Pirani Score Research Articles

Ponseti Method in the Management of Clubfoot under the 4 Years of Age

Background: The number of children born in the United States with a congenital clubfoot rises steadily each year. As per the Centers for Disease Control and Prevention, CTEV is spread once every 1,000 births. The vast majority of those infants are born in countries where they are mistreated or get insufficient care, resulting in a decrease in their overall life quality. CTEV has managed and been familiar to humanity since the dawn of time, and its surrounding disputes have existed similarly. Numerous studies have contributed to our understanding of patho-anatomy and therapy accountability for various illnesses. This study looked at how well a CTEV cast repair worked after a series of Ponseti cast repairs. Objective: Patients with a history of congenital talipesequinovarus who underwent serial cast repair using the Ponseti procedure were the focus of the study. Study Setting: Teaching Hospital Kech ;Turbat Pakistan Methods: The Ponseti method was used to treat 60 children between June 2017 and December 2019. A 1.5–2 year follow-up was undertaken in this study. Utilizing the goniometry and Pirani score, the researchers evaluated the deformity before and after therapy. Data was analysed with the SPSS programme. An average of five castings were necessary before the entire project could be completed. 85% of the feet were cast for a total of seven weeks of wear. Ninety-four patients (33%), requiring tenotomies, had a fully repaired achilles tendon. Pirani and goniometry scores differed significantly between the pre- and post-treatment periods. According to the optimistic prognosis, there were 66 cases of clubfoot, or 90.4%. For a moderate prognosis, the number was four, or 5.4%. In the event of a poor prognosis, the number of deformities was three, which corresponds to 4.1%. Conclusion: Regarding addressing clubfoot deformity, the Ponseti manipulation approach is effective, and plaster casting is also quite effective. It is fundamental in underdeveloped nations, and well-trained doctors and other healthcare professionals can successfully supervise cases through the use of casts and other control measures.

Management of Spina Bifida Related Non Idiopathic Club-Foot with Ponseti's Method

Objective: To determine the outcome of Ponseti’s method among children with spina bifida related non-idiopathic clubfoot at a leading pediatric tertiary care children hospital of South Punjab, Pakistan. Study Design: A retrospective cohort. Place and Duration of the Study:Department of Pediatric Orthopedic Surgery, The Children’s Hospital and Institute of Child Health, Multan Pakistan from 1st January 2016 to 31st March 2022. Material and Methods: A total of 24 children (41 feet)of both genders aged up to 3 months presenting with non-idiopathic clubfoot related to spina bifida who underwent Ponseti’s method for treatment of clubfoot, with a minimum post-treatment follow up of 3 years were included. Demographic data, severity of clubfoot disease along outcomes in terms of successful correction, unsuccessful correction, relapse were noted during the study period. Results: In a total of 24 children, 15 (62.5%) were boys. Overall, mean age was calculated to be 2.6±2.2 weeks while 14 (58.3%) children were aged between 0-2 weeks. Bilateral feet were involved in 17 (70.8%) children while unilateral feet involvement was noted in 7 (29.2%) cases so total number of feet were 41. Out of these 41 feet, 38 (92.7%) had severity of clubfoot as per Pirani Score as 6. Number of casts performed were 8 or below in 39 (95.1%). Mean duration of follow up was 3.8±0.6 years. Correction of clubfoot was achieved in 36/41 (87.8%) feet. During the follow-ups, recurrence occurred in 11 (26.8%) feet. Conclusion:Initial clubfeet correction in the spina bifida cases achieved good correction rates. Rate of recurrence was considerably high with a minimum follow up period of 3 years among spina bifida associated clubfeet. Keywords: Achilles tendon, clubfoot, Pensoti’s method, spina bifida.

Clinically Detected Leg Length Discrepancy in Patients With Idiopathic Clubfoot Deformity: Prevalence and Outcomes.

This study evaluates the prevalence and outcomes of patients with idiopathic clubfoot and clinically detected limb length discrepancy (LLD). This is a retrospective cohort study of idiopathic clubfoot patients in a Research Ethics Board-approved clubfoot registry. Patients with LLD ≥0.5 cm (LLD+) were compared with those with no or <0.5 cm LLD (LLD-). LLD was determined by documented clinical examination. Exclusion criteria included nonidiopathic clubfoot deformity, <2-year follow-up, and incomplete records. Of the 300 patients included, 27 (9.0%) had an LLD, of whom 23 patients had a unilateral clubfoot deformity. The prevalence of LLD was 15.3% and 2.67% in unilateral and bilateral clubfoot patients, respectively. The mean LLD was 1.21 cm (0.5 to 3.5 cm, SD: 0.78 cm) in LLD+ patients, with a mean of 1.27 cm (SD: 0.79 cm) in unilateral clubfoot patients and 0.88 cm (SD: 0.75 cm) in bilateral patients. The total number of casts applied in LLD+ unilateral clubfoot patients was significantly higher than in LLD- unilateral patients (9.5 vs. 6.8 casts; P =0.015). The overall relapse rate in all patients was 30.3% and was significantly higher in the unilateral only LLD+ group [relative risk (RR)=2.89] and the total LLD+ patient cohort (RR=1.68). The risk of repeat casting for relapse was also higher in the unilateral LLD+ group (RR=2.45) and the total LLD+ group (RR=1.87). The risk of surgery for relapse was significantly higher in the unilateral LLD+ group for any surgery ( P =0.046), and most specifically for open tendo-Achilles tenotomy ( P =0.008) and tibialis anterior tendon transfer ( P =0.019). There was no correlation between the severity of LLD and Pirani score at presentation. LLD was present in 9% of idiopathic clubfoot patients, and most were <2 cm. There is a significantly higher risk of relapse in patients with unilateral clubfoot and LLD. The risk of surgery overall was higher in all patients with a unilateral LLD. Assessment of LLD should be routinely performed in clubfoot patients. Level III.

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.

Clubfoot: Review on Assessment, Treatment, Challenges, and Engineering Aspects

ABSTRACT Introduction Clubfoot, mainly CTEV, is a complex three-dimensional deformity challenging physicians from ancient times. Among a thousand babies born, one to six suffer from clubfoot deformity; that is, in India alone, around 35,000 need treatment for clubfoot annually. This review summarizes the various practices of clubfoot assessment, noninvasive treatment, and engineering aspects of clubfoot treatment. The shortcomings of assessment methods and challenges with implementation of treatment methods are also presented. Methods A narrative review of all related research papers available to authors was carried out. Results Various clubfoot assessment methods have been developed to help physicians understand the severity of the problem and predict treatment parameters. The Pirani score and Dimeglio score are used predominantly for the assessment of deformity. However, these methods suffer from implementation-related limitations. Noninvasive methods, namely, Kite's method, functional physiotherapy method, and Ponseti method, are used in practice for treatment. The Ponseti method is the most popular with parents and physicians and is considered the gold standard for the treatment of clubfoot. However, it also suffers from various implementation issues, like treatment cost and lack of experts, particularly in low- and middle-income countries (LMICs). Engineers are using various technologies like computer-aided design (CAD)/computer-aided engineering (CAE) and additive manufacturing for modeling and analysis of clubfoot. Engineers have also attempted to develop corrective and maintenance orthosis for CTEV treatment. Conclusions Because newer and newer technologies are becoming accessible for interdisciplinary use, there is a need to apply contemporary technologies, especially to develop a corrective orthosis so that the current challenges of clubfoot assessment and treatment are addressed. The corrective orthosis should be based on Dr Ponseti's insights into clubfoot biomechanics. Clinical Relevance There is a need to explore contemporary technologies like data acquisition and CAD/CAE to address CTEV assessment–related issues. A corrective orthosis based on the understanding of the foot biomechanics for treatment can solve the various implementation-related challenges of the Ponseti method, particularly in low-resource settings.

LOW TEMPERATURE THERMOPLASTIC SPLINTING IN THE MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS

Congenital talipes equinovarus (CTEV) is one of the most common congenital deformities. Treatment of clubfoot should begin at the earliest to have the best outcome. The goal of treatment is to eliminate all deformities of CTEV so that patient has a functional, pain free, plantigrade foot with good mobility within minimum time duration. Treatment includes non-surgical and surgical methods. Conventionally Plaster of Paris (POP) is used for splinting though leather, polypropylene and rubber are also used. Objective of this study is to evaluate the effectiveness of low temperature thermoplastic (LTTP) splinting in CTEV management. This is an on observational study over a period of one year in Thirty-two CTEV patients with Pirani score of less than three. Effectiveness of LTTP splinting was evaluated in detail. It was found that LTTP splinting was cost effective, cosmetically better, reusable, demoldable, and easier to apply. It was of light weight, and required lesser time. It avoids the need for repetitive casting and same splint can be used as maintenance splint also. Pirani score lowered from 3 to 0 after 6 months of splinting. Conclusion –The compliance in donning the splint was high and acceptable among the children studied. Parental satisfaction regarding the splint wearing time and correction of deformity factor was high. Skin complications associated with POP casting were absent in the study population. Hence correction of CTEV with LTTP splinting was more effective than conventional POP casting.

Eight-year Review of a Clubfoot Treatment Program in Pakistan With Assessment of Outcomes Using the Ponseti Technique: A Retrospective Study of 988 Patients (1,458 Clubfeet) Aged 0 to 5 Years at Enrollment.

Objective:To conduct an 8-year retrospective review of a clubfoot treatment program using the Ponseti technique with close monitoring of outcomes.Methods:Between October 2011 and August 2019, 988 children with 1,458 idiopathic clubfeet were enrolled, ages ranging from new born up to 5 years. Ponseti treatment was used, and progress was monitored by comparing mean Pirani scores at enrollment (P1), initiation of bracing (P2), and end of treatment (P3) or most recent visit (P4) for children under treatment.Results:A statistically significant reduction in Pirani scores was noted (P < 0.001) for all feet. For 320 feet completing treatment (213 children), the mean Pirani scores reduced from P1: 3.8 (±1.1) to P2: 1.1 (±0.6) and finally to P3: 0.6 (±0.3). Four hundred sixteen children are currently undergoing bracing. Higher education of the head of household and male sex of the child were markedly associated with improved outcomes in foot correction status. Correction was obtained with a mean of 5.8 casts per foot, the tenotomy rate was 68.2%, and the mean duration of bracing in children completing treatment was 3.6 years (±0.9). No surgical correction, other than tenotomy, was required. Relapse was noted in 12.1% of the total enrolled feet, and 32.0% children were lost to follow-up from the entire cohort of 988 children.Conclusion:Clubfoot treatment requires long-term follow-up. A dedicated clubfoot program is effective in maintaining continuity of care by encouraging adherence to treatment.

Initiating Ponseti management in preterm infants with clubfoot at term age.

Purpose:Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1 year post-correction following Ponseti management in infants who were born preterm but treated at term age.Methods:A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37 weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs).Results:Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8–5.6) in the idiopathic group and 5.7 (95%CI: 5.0–6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1–6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0–7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery.Conclusion:Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to term-born infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method.Level of evidence:Level IV.

Ponseti method under general anesthesia is an effective method of treatment for neglected congenital talipes equino varus: a cohort study.

Background:Neglected congenital talipes equino varus (CTEV) deformity is common in poorer developing countries. If ignored, children with CTEV result in callosity, potential bone and skin infection, and a significant mobility limitation resulting from stiffness. There are many management options that can be used to manage neglected CTEV. Until now, the Ponseti casting technique is a gold standard for treating CTEV without surgery. Ponseti methods effectively correct CTEV deformity in all ages. However, patients treated with the Ponseti process will suffer pain during correction in daily practice. Therefore, it is necessary to give anesthesia to reduce pain and relax soft tissues to achieve a satisfactory outcome when correction is carried out. Methods:This study design is a retrospective. Our study consisted of 32 patients, divided into two groups. Group A is the group that was treated with the Ponseti using general anesthesia (GA), and group B is the group without using GA. The children were anesthetized using isoflurane inhalation with 1-2 mcg/kg. After that, we performed serial casting every week and evaluated the outcome and number change cast between using GA and without GA. Lastly, we used a paired t-test statistical analysis to determine the relationship between before and after therapy. Results:In group A, the mean Pirani score significantly reduced from 5.81 ± 0.403 to 0.625 ± 0.40. In contrast with roup B, where the mean Pirani score slightly decreased from 5.81 ± 0.403 to 4.437 ± 1.093. After the last serial cast, in group A, only four cast replacements were needed to achieve a good outcome, whereas, in group B, the results remained unsatisfactory after 10 cast changes. Conclusions: Ponseti method under GA is an effective treatment and reduced the number of cast changes for neglected CTEV.

Factors predictive of Ponseti casting for treating clubfoot: analysis of Bayesian Poisson regression model.

Clubfoot is a growing public health concern in Bangladesh, with the incidence of approximately 0.64 to 6.8 in every 1000 live births. For over a decade, Ponseti method has been considered a gold standard for treating the clubfoot. Despite few studies have been estimating the number of casts required to correct the clubfoot deformities by Ponseti method, the subject of interest has always remained. Therefore, this current study aimed to investigate the significant predictive factors for the number of casts required to correct congenital clubfoot. In this retrospective cohort study, we used Bayesian Poisson Regression Model to investigate the influencing factors that could predict how many casts are needed to correct the clubfoot. We included 69 patients with 99 affected feet, who completed their corrective phase of treatment in the Ponseti method. For this cohort study, we integrated only pre-tenotomy casting data with no age restrictions. We used Bayesian Poisson regression analysis technique to estimate the predictive factors. In Bayesian Poisson model, age was the most influencing predictive factor (24.3%) for increasing the number of castings to correct the clubfoot deformity. The clubfoot offspring of the ≤1-year-old was positive, and the incidence rate increased significantly with the casting number. The number of Ponseti casts in male clubfoot children was 28% higher than in female, and this was marginally statistically significant. There was no marked change estimated in the pattern of clubfoot, foot involvement and Pirani score of the severity. We concluded that the age factor may influence the number of casts required for the correction of clubfoot and specifically ≤ 1-year-old children are highly impacted. Treating clubfoot at an early age is suggested in this study to increase the success of clubfoot treatment and decrease the risk of relapse.

Semirigid Fiberglass Casting for the Early Management of Clubfoot: A Single-Center Experience.

BackgroundSemirigid fiberglass (SRF) is an alternative material to plaster of Paris (POP) for idiopathic clubfoot casting in the Ponseti method. The purpose of this study was to evaluate early clinical outcomes in a series of idiopathic clubfoot patients treated with SRF at a single institution and to compare these findings to historical norms with POP casting present in the literature.MethodsA series of idiopathic clubfoot patients managed exclusively with SRF in the Ponseti method was identified. Treatment efficacy was evaluated by number of casts, change in Pirani score, frequency of treatment-related complications, and frequency of surgery other than tenotomy. A comprehensive literature review was used for comparative historical norms.ResultsThe study included 34 feet in 26 patients. Pirani score was 4.7±1.3 at presentation and 1.9±1.4 at the end of casting, representing a score change of 2.8±1.3 with SRF. Initial correction was obtained with 6.9±1.4 casts. Treatment-related complications occurred in six treated feet (17.6%) including 13 cast slippages in five feet and one cast-related thigh abrasion. A total of 25 (73.5%) feet underwent tenotomy. Two feet required an additional surgical procedure.ConclusionClubfoot patients treated with SRF demonstrated acceptable deformity correction following Ponseti-style casting. The quantitative clinical outcomes evaluated appeared similar to norms using POP present in the literature. The findings of this study support SRF as a viable alternative to plaster casting for clubfoot correction utilizing the Ponseti method. As such, further investigation for rigorous comparative assessment is warranted.

Effectiveness of Ponseti Technique in Treatment of Idiopathic Clubfoot in age of 2 to 5 Years

Objective To evaluate effectiveness of Ponseti technique in treatment of clubfoot in children from 2 years to 5 years of age Material and methods: Our study is Descriptive case series done at Department of Orthopedic Surgery, SMBBMU, Larkana, from April 15, 2019 to October 14, 2019. Patients fulfilling inclusion criteria attending Ponseti clinic of SMBBMU, Larkana were incorporated in our study. After getting consent, procedure was explained in detail with merits and demerits. Treatment was labeled effective if Pirani score after treatment ≤1/6. Bracing phase with Dennis Brown shoes was started for maintenance of the corrected foot after post tenotomy cast removal. Data was collected and entered into the performa attached. Results: Mean and standard deviation for age was 4.08±2.17 years. Among 71 patients, 48 (67.6%) patients were male and 23 (32.4%) were female. Positive family history was found to be in 8 (11.26%) patients. Modes of delivery shows that 46 (64.8%) patients had gone through C-Section while 25 (35.2%) had normal vaginal delivery. Efficacy of Ponseti technique was noted in 52 (73.2%) patients. Conclusion: From the studies it was shown that Ponseti technique for club foot in both presenting earlier or late is safe and effective. Keywords: Clubfeet, Congenital Talipes Equinovarus, Ponseti Technique, Pirani Score

Outcome of Atypical & Complex Clubfoot Managed by Modified Ponseti Method—A Prospective Study

Atypical or complex clubfoot constitutes a small number of cases. Due to the difference in complexity of anatomy, standard deformity correction by Ponseti is not effective. Hence a modified Ponseti method was advised which focuses on deformity differences for treatment. We conducted a prospective study to analyze the outcome in atypical or complex clubfoot treated with the modified Ponseti method. All the children of age less than 1 year were included in the study with atypical or complex clubfoot. Every case was treated according to the modified Ponseti method and tenotomy. Pirani scores were measured at pretreatment, each visit, before application of a brace, and at the latest follow-up. Statistical analysis of all continuous and categorical variables was done. A total of 30 patients (47 feet) were included in the study. Mean Pirani score improved from 5.69 at presentation to 0.45 at time of brace application and latest follow-up 0.34 (p < .001). Six patients (9 feet) had a relapse which was managed with recasting. The mean Pirani score of relapse was 0.72, which after correction reduced to 0.11 (p = .008). Six patients had cast-related complications which were managed with conservative treatment. With an increase in popularity of the Ponseti method, a greater number of complex clubfoot cases are seen due to inadequate reduction or slippage of cast or improper cast application techniques. All these need to be identified at an early age. This helps in proper treatment and improves the quality of life as well as foot appearance.

Factors associated with the relapse in Ponseti treated congenital clubfoot

ObjectivesWe retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method.MethodsWe retrospectively reviewed all children with congenital clubfoot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee.ResultsIn this study, there were 148 cases (164 ft) in total that underwent the Ponseti method, with the follow–up period at least 5 years. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50 ± 2.15 months. The average initial Pirani score was 4.98 ± 1.33, and the average number of casts was 5.71 ± 2.28 times. The mean age of mothers at birth was 25.81 ± 2.38 years old. The walking age of children was at a mean of 14.83 ± 1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 ft (76.4%). The average follow–up period was 7.27 ± 1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group .ConclusionThe initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

Two-year retrospective cohort results on use of a dynamic unilateral brace for treatment of clubfoot: Can compliance and prevention of recurrence both be achieved?

ObjectivesThe Ponseti method has led to vast improvements in outcomes for infants born with clubfoot deformity, but challenges with compliance during the bracing phase of the protocol remain. Unilateral braces promise higher compliance but often have led to unacceptably high recurrence.MethodsWe have developed a novel unilateral brace for clubfoot deformity that strategically applies patient-specific, anatomically-targeted forces to the lower limb to maintain correction. We retrospectively reviewed the cases of 26 patients with minimum follow-up of 24 months. The data were analyzed for recurrence rates, caregiver-reported compliance, and differences in Pirani score, dorsiflexion, abduction, hindfoot eversion, and resting rotation between initial and final follow-up.ResultsMost patients (N = 23, 88%) were compliant with the bracing protocol. Two patients showed recurrence of deformity (8%). There were statistically significant improvements in Pirani score, dorsiflexion, abduction, hindfoot eversion, and resting external rotation. A subset of patients with sub-optimal correction at baseline showed improvement in all parameters across the course of bracing.ConclusionsThis novel unilateral brace for maintenance of clubfoot correction after Ponseti treatment demonstrates rates of recurrence rates and caregiver-reported compliance at 2 years of follow up that are comparable to outcomes with traditional bilateral foot abduction orthoses.

Evaluation of Results of Ponseti Technique in Idiopathic Clubfoot using Clinical Evaluation and Radiological Assessment.

Background:Congenital clubfoot (congenital talipes equinovarus) occurs in approximately one in 1000 live births and is one of the most common congenital birth defects. The Ponseti method is at present a well-established method of treatment for idiopathic clubfoot deformities.Aim:The aim of the present study was to evaluate the results of serial casting in clubfoot deformity with Ponseti method on the basis of Pirani's scoring and radiological findings before and after completion of treatment.Materials and Methods:A total of 30 patients were enrolled in the study and were treated with Ponseti's casting after grading the severity of deformity clinically by Pirani's scoring and radiological assessment by calculating the talo-first metatarsal angle in anteroposterior (AP) view and talocalcaneal angle in AP and lateral views. The same clinical and radiological assessment was done at the end of treatment before putting a patient on foot abduction orthosis (FAO).Results:The average number of casts applied before full correction was 5.56 (range: 5–8). The average duration of treatment was about 6.65 weeks before the patient was put on FAO. Pirani score significantly improved from an average of 5.50 (range: 4–6) on presentation to 0.24 (range: 0–2) after correction of deformity.Conclusion:The Ponseti method is an excellent method for the correction of all four deformities associated with congenital idiopathic clubfoot, and we found that the addition of radiographic to clinical evaluation helps in the better assessment of correction. It provides statistically significant results both clinically as measured by Pirani severity score and radiologically assessed by talocalcaneal and talo-first metatarsal angle.

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.

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.

Comparison of Results of Standard Versus Accelerated Ponseti Method for Congenital Club Foot Deformity

Objective: To compare the outcome of standard versus accelerated Ponseti method for congenital club foot deformity. Study Design: Randomized Controlled Trial Place and Duration: Department of Orthopedics Surgery, Fouji foundation hospital, Rawalpindi, duration was six months from February 2021 to July 2021. Methodology: Total 80 patients of either gender presented with congenital club foot deformity were enrolled. Patients’ ages were ranging between 1-6 months. Patients will be randomly divided into two groups by using lottery method. Group-A (n=40) patients were received accelerated Ponseti techniques and Group-B (n=40) patients had received standard Ponseti techniques. The cast were changed twice weekly in the accelerated group and once weekly in the standard group. Patients will be followed-up in OPD after 1, 4, 8 and12 weeks.After 12 weeks, patients will be evaluated for Pirani and Dimeglio scores by using modified functional rating system score. Results: There were 25 (62.5%) male and 15 (37.5%) patients were females in Group A with mean age 2.36±1.48 months. In Group B, 23 (57.5%) patients were males while 17 (42.5%) were females with mean age 2.48±1.74 months. In group A, mean Pirani score at presentation was 6.48±2.76 and in group B it was 6.58±2.66. Mean number of cast required in group A was 6.68±1.74 and in group B it was 6.14±1.56. At end of treatment men Pirani score in group A and B was 0.48±0.36 and 0.54±0.32, no significant difference was found between both groups with p-value &gt;0.05. At presentation, mean Dimeglio score in group A and B was 11.04±2.48 and 11.56±2.74, at follow-up it reduces to 0.86±0.48 and 0.88±10.56. At final follow-up, 22 (55%) patients had excellent and 18 (45%) had good functional outcomes in group A and in group B 20 (50%) had excellent, 18 (45%) had good and 2 (5%) had fair functional outcomes. Conclusion: It is concluded that both accelerated and standard techniques had comparable efficacy and safety for club foot deformity. Keywords: Club Foot Deformity, Standard Ponseti, Accelerated Ponseti Method, Pirani Score

Three Dimensional (3D) Assesment of Clubfoot

Background: The congenital talipes equinovarus (CTEV) or clubfoot is one of the most common and complex congenital deformities and is a completely reversible condition with timely and appropriate treatment. The aim of this study is to perform three dimensional assessments for clubfoot to evaluate the initial severity of the clubfoot and to monitor the structural changes in clubfoot after each casting intervention.&#x0D; Methods: A Comparative Experimental Prospective Study conducted from October 2019 to October 2021 for a period of 2 year in the Department of Orthopaedics, JNMC &amp; AVBRH. The 3D scanning using Kinect 3D scanner is performed weekly before each casting. Pirani Score and 3D assessment at different time periods are considered as primary outcome variables.&#x0D; Results: In this study we will get to know the severity of club foot after each casting interval and the structural changes can the evaluated in foot of patient to quantify the extent of disease and the improvement after treatment protocol&#x0D; Conclusion: Our study primarily tries to evaluate clubfoot by using 3D scanner and get the quantification of the disease