Management Of Idiopathic Clubfoot Research Articles

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.

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

Management of Idiopathic Clubfoot by Ponseti Method- Our Experience

Management of Idiopathic Clubfoot by Ponseti Method- Our Experience

Comparison of Blade and Needle Tenotomy for Treatment of Residual Equinus in Idiopathic Clubfoot.


 Background: Tenotomy for residual equinus is commonly required in the management idiopathic club. The need to reduce complication and cost has made the advancement from mini open to needle tenotomy. This is even more pertinent in low- and middle-income country where clubfoot is more common. The study compared the outcome of needle and blade tenotomy for management of idiopathic club foot.
 Patients and Methods: it is a prospective randomized study of patient requiring tenotomy for residual equinus from July 2015 to June 2020 at a tertiary Orthopediccenter.
 Results:A tenotomy rate of 60 percent was noted. It involves thirty-one patients with forty-three feet were include in the study. The mean follow up was 27,1 months. There was no significant difference in the outcome of equinus correction. Three patients had relapse of deformity, two in the blade group and one in the needle group. All were resolved by further manipulation.
 Conclusion: Needle tenotomy offers similar outcome to blade tenotomy. It is less expensive and more acceptable to those scared of the surgical blade.

Narrative review of the management of a relapsed clubfoot.

The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators). These are discussed from the least to the most invasive. Available evidence, and limitations of the literature, for the management of relapses following both the Ponseti method and initial surgical release is reviewed along with along with the reported outcomes. Future efforts should be geared towards standardizing the definition of a relapse with objective criteria for its management.

Development of a core outcome set for idiopathic clubfoot management.

AimsThis study aims to define a set of core outcomes (COS) to allow consistent reporting in order to compare results and assist in treatment decisions for idiopathic clubfoot.MethodsA list of outcomes will be obtained in a three-stage process from the literature and from key stakeholders (patients, parents, surgeons, and healthcare professionals). Important outcomes for patients and parents will be collected from a group of children with idiopathic clubfoot and their parents through questionnaires and interviews. The outcomes identified during this process will be combined with the list of outcomes previously obtained from a systematic review, with each outcome assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). This stage will be followed by a two round Delphi survey aimed at key stakeholders in the management of idiopathic clubfoot. The final outcomes list obtained will then be discussed in a consensus meeting of representative key stakeholders.ConclusionThe inconsistency in outcomes reporting in studies investigating idiopathic clubfoot has made it difficult to define the success rate of treatments and to compare findings between studies. The development of a COS seeks to define a minimum standard set of outcomes to collect in all future clinical trials for this condition, to facilitate comparisons between studies and to aid decisions in treatment.Cite this article: Bone Jt Open 2021;2(4):255–260.

Treatment evaluation of clubfoot condition by Ponseti method prevalence and clinical outcomes of spinal tuberculosis with multi drug resistance

Introduction: Dr. Ponseti developed a method of clubfoot correction that is effective, inexpensive. Many long-term follow-up studies reveal that foot treated by Ponseti technique are strong, flexible, and pain‑free. The correction achieved has been reported as being long lasting with some patients followed up to their fourth or fifth decade. Hence the present study was to assess the efficacy of Ponseti method in the management of Idiopathic Clubfoot. Materials & Methods: As per the criteria, a total of 72 clubfoot diagnosed with the condition of iditopathic clubfoot were included in the study. In all the included babies the Pirani scoring was done to assess the severity of the condition. The deformity of the cavus was corrected first by supinating the forefoot to bring in the alignment with the hindfoot. Results: When the treatment was completed the post treatment Pirani score was found to be decreased in all the age group patients. In the resent study around 52 feet did required to undergo tenotomy. Results clearly states that more severity in deformity or late presentation of condition for treatment, more will be the visit required with increase number of casting. Conclusion: The Ponseti method of clubfoot treatment is an excellent method as per our study. The follow-up of patients treated with this method has been over 40 years in some of the previous studies. Results of the clubfoot treatment by Ponseti technique in our study have been good and rewarding and now all the clubfeet are treated in our institution by this technique only.

Outcomes of Ponseti technique in management of idiopathic clubfoot in Infants - A short term study of Ninety feet in rural India

Outcomes of Ponseti technique in management of idiopathic clubfoot in Infants - A short term study of Ninety feet in rural India

Extended Ponseti method for failed tenotomy in idiopathic clubfeet: a pilot study.

We evaluated the outcome of a new protocol of an extended Ponseti method in the management of idiopathic club foot with residual equinus following failed Achilles tenotomy. We also compared the failed with a successful tenotomy group to analyze the parameters for failure. The Ponseti technique-treated idiopathic club foot patients with failed percutaneous Achilles tenotomy (failure to achieve <15° dorsiflexion) were treated by continued stretching casts, with a weekly change for a further 3 weeks. Final dorsiflexion more than 15° if achieved with the above protocol was recorded as a success. Twenty-six (16%) patients with failed Achilles tenotomy and residual equinus out of a total of 161 patients with primary idiopathic club foot were tested with the protocol. Ten (38.5%) failed patients had bilateral foot involvement and 16 (61.5%) had unilateral foot involvement. A total of seven (26.9%) patients achieved the end point dorsiflexion of more than 15° in one further cast, 10 (38.5%) in two casts, and four (15.4%) in three casts, respectively. Overall success of the extended Ponseti protocol was achieved in 21/26 (80.8%) patients. The patient's age, precasting initial Pirani score, number of Ponseti casts, pretenotomy Pirani score, and pretenotomy ankle joint dorsiflexion were statistically different in the failed compared with the successful tenotomy group. The tested extended Ponseti protocol showed a success rate of 80.8% in salvaging failed tenotomy cases. The failed tenotomy group was relatively older at presentation, had high precasting and pretenotomy Pirani scores, received extra number of Ponseti casts, and less pretenotomy ankle joint dorsiflexion compared with successful feet.

Surgical Management of Idiopathic Clubfoot in the United States from 1997-2012: An analysis of 11,940 discharges

INTRODUCTION: With the introduction of the Ponseti Method in the late 1990’s, rates of operative intervention of clubfoot within the first year of life have significantly declined. However, operative procedures for clubfoot continue to be routinely performed in the United States. Our purpose was to analyze trends in the operative management of clubfoot in the US, including total costs from 1997-2012. METHODS: The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) was used to identify discharges associated with idiopathic clubfoot (ICD-9-CM diagnosis codes 754.70 and 754.51) and one …

Management of idiopathic clubfoot by Ponseti’s technique

Background and objective: Idiopathic Congenital Talipes Equinovarus (CTEV) is a complex deformity that is difficult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in paediatric orthopaedics. Most orthopaedicians agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short term follow up of 30 patients treated by the Ponseti method at the department of Orthopaedics, Mahatma Gandhi Medical College & Research Institute, Pondicherry to assess the efficacy of Ponseti’s technique for the treatment of CTEV. Methods: 30 patients were selected from the Out-Patient section of the Department of Orthopaedics and Traumatology, M.G.M.C & R.I, Pondicherry for correction of idiopathic CTEV using the Ponseti technique from June 2011 to March 2013. Children included in the study were assessed for the severity of the deformity using the Pirani severity scoring system and clinical photographs were obtained. Casting of the foot was started by the technique described by Ponseti. Before cast placement every week, the foot deformity severity was assessed using the Pirani scoring system. These patients were followed up in a prospective manner for a period of minimum of six months. Results: At 6 months’ follow-up, Ponseti’s technique gave us 64.86% excellent results, 29.72% good results and a 5.4% poor results. 43.24 % required pecutaneous tenotomy, while 56.76% did not require tenotomy. There was an incidence of 8.1% for postero-medial soft tissue release. Interpretation and conclusion: The Ponseti method is a safe and cost effective treatment modality for congenital idiopathic clubfoot which gives excellent results, and radically decreases the need for extensive corrective surgery.

Predicting the Need for Tenotomy in the Management of Idiopathic Clubfoot by the Ponseti Method

Purpose: The aim of this study was to determine the role of Pirani scoring system for predicting the treatment of idiopathic clubfoot with the Ponseti technique. Materials and Methods: A retrospective study was conducted. The records of 132 idiopathic clubfeet of patients treated by the Ponseti method and scored by the Pirani system between May 2007 and September 2015 were analyzed. Result: Of the 132 feet, 101 (76.5%) feet of the patients required tenotomy. The mean number of casts required was significantly higher (P=0.033) for the group that required tenotomy (5.53 ± 1.6 casts) than the group that did not require tenotomy (4.87 ± 0.9 casts). Conclusion: The initial Pirani score is predictive of the number of casts that may be required and the need for a tenotomy of the Achilles tendon. Keywords: Casting, Clubfoot, Congenital talipes equinovarus, Pirani scoring, Ponseti, Tenotomy

Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting

Idiopathic clubfoot or congenital talipes equinovarus is the commonest congenital foot deformities having 1 in every 1000 children born worldwide. Around 80% of the cases occur in developing nations. It remains the most difficult to treat. The most widely used treatment is the Ponseti method of manipulation and serial plaster followed by an Achilles tenotomy. This method is effective in 90% of all cases. The objective of this study was to evaluate the outcomes of the Ponseti manipulation and casting method in the management of idiopathic clubfoot. This is a prospective study of 80 feet in 52 children treated by the Ponseti method in the department of Orthopedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, and Jharkhand. Evaluation of the deformity was done by Pirani score before and after the treatment and the results were assessed. The average number of castings used to correct the deformity was 6.5 times (range: 4 to 12). Tenotomy was performed in 66 (82.5%) of the feet. In all patients, plantigrade foot was achieved. The patients with bilateral clubfeet, higher Pirani score and higher age had inferior final outcome compared to those with unilateral clubfoot, lower Pirani score and lower age. 11 (13.75%) feet had skin excoriation secondary to cast problems and four patients had pain and tenderness at the site of the tenotomy. Recurrence was seen in three cases. 90.38% of parents were completely satisfied with their child’s gait and foot appearance.

Predictive value of Pirani scoring system for tenotomy in the management of idiopathic clubfoot.

To determine the predictive value of the Pirani scoring system in the need for tenotomy using the Ponseti method for management of idiopathic clubfoot. This is a prospective observational study involving patients less than 2 years of age with idiopathic clubfoot. The consenting parents and institution ethical board approved the study. The relationship between Pirani scores and the need for tenotomy was evaluated using the independent t-test and the binary logistic regression to predict the need for tenotomy. Pearson's r and Cohen's κ were used to measure correlation and agreement, respectively, between the predicted and observed values. A receiver operating characteristic curve was used to interpret sensitivity and specificity levels as well as to obtain a cutoff score for predicting the requirement for tenotomy. Eighty-four clubfeet from 50 patients were studied. Thirty-eight feet (45%) had percutaneous tenotomy. The initial total Pirani and hindfoot scores were found to predict the need for tenotomy with the model for prediction being able to predict correctly in 72.6% and 75% of the time, respectively. A higher Pirani score was associated with higher odds of requiring tenotomy (OR = 4.402, p < 0.001) and total Pirani score above the cutoff point of 4.75 predicted the need for tenotomy. The indication for tenotomy appears to be well predicted using the Pirani scoring system with the odds of requiring a tenotomy increasing by more than fourfold for every unit increase in Pirani score.

Management of idiopathic clubfoot by Ponseti’s method: a comparative clinical study on toddlers with radiological correlation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In developed countries, many children with clubfoot undergo extensive corrective surgery, often with disturbing failures and complications. The need for one or more revision surgeries is common. Although the foot looks better after surgery, it is stiff, weak, and often painful. Non-operative treatment of clubfoot provides a lower complication rate, less pain, and higher function as the patient ages. Lack of information regarding reasons for adherence to the regimen makes it difficult for health providers and health planners to determine the impact of treatments on health status or weigh the cost/benefit ratio for prescribing costly treatments to the patients. Therefore, it is important to understand how parents and health care givers manage their children’s treatment and the potential barriers these parents encounter during the utilization of clubfoot treatment services. It is important to determine the compliance of patients to clubfoot correction treatment in order to identify and target factors that may positively or negatively influence cases attending the clinic.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 25 cases with clubfoot were studied in the Department of Orthopaedics, Katihar Medical College. Out of these, 13 cases (Group A) were children over 1 year of age with neglected clubfoot and 12 cases (Group B) were children under one year of age with idiopathic clubfoot.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The Ponseti method delivers excellent correction of clubfoot without the associated risks and complications of major foot surgery. Patients treated with Ponseti’s method have leverage in treatment of clubfoot than those treated by other conservative methods. The method provides more flexible foot and ankle than those treated surgically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Treatment of clubfoot if commenced early will have better result. Children of age less than 1 year respond better than children of older age group. Younger children require fewer correction casts.&lt;/p&gt;

Management of idiopathic clubfoot in toddlers by Ponseti's method

The Ponseti method has been reported to have successful results in clubfoot patients less than 6 months of age but the literature on its efficacy in older clubfoot patients still remains sparse. In our study, we prospectively evaluated 55 clubfeet (37 patients) to determine clinically whether the Ponseti method is effective in the management of clubfoot in older children between the age of 12 and 36 months (mean: 24.8 months). All the patients belonged to moderate or severe grades of deformity as per the Pirani scoring. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 49 clubfeet. Seven patients (seven feet) developed recurrence of adduction, varus and equinus deformity whereas three patients (five feet) developed isolated recurrence of equinus deformity. These seven patients responded to repeat treatment and obtained satisfactory outcome. Four of these seven patients underwent tibialis anterior transfer to third cuneiform for dynamic supination. Three patients, those developed isolated recurrence of equinus deformity, underwent repeat tenotomy. One foot achieved satisfactory amount of dorsiflexion, three feet underwent tendoachilles lengthening whereas another foot underwent posterior release to obtain satisfactory dorsiflexion. Six to 12 numbers of casts (mean: 10) were required to obtain correction of clubfoot deformities. Mean period of immobilization in a cast was 13.9 weeks (10-15 weeks). We found that the Ponseti method is effective in children between the age of 12 and 36 months.

Management of idiopathic clubfoot by the Ponseti technique: our experience at a tertiary referral centre

BackgroundClubfoot or congenital talipes equinovarus is a common congenital abnormality of uncertain etiology. The purpose of this study was to assess the results of the Ponseti method in India and to investigate the demography of relapse and resistant cases. MethodsA total of 86 children (146 feet) below 1 year of age who had presented to the paediatric orthopedic outpatient department of our institution between June 2003 and January 2007 with unilateral or bilateral idiopathic clubfoot deformity were included in our study and treated conservatively by use of the Ponseti technique. Results128 feet responded to the Ponseti casting technique initially and 18 feet were resistant to the conservative treatment. Of the responsive feet, for 20 feet there was a relapse of the deformity. Evaluation of the results showed that poor compliance with splintage was the most common cause of relapse; delayed presentation and atypical clubfeet resulted in high resistance to this technique. Correction achieved at our centre was 82.18%. This is less than in many recent studies and could be attributed to increased incidence of delayed presentation, poorer compliance, and atypical feet in our population. ConclusionWe conclude that the Ponseti technique is recommended for management of clubfoot and strict compliance with splintage is essential to prevent relapses. People of lower socioeconomic status are at high risk of relapse and must be targeted to create awareness among them about the importance of compliance with splintage.

The Predictive Value of Pirani Scoring System in the Management of Idiopathic Club Foot by Ponseti Method

The purpose of this study is to determine the predictive value of Pirani scoring system in the management of idiopathic club foot by Ponseti method.A total number of 50 feet in 30 patients of clubfoot were studied and rated according to Pirani scoring system prospectively at Guru Govind Singh Hospital, M.P.Shah Medical College, Jamnagar during the period of April 2005 to April 2008 by Ponseti method performed by a single surgeon. Tenotomies were performed in 31 of 50 feet (62%). Out of 20 feet with a Pirani score greater that or equal to 5.0 at initial presentation, 90% required tenotomy. The mean number of the casts required was significantly greater (range 6-9 casts) for tenotomy group than that of the non-tenotomy group (range 4-6 casts). Following the removal of the final cast, no significant differences were found between the tenotomy and non tenotomy group with reference to Pirani score system.

Role of Joshi's external stabilisation system fixator in the management of idiopathic clubfoot.

To explore the role of Joshi's external stabilisation system fixator in correcting cases of clubfoot peculiar to India, we studied cases of neglected clubfoot, dropout cases of plaster-of-paris cast treatment, or failed surgical procedures that had been followed for a minimum period of 2 years. 26 children underwent 44 Joshi's external stabilisation system procedures at the Central Institute of Orthopaedics at the Safdarjung Hospital, New Delhi, between January 1998 and December 1999 for the conditions of interest. Three-dimensional correction was achieved by use of the distractor device. Excellent results were obtained in 77% of the cases, good results in 13%, and poor results in 9% of the cases. Complications in half of the cases were pintract infections, which eventually healed on an outpatient basis without any residual sequelae. The Joshi's external stabilisation system frame is ideally suited for the child in whom clubfoot deformities remain uncorrected by plaster-of-paris casts and manipulation, as well as for recurrent clubfoot. Casting after complete correction not only protects the osteopenic bones while the pin-tracts heal, but also maintains correction and allows gradual weightbearing.