optimal approach to management of congenital clubfoot. Continuing with alternative methods should considered as malpractice. Aim: to assess causes of non-optimal treatment of congenital clubfoot in children.Materials and methods: Assessment group included 60 patients treated earlier in other clinics with non-optimal results. Control group included 60 patients treated in our clinic by Ponseti method. We used case history analysis and parents’ interviewing.Results. Family history of clubfoot and prenatal diagnosis positively influenced on the choice of Ponseti method. Primary consultancy of orthopedist and Internet search were main factors for choosing Ponseti method after birth. In contrast, the methods lead to non-optimal results chosen after maternity home and pediatricians.Conclusion. Main cause of non-optimal results of congenital clubfoot treatment is the lack of information regarding current approaches among non-orthopedic physicians, which emphasizes necessity of adequate informational support.

Use of Keratome 1-0 for percutaneous Tendo Achilles tenotomy for correction of equinus deformity in club foot.

To the Editor, With an incidence of one per thousand births, club foot is the most common congenital musculoskeletal disorder. Although most cases are sporadic; families have been reported with club foot presenting as an autosomal dominant trait with incomplete penetrance. It is seen more commonly in males and is bilateral in about 50% of the cases.1 Although Ponseti's method of treatment has been there for around 50 years it has aroused interest in the recent past after the long term results of this method were published. In a 34 year follow-up of patients treated by Ponseti's method Cooper and Dietz reported 78% good to excellent results.2,3 Today Ponseti's method is universally accepted, and is first line treatment in the management of congenital club foot. As per Ponseti, all components must be corrected simultaneously but for equines which takes place in ankle joint and must be corrected last. Seventy to eighty percent feet require tenotomy of Achilles tendon for correction of equinus.4 Traditionally, a scalpel or a no 11 blade is used for doing the tenotomy. However we found Keratome 1-0 (Fig. 1) to be a good alternative for performing Tendo Achilles tenotomy. Its advantage over standard surgical blade include:- 1. Smaller skin incision (Fig. 2b). Fig. 2 a Patient with congenital club foot with residual equinus deformity. b After Tendo Achilles tenotomy using Keratome 1-0. The deformity is completely corrected and surgical scar is negligible. 2. Lesser bleeding. 3. Lesser chances of enlarging skin incision as we go deeper and therefore no requirement of suturing. 4. Lesser chances of damaging neurovascular bundle. 5. Lesser chances of scar formation. Fig. 1 Figure comparing the size of Keratome 1-0 with surgical blade no 11.

The effectiveness of Ponseti technique in the management of congenital club foot: A systematic review of the literature

The effectiveness of Ponseti technique in the management of congenital club foot: A systematic review of the literature

The effectiveness of Ponseti technique in the management of congenital club foot: A systematic review of the literature

Objectives The general objective of this study is to assess the effectiveness of Ponseti method in the management of congenital talipes equino varus (club foot) Research questions What is the evidence of effectiveness of the Ponseti method versus other conservative treatments in the management of congenital talipes equinovarus (club foot)? Types of participants This review will include any study using the Ponseti method to children 0-2 years old with idiopathic clubfoot born full term. Children with co-existing pathologies and those who underwent surgical procedures prior to commencing of Ponseti treatment will be excluded. Types of interventions The Ponseti method is a very well defined technique involving a number of manipulations and serial application of casts which gradually corrects plantar flexion of the ankle, inversion of the heel and the adduction of the hind and forefoot. This review will consider studies that include the Ponseti technique as an intervention. Outcome measures Correction of the position of the foot measured by: range of motion, time required for correction (weeks), number of relapses, number of children sent for extensive surgery.

Association française de chirurgie du pied: Le pied bot varus équin : traitement chez l’enfant et devenir à l’âge adulte

Purpose of the symposium Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to realign the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. Management of congenital clubfoot in children Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. Outcome in adulthood There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree undercorrection is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. Conclusion A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; undercorrection is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Results of soft tissue operations in the management of congenital club foot: J. Kránicz, O. Barta, and Á. Bellyei. Magy Traumatol Orthop 23:191–200, 1980

Results of soft tissue operations in the management of congenital club foot: J. Kránicz, O. Barta, and Á. Bellyei. Magy Traumatol Orthop 23:191–200, 1980

The evolution of biomechanical analysis in the management of congenital clubfoot.

The evolution of biomechanical analysis in the management of congenital clubfoot.