Ponseti Method For Treatment Of Clubfoot Research Articles

Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.

Exploring Bracing Adherence in Ponseti Treatment of Clubfoot: A Comparative Study of Factors and Outcomes in Uganda.

The Ponseti method of clubfoot treatment involves two phases: initial correction, usually including tenotomy; and bracing, to maintain correction and prevent relapse. Bracing should last up to four years, but in Uganda, approximately 21% of patients drop from clinical oversight within the first two years of using the brace. Our study compared 97 adherent and 66 non-adherent cases to assess the influential factors and effects on functional outcomes. We analyzed qualitative and quantitative data from clinical records, in-person caregiver interviews, and assessments of foot correction and functionality. Children who underwent tenotomy had 74% higher odds of adherence to bracing compared to those who did not undergo tenotomy. Conversely, children from rural households whose caregivers reported longer travel times to the clinic were more likely to be non-adherent to bracing (AOR 1.60 (95% CI: 1.11-2.30)) compared to those without these factors. Adhering to bracing for a minimum of two years was associated with improved outcomes, as non-adherent patients experienced 2.6 times the odds of deformity recurrence compared to adherent patients. Respondents reported transportation/cost issues, family disruptions, and lack of understanding about the treatment method or importance of bracing. These findings highlight the need to address barriers to adherence, including reducing travel/waiting time, providing ongoing education for caregivers on bracing protocol, and additional support targeting transportation barriers and household complexities.

Challenges in Establishing a New Clubfoot Clinic at a Public Hospital: an Appraisal of the Initial 384 Cases

The Ponseti method of clubfoot treatment has revolutionized the clubfoot treatment. Participation of non-government organizations (NGOs) has helped expand the reach of clubfoot treatment and improve the outcomes. Establishing new clubfoot clinics may have their teething problems, which need to be anticipated and addressed for their efficient functioning. This retrospective observational study was performed using records of children enrolled in the initial 4 years of an NGO supported clubfoot clinic at a teaching public hospital. Patient details were analyzed to act as surrogate indicators of the challenges faced in the efficient delivery of care at this new clubfoot clinic. Furthermore, the authors’ suggestions would help other clinicians in starting a clubfoot clinic more effectively. Three hundred eighty-four children were enrolled in the initial 4 years. Two hundred ninety-seven children completed their cast treatment. Two hundred four (53.12%), which was more than half of all the enrolled children, had received some prior treatment. Only 86 (22.4%) children followed up for 4 years or more. A high dropout rate at different stages of treatment and follow-up was also noticed. The high dropout rate with the knowledge that most of the enrolled children had some prior treatment points to the clinicians’ and counselors’ failure to educate the parents. Electronic instead of manual data entry would play a role in tracing children in the setting of a new clubfoot clinic. A dedicated team of clinicians and counselors right from the beginning would help in gaining parental trust. Field visits by volunteers might be a useful additional strategy in improving the follow-up and the overall results.

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.

To study the relapse pattern of clubfoot and its management which occured following ponseti method of clubfoot treatment

Background: CTEV (Clubfoot) is the most common congenital orthopaedic condition of lower limb and being treated worldwide by the Ponseti method. The treatment is started as soon as possible after birth. Despite treatment with ponseti method many patients develop relapse during follow up. A study was conducted with the aim to find out pattern of relapse and its subsequent management. Methods: It is a Oupatient department based retrospective (Medical Record) along with prospective (Follow-up) study design,during period of June 2017 to November 2018 with medical record data since year 2012 of all enroled CTEV relapse cases. The method used for the management was serial manipulation and long leg plaster of Paris casting after getting the Pirani score at every visit. Results: A total of 30 children (with age 0-5 year) with relapsing CTEV were selected and treated with Ponseti method. Patients showed a significant decrease in the mean Pirani score post treatment. Conclusion: Ponseti method in management of relapsing CTEV showed excellent results (82%) followed by good (17%) and fair (1%).

Developmental dysplasia of the hip and clubfoot treated by Pavlik and Ponseti methods.

Children having both typical developmental dysplasia of the hip (DDH) and clubfoot are rare, and early treatments of both conditions are recommended. The aim of this study was to evaluate the effects of the Ponseti method of clubfoot treatment on hips with DDH. After institutional review board approval, we identified children treated by the Ponseti and Pavlik methods between 2003 and 2016. During the Ponseti method treatment, the duration of manipulations, number of casts, tenotomies performed, and days in clubfoot orthosis were recorded. During DDH treatment, we registered duration for Pavlik and hip brace usage. Hips had dynamic sonography and radiographic evaluations. The cases were grouped according to the combination of DDH and clubfoot treatments: (a) concurrent, (b) sequential, and (c) hip observation. Seven cases of DDH and clubfoot were identified. The average number of Ponseti casts was 5.8 (range: 4-8 casts). The average number of days following the post-Achilles-tenotomy casting to the end of clubfoot bracing was 870 days (range: 90-1605 days). Eleven (four bilateral cases and three unilateral) clubfeet were corrected initially by the Ponseti method. The average number of days for Pavlik harness treatment was 74 (range: 10-126 days). Additionally, a hip orthosis was utilized in three children for an average of 131 days. At follow-up, all children had a high femoral neck-shaft angle averaging 152° (range: 144°-164°). One child (case 5) developed avascular necrosis of the femoral head, Kalamchi type I. Children with typical and nonsyndromic DDH and clubfoot treated by Pavlik harness and Ponseti methods are associated with abnormal hip development (coxa valga).

The Ponseti method of clubfoot treatment in walking age children: is it effective? A study of 56 children from 1 to 10 years of age

The Ponseti method is well-established for the treatment of clubfoot in younger babies; however, its effectiveness in older children is still unclear. The aim of our study was to report our results of the 'traditional' Ponseti method in the management of clubfoot in children of walking age. A total of 56 (81 clubfeet) children with a mean age of 3.16±2.35 years (1-10 years) were divided into two groups: group I consisted of 12 (18 clubfeet) patients with a mean age of 3.36±2.7 years (range: 1-8.4 years) who presented with an untreated clubfoot whereas group II consisted of 44 (63 clubfeet) patients with a mean age of 3.19±2.34 years (range: 1-10 years) who presented with a recurrent clubfoot. All children underwent the standard manipulation and casting technique described by Ponseti, including a percutaneous tenotomy of the Tendo Achilles. The bracing protocol was modified appropriately. All feet corrected with a mean of 7.36 (3-17) casts in group I and 4.49 (1-12) casts in group II. All children in group I and 70.45% in group II underwent a percutaneous Tendo Achilles tenotomy. There was a statistically significant change between the pretreatment and post-treatment Pirani scores in both groups. Nineteen (30.86%) patients underwent relapse at a mean follow-up of 2.84±1.25 years (1.2-5.4 years), who were treated by re-casting, bracing and tibialis anterior tendon transfer. The Ponseti method is effective even in walking age children upto the age of 10 years with a good success rate, although approximately one-third of the clubfeet relapsed and needed further treatment. No modifications to the standard casting protocol are required. Despite a high relapse rate, a supple, plantigrade and pain-free foot is achievable without the need for extensive soft-tissue surgeries or bony procedures. The Ponseti method lends itself well to developing a nation-wide program for clubfoot treatment in countries with limited resources. Level of Evidence: Level III.

Ponseti treatment for clubfeet: an international perspective

The purpose of this article is to acquaint the reader with the Ponseti method of clubfoot treatment and to describe the features of the technique that make it superior to other forms of clubfoot treatment. These features make the technique applicable across a wide spectrum of healthcare delivery systems on a truly international basis. The Ponseti method has proven to be successful around the globe, in both industrialized countries and developing nations. In many settings, nonphysician practitioners are primarily responsible for the casting phase of treatment, particularly in areas with a shortage of physicians. Internationally, researchers are effectively expanding the scope of clubfeet treated: older children, postsurgical recurrent deformities, and nonidiopathic clubfeet. The barriers that undermine the outcomes of a Ponseti clubfoot program are primarily poverty and noncompliance with the extended post-casting brace protocol. The Ponseti method should be considered the best treatment modality for all children with clubfeet. In the developing world, where most neglected clubfeet occur, emphasis should continue to be the training of practitioners and implementation of programs to reach all affected children. Research will continue to broaden the indications for the method.

Resource Utilization in Clubfoot Management

Both private and socialized healthcare systems require treatments to be not only effective, but also cost-efficient. Although the Ponseti method of clubfoot treatment is effective, its cost-effectiveness has not been demonstrated. We compared the difference in resource use between two prospective cohorts treated for clubfoot by either the Ponseti method or below-knee casting followed by primary surgical release in the socialized healthcare system of New Zealand. Using these cohorts and US billing data, costs of treating these cohorts in the US healthcare system were also calculated. Treatment of initial deformity, recurrences, and complications in both cohorts were included in the final assessment. Twenty-six patients (40 feet) were enrolled in the Ponseti cohort and 29 (46 feet) in the primary surgical cohort. For most patients, the Ponseti method was more cost-effective than the primary surgical treatment in both healthcare systems. The cost of treating both cohorts was lower in the socialized system than in the US healthcare system. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Mini-Open Technique for the Achilles Tenotomy in Correction of Idiopathic Clubfoot

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30 degrees ) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced.

Understanding the barriers to clubfoot treatment adherence in Uganda: A rapid ethnographic study

Purpose. The Ponseti method has been demonstrated to be an effective, low-technology method of correcting congenital clubfoot. The purpose of this paper is to identify barriers to adherence to the Ponseti method of clubfoot treatment in Uganda. Understanding of barriers underlies successful and culturally appropriate approaches to program implementation.Method. A qualitative study (rapid ethnographic study), using semi-structured interviews, focus groups and observation, was conducted. Interviews were conducted with parents of children with clubfoot (42), adults with clubfoot (2), community leaders (40), traditional healers (39) and practitioners treating clubfoot (38). Some 48 focus groups (24 male, 24 female) were conducted with general community members to ascertain their opinions on the potential barriers. The data was collected by a team of researchers in 8 districts of Uganda over the period of one month. It was then coded manually by the researchers and sorted into themes.Results. The barriers to adherence were classified into 6 themes: (i) problems with programmatic resource availability and regional differences, (ii) distance to treatment site, (iii) poverty, (iv) lack of paternal support, (v) caregiver's other responsibilities, and (vi) challenges of the treatment process. A number of factors that were helpful for encouraging adherence were also identified: (i) outreach and follow-up services, (ii) counselling/caregiver-practitioner partnership, (iii) family harmony and solidarity, and (iv) receiving quality care.Conclusions. Our study highlights the barriers to adherence in the treatment of clubfoot, as well as factors that could be helpful for overcoming these barriers. This information provides health planners with knowledge to assist them in meeting the needs of the population and implementing effective and appropriate awareness and treatment programs for clubfoot in Uganda.