Pirani Score Research Articles

Impact of guidance and telemonitoring on foot flexibility due to postural congenital clubfoot in the first month of life: a longitudinal descriptive study

INTRODUCTION: Early intervention is essential for proper foot growth in postural congenital clubfoot (PCC), but little is known about its contribution to this deformity when subjects are evaluated through telemonitoring. OBJECTIVE: This study aimed to monitor the foot’s flexibility of newborns diagnosed with PCC by telemonitoring them during the first months of life. METHODS: A longitudinal descriptive study was carried out with a full-term newborns group diagnosed with PCC in at least one limb, presenting a grade ≥ 0,5 on the Pirani score. Newborns with other malformations were excluded. They were assessed twice: before and 30 days after hospital discharge, and the foot flexibility classification by the Pirani score was provided. The telemonitoring occurred weekly between the assessments, and the parents were encouraged to mobilize their feet and maintain foot position using orthosis or taping. RESULTS: Thirteen newborns (eighteen feet) presenting PCC were included in this study; seven neonates discontinued the study due to absences from pre-scheduled evaluations, and six were telemonitored for 30 days. They were born at 39 weeks (± 1.18) and 3346.54 g (± 306.51). The majority of the newborns were female (69%), one was born vaginally, and eight (61%) had a family history of PCC. Pirani's score ranged from 1 to 3 in the initial assessment. After one month of telemonitoring, three feet progressed to 0, and four feet scored between 0.5 and 1. CONCLUSION: This study shows an important improvement in the foot’s flexibility of newborns diagnosed with PCC evaluated through telemonitoring. Telemonitoring may be an additional resource for assisting newborns with PCC.

Non-zero Pirani score in corrected clubfoot due to empty heel: A prognostic dilemma

PurposeThe aim of this study was to track the correction of individual components of Pirani scoring system (PSS) over the manipulation and tenotomy phase of Ponseti casting method in idiopathic clubfoot. Additionally, non-zero PSS scores were analysed to find out the residual deformities. MethodsThe included feet were assessed initially according to the six component PSS. The individual scores of each component of midfoot and hindfoot were scored at each visit till the final follow up. The final scoring was done before the start of the bracing phase of the feet (with or without tenotomy). ResultsEvaluation was performed for 42 feet in 28 infants (14 bilateral) with mean age of 42.5 ± 39.2 days (range, 15–150 days). All the six components of PSS showed a significant change from the first cast till the pre tenotomy cast. Post tenotomy, there was a significant change in the scores of posterior crease (0.4 ± 0.2 to 0.1 ± 0.1, p < 0.001) and rigid equinus (0.8 ± 0.3 to 0.1 ± 0.2, p < 0.001). 66.7 % (28/42) of the feet had an abnormal empty heel sign of either 0.5 [22/42 (52.3 %)] or 1 [6/42 (14.4 %)] at initiation of bracing. ConclusionsThe individual components of Pirani scoring system changed to a variable extent as the treatment progressed. Curvature lateral border and talar head reached normalcy prior to tenotomy. Posterior crease and rigid equinus showed a significant reduction after tenotomy. The non-zero empty heel component may require careful interpretation both post treatment and during follow ups.

Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials.

Clubfoot, or congenital talipes equinovarus deformity, is a common anomaly affecting the foot in infants. However, clinical equipoise remains between different interventions, especially those based on the Ponseti method. The aim of this study was to examine the clinical outcomes of the various interventions for treating idiopathic clubfoot. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Scopus, and CINAHL were conducted. Randomized controlled trials comparing different interventions, including the Ponseti method, accelerated Ponseti method, Ponseti method with botulinum toxin type A (Botox) injection, Ponseti method with early tibialis anterior tendon transfer (TATT), Kite method, and surgical treatment, were included. Network meta-analyses (NMAs) were conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guidelines. The primary outcomes were the change in total Pirani score and maximal ankle dorsiflexion. Secondary outcomes were the number of casts, time in casts, and rates of tenotomy, total complications, relapse, adverse events, and additional required major surgery. Eleven randomized controlled trials involving 740 feet were included. According to the SUCRA (surface under the cumulative ranking curve)-based relative ranking, the Ponseti method was associated with the best outcomes in terms of Pirani score changes, maximal ankle dorsiflexion, number of casts, adverse events, and total complications, whereas the accelerated Ponseti method was associated with the best outcomes in terms of time in casts and tenotomy rate. Early TATT ranked best in terms of relapse rate. The Ponseti method with Botox injection was associated with the best outcomes in terms of the need for additional major surgery. The NMAs suggest that the Ponseti method is the optimal treatment overall, despite potential drawbacks such as longer time in casts and higher rates of tenotomy, relapse, and the need for additional surgery compared with other modified approaches. Therefore, clinicians should consider how treatments can be tailored individually. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

CAN THE PIRANI SCORE PREDICT THE NECESSITY OF ACHILLES TENOTOMY FOR IDIOPATHIC CLUBFOOT PATIENTS TREATED WITH THE PONSETI METHOD?

Background: Idiopathic clubfoot is one of the most common congenital problems affecting newborns. Several methods are used for grading its severity, of which Pirani score is the most reliable one. The Ponseti method of clubfoot management is effective, producing better results and fewer complications than traditional surgical methods. Methods: The study includes 27 clubfeet who were diagnosed with clubfoot and who were scored using Pirani score and were treated with the Ponseti method with possible Achilles tenotomy. Result: The study showed that the mean Pirani scores before treatment were significantly higher in the tenotomy than in the non-tenotomy group (3.54 vs. 2.23 for the total Pirani score, 2.25 vs. 1.69 for the midfoot Pirani score and 1.29 vs. 0.59 for the hindfoot Pirani score). The study proposes a “before treatment” cutoff point of 2.75 for the total Pirani score, 1.75 for the midfoot Pirani score and 1.25 for the hindfoot Pirani score, where a score above these cutoff points can predict the need for tenotomy. Conclusion: This study showed that the Pre-treatment Pirani score can help surgeons decide whether to do tenotomy or not in patients treated with the Ponseti method.

A single-center, single-blinded, randomized, parallel-group, non-inferiority trial to compare the efficacy of a 22-gauge needle versus a 15 blade to perform an Achilles tendon tenotomy in 244 clubfeet—study protocol

BackgroundAchilles tendon tenotomy is an integral part of the Ponseti method, aimed at correcting residual equinus and lack of dorsiflexion after correction of the adductus deformity in clubfoot. Percutaneous tenotomy using a number 15 scalpel blade is considered the gold standard, resulting in excellent results with minimal complications. The use of a large-bore needle to perform Achilles tendon tenotomies has been described in literature, but a large-scale randomized controlled trial is currently lacking. In this trial, we aim to show the non-inferiority of the needle tenotomy technique compared to the gold standard blade tenotomy technique.MethodsWe will randomize 244 feet into group A: needle tenotomy or group B: blade tenotomy. Randomization will be done using a block randomization with random block sizes and applying a 1:1 allocation to achieve an intervention and control group of the exact same size. Children will be evaluated at 3 weeks and 3 months post-tenotomy for primary and secondary clinical outcomes. The primary clinical outcome will be the range of dorsiflexion obtained the secondary clinical outcomes will be frequency of minor and major complications and Pirani score. The non-inferiority margin was set at 4°, and thus, the null hypothesis of inferiority of the needle technique will be rejected if the mean difference between both techniques is less than 4°. The statistical analysis will use a multi-level mixed effects linear regression model for the primary outcomes and a multi-level mixed effects logistic regression model for the secondary clinical outcomes. The physician performing the evaluations post-tenotomy will be the only one blinded to group allocation.Trial registrationThis trial was registered prospectively with ClinicalTrials.gov registration number: NCT04897100 on 21 May 2021.

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

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

Effects on the Lower Limb Anthropometry in Patients with Unilateral Idiopathic Clubfoot Treated Conservatively with Ponseti Technique

Category: Other; Basic Sciences/Biologics Introduction/Purpose: Congenital Talipes Equino-Varus is amongst the most common congenital orthopaedic anomalies. Limb length discrepancy is considered as the commonest complication in patients with unilateral clubfoot despite the best non- operative correction. In the present series of cases we aim to study all the possible effects on the lower limb anthropometry in patients with unilateral idiopathic clubfoot who have been managed conservatively. Methods: This retrospective study included 47 patients with idiopathic, unilateral CTEV who were successfully treated with Ponseti’s technique. Patients with neuromuscular causes, those requiring extensive soft tissue releases or osteotomies and cases with relapsed or recurrent CTEV were excluded. Casting was initiated following maternal manipulation for one to two weeks. Pirani scores were recorded initially and weekly till correction. After deformity correction, anthropometric measurements (femur and tibia length, calf girth and foot length and foot height) were recorded and compared to the opposite normal limb. Results: Only four patients showed a difference in their femur length while difference in tibia length was noted in 10 patients which were statistically not significant. A significant difference was found in the calf girth, foot height and foot length affecting 28, 43 and 42 patients respectively. Conclusion: Patients with unilateral clubfoot treated with Ponseti’s correction tend to have anthropometric difference between the affected and the unaffected extremity. While there is a relative sparing of femur and tibia length, calf girth, foot height and foot length are consistently less compared to the unaffected side.

Treatment of Complicated Clubfoot Using External Fixation: A Scoping Review

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The treatment of relapsed, resistant, or neglected clubfoot presents a challenge — some patients may not respond to the traditional Ponseti method. Studies involving gradual distraction using external fixators for treatment of these cases have been performed, but no systematic review has been conducted on the subject. Methods: A comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science according to PRISMA guidelines. Only articles that pertained to the treatment of pediatric patients with clubfoot using external fixation and contained three or more human subjects were included. Reviews, professional opinions, and studies with non-human subjects were excluded. Results: Of 6,469 articles generated from the initial search, 25 met inclusion criteria. 609 total feet (490 total patients) were included, and 533 of these feet (445 patients) were treated with external fixation. The mean age of patients was 8.5 [2-18] years with a mean follow-up length of 40.9 [5-126] months. 21 (84%) studies used the Ilizarov apparatus, two used Joshi’s external stabilization system, and one used the Taylor spatial frame. The most reported primary scoring systems were the 60-point International Clubfoot Study Group (ICFSG) score (20%), Dimeglio classification (12%), Pirani score (8%), and Reinker and Carpenter scales (8%). All but one study found significantly improved primary outcomes for the majority of respective patients. Conclusion: External fixation, which may or may not include open surgery, is a promising intervention for neglected or relapsed clubfoot. However, encouraging more standardized outcome measurements would allow for more thorough comparisons between studies.

Treating Older Children with Clubfoot: Results of a Cross-Sectional Survey of Expert Practitioners.

Treating clubfoot in walking-age children is debated, despite studies showing that using the Ponseti casting principles can correct the midfoot effectively. We aimed to explore techniques and approaches for the management of older children with clubfoot and identify consensus areas. A mixed-methods cross-sectional electronic survey on delayed-presenting clubfoot (DPC) was sent to 88 clubfoot practitioners (response rate 56.8%). We collected data on decision-making, casting, imaging, orthotics, surgery, recurrence, rehabilitation, multidisciplinary care, and contextual factors. The quantitative data were analysed using descriptive statistics. The qualitative data were analysed using conventional content analysis. Many respondents reported using the Pirani score and some used the PAVER score to aid deformity severity assessment and correctability. Respondents consistently applied the Ponseti casting principles with a stepwise approach. Respondents reported economic, social, and other contextual factors that influenced the timing of the treatment, the decision to treat a bilateral deformity simultaneously, and casting intervals. Differences were seen around orthotic usage and surgical approaches, such as the use of tibialis anterior tendon transfer following full correction. In summary, the survey identified consensus areas in the overall principles of management for older children with clubfoot and the implementation of the Ponseti principles. The results indicate these principles are well recognised as a multidisciplinary approach for older children with clubfoot and can be adapted well for different geographical and healthcare contexts.

Conventional Versus Accelerated Ponseti in the Management of Cases of Idiopathic Clubfoot: A Systematic Review and Meta-Analysis.

This study aimed to compare the outcomes of the accelerated and standard Ponseti method for clubfoot pathology by constructing a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted to identify the relevant studies through PubMed, Google Scholar, and Cochrane depending on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keywords used included "accelerated" AND "standard" AND "Ponseti" AND "clubfoot" AND "Congenital Talipes Equinovarus" AND "CTEV" AND "prospective comparative design" AND "randomized trial." We conductedthis analysis among 13 studies that met the criteria adopted in this reviewwhere eight studies were prospective comparative studies, and five studies were randomized prospective comparative studies which were published in the period between2015 and 2022. Statistically, accelerated Ponseti showed superior impact over standard Ponseti considering the duration of treatment (22.53 days vs. 40.61 days, p<0.001). No significant difference was reported between the two methods considering final Pirani score (0.64 vs. 0.56, p=0.194), number of casts (5.23 vs. 5.25, p=0.425), rate of tenotomy (66.2% vs. 63.1%, OR=1.246, 95% CI: 0.86-1.80, p=0.245), relapse rate (9.51% vs. 8.54%, OR=1.126, 95% CI: 0.68-1.86, p=0.642) and complication rate (14.4% vs. 13.1%, OR=1.130, 95% CI: 0.58-2.19, p=0.717). We concluded thatthe accelerated Ponseti method could achieve comparable efficacy to the standard method in terms of post-procedure Pirani score, tenotomy rate, relapse rate, complications rate, and number of casts needed by the patients with advantage of requiring shorter duration of treatment which is associated with more patient's compliance.

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

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

Outcomes of the Ponseti Technique in Different Types of Clubfoot-A Single Center Retrospective Analysis.

Background: Clubfoot is a congenital deformity that can affect one or both of a newborn's lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.

ROLE OF ULTRASOUND AS PROGNOSTIC INDICATOR DURING PRONSETI CORRECTION

Objective: Clubfoot ultrasonography is an objective means of determining severity. The purpose of this study is to evaluate the reliability of measuring clubfoot severity by sonographic evaluation of the talonavicular angle (TNA) and the reliability of assessing angle change on simulated Ponseti manipulation. Methods: Twenty-six infants with unilateral idiopathic clubfoot were evaluated prospectively using clinical scoring and Pirani scoring and sonographic measurements of TNA at the start of treatment, after midfoot correction, and after the complete correction was achieved. The TNA and its change during simulated Ponseti manipulation were recorded. Results: In static posture, the mean TNA of the clubfoot (66.46°) differed substantially from that of the contralateral normal foot (101.3°). The mean shift in TNA after simulated Ponseti manipulation was 22.54° (5-50°), and it correlated negatively with clinical ratings and the total number of casts required for final correction (p&lt;0.05). Linear regression research demonstrated that the change in TNA on simulated Ponseti manipulation was the strongest predictor of treatment outcome in CTEV (with a prediction of 60% compared to 25% for Pirani scores). Conclusion: The severity of clubfoot in babies can be better accessed via sonographic examination of TNA and change in TNA following simulated Ponseti manipulation. This objective form of assessment is less expensive, more reproducible in clinical settings, and can better predict treatment outcomes.

The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot.

The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized. The purpose of this study was to evaluate the clinical outcomes at the end of the casting period while addressing these issues. A retrospective study of 17 patients with 25 complex clubfeet over a period of 2years was conducted. Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads. The mean age of patients at diagnosis was 4.41months (2-7months). The mean pre-casting Pirani score was 4.8 (4-6) and post casting Pirani score was 0.4 (0-1). A total of 128 casts were applied to correct 25 complex clubfeet. The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4-7). Overall, four incidences of cast slippage occurred. The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast.Level of evidence Level 4. The online version contains supplementary material available at 10.1007/s43465-023-00910-w.

Bilateral congenital idiopathic clubfoot treatment with the Ponseti technique in Umuahia: A comparison of individual foot characteristics

Background: Clubfoot is the commonest musculoskeletal congenital deformity affecting the foot. The idiopathic variety is the most common type and worldwide the agreed treatment method is the Ponseti method. In bilateral cases, the feet may have different anthropometric characteristics. These differences were evaluated in this study.Objective: To assess the effect of the differences in the anthropometric parameters of the legs and feet (Calf circumference, foot length, degrees of cavus, adduction and equinus and Pirani score) in a child with bilateral clubfoot on the treatment outcome and recurrence of the deformity.Method: This was a prospective study that analyzed idiopathic bilateral clubfoot patients aged 0-5 years and treated using the Ponseti Technique at Federal Medical Center, Umuahia from October 2019 to September 2020. The Pirani scores, the lengths of the feet, the calf circumferences and degrees of cavus, adduction and equinus were measured at initial presentation, commencement of bracing and 3 months after commencement of treatment. These measurements were then compared.Results: A total of 47 patients participated in the study with a male preponderance. The right calf circumference and length of the right foot were consistently bigger than the left at each measurement; and these differences were statistically significant. The degrees of cavus, adduction and equinus were significantly worse on the right foot at presentation. Thirty-six patients (76.6%) had the same Pirani score on both feet at presentation. The differences in anthropometry parameters did not predict the number of casts needed to correct the deformity, the need for tenotomy nor the recurrence of the deformity.Conclusion: Although there were differences in the lower limb anthropometry of children with bilateral clubfoot, they did not predict deformity correction nor recurrence.

Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment. Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors. Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed. Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons.

The Association between Achilles Tendon Elasticity and Pirani Score with The Need for Achilles Tendon Lengthening in Patients with Congenital Talipes Equinovarus Post Ponseti Serial Casting

Backgrounds: Congenital Talipes Equinovarus (CTEV) is the most common congenital abnormalities in the musculoskeletal system. Currently there is no definite parameter to determine the necessity of surgery in CTEV. This study aimed to examine the association between Pirani score and the elasticity of achilles tendon with the need for Achilles Tendon Lengthening (ATL) in CTEV patient. Methods: This study is a prospective study which begins with calculating Pirani score and examining achilles tendon elasticity using Shear-Wave Elastography. The subject was performed ponseti serial casting and followed up for up to 6 weeks. After 6 weeks, an assessment was made to determine the necessity of ATL procedure based on the ability to perform 150 dorsiflexion. Data analysis was performed using SPSS version 22 to calculate receiver operating characteristic curve, spearman correlation test, and chi-square test. Results: There were a total of 33 feets included. Pirani score above 4.25 and achilles tendon elasticity above 19.39 kPa predicted the need of ATL. Correlation test showed moderate positive correlation between the Pirani score and the Achilles tendon elasticity score (r= 0.447; p = 0.009). There is an association between Pirani Score with surgery necessity (RR 4.52; 95%CI 1.52-13.45; p=0.001) and achilles tendon elasticity with surgery necessity (RR 9.625; 95% CI 2.54-36.35; p&lt;0.001). Conclusion: There is an association between the Pirani score and achilles tendon elastography with the need of ATL procedures in CTEV patients. Both Pirani score and achilles tendon elastography are recommended to predict the need of ATL.

Does age and start of Ponseti treatment affect the functional outcome in club foot: A comparative study

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct. Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age &lt;1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment. Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant. Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

Background: Clubfoot is a birth defect found in about 1000 live births yearly in Cameroon and its treatment is often associated with relapses. The objective of this study was to evaluate treatment outcomes with the Ponseti’s technique and factors associated with relapses. Methods: We conducted a 5-year retrospective study on clubfoot children at the Bafoussam Baptist Healthcare Center (BBHC). Data on age, sex, birth setting, previous treatment, pirani scoring, number of casts and follow-ups, bracing and relapse were recorded in case report forms. Data were analyzed with SPSS: 25 software; bivariate analysis was performed to determine factors associated with relapse. Results: This study enrolled 78 clubfoot children with median age, 12 months (IQR1,24), 44 (56.4%) had undergone previous treatment elsewhere. The mean Pirani score before treatment was 4.9 [±SD: 0.9] for the left foot (LF), and 4.9 [±SD: 1] for the right (RF). The average number of casts performed was 6.5 [±SD: 1.5]. Tenotomy of the Achilles tendon was performed in 54 (69.2%) children. The mean final Pirani score was 0.9 [±SD: 0.5] for the LF and 0.8 [±SD: 0.6] for the RF. Only 5 (6.4%) cases did not wear Iowa braces and loss of sight rate was 1.3% (1/78). The relapse rate was 9.1% (7 /77). Treatment requiring &gt;8 casts was associated with relapse (aOR: 10.35; CI [1.05-101.55]; P=0.04). Conclusion: The Ponseti’s technique is effective in the treatment of CTEV in the West region of Cameroon. Treatment requiring more than 8 cats is a risk factor for relapse.

OUR CTEV ACHILLES TENOTOMY JOURNEY: FROM CONSULTANT-DELIVERED CARE UNDER GENERAL ANAESTHETIC TO PHYSIOTHERAPY-DELIVERED CARE IN OUTPATIENT CLINIC. OUTCOMES FROM 45 FEET

To our knowledge, we are the only centre in the UK where Achilles tenotomies (TA) for CTEV Ponseti correction are performed in outpatient clinic under local anaesthetic by an Advanced Physiotherapy Practitioner (APP) in orthopaedics. This study aims to present the outcomes and safety of this practice.Retrospective analysis of cases of idiopathic CTEV undergoing Ponseti correction January 2020 to October 2022. Demographic data: Pirani score and number of casts before boots and bar. Patients were divided into five groups: Group 1: TA performed by an Orthopaedic consultant under general anaesthetic (GA) in theatre. Group 2: TA performed by an Orthopaedic consultant under local anaesthetic (LA) in theatre. Group 3: TA performed by APP under GA in theatre. Group 4: TA performed by APP under LA in theatre. Group 5: TA performed by an APP under LA in outpatient clinic. Complications recorded: revision TA, infection, neurovascular injury or need for re-casting. Mean follow up 18 months.45 feet included. Mean Pirani score 5.5, age started casting 33 days and total number of casts 6. No significant difference in demographic details between groups. 6, 4, 20, 5 and 10 tenotomies were performed in groups 1, 2, 3, 4, and 5 respectively. Complications were 1 revision tenotomy from group 2, one from group 4 and 1 renewal of cast from 3.This study demonstrates that TAs performed in outpatient clinic under LA by an APP is safe and feasible. No increase in complications were observed compared to TAs performed by orthopaedic consultants.