Clubfoot Severity Research Articles

Scale of severity of congenital clubfoot by the degree of rigidity of foot deformity

Scale of severity of congenital clubfoot by the degree of rigidity of foot deformity

Rigidity of foot deformity in congenital clubfoot: foot stiffness index

BACKGROUND: A unified system for assessing the severity of congenital clubfoot in newborns and young children worldwide remains to be established. “Rigidity” of foot deformity refers to the degree of “resistance” of foot tissues during manual correction of elements of the deformity and is often used in subjective severity of foot deformity assessment. However, there is no objective quantitative assessment for the degree of foot rigidity. AIM: The study aimed to introduce a novel clinical sign — ”rigidity of foot deformation”, which enables objective assessment of the severity of foot deformity in congenital clubfoot. MATERIALS AND METHODS: Before applying the first plaster cast, a clinical dynamometric examination was performed on 350 feet of 229 children, followed by a mathematical calculation of the foot rigidity index. Statistical analysis was performed using the nonparametric Mann–Whitney U-test and Spearman’s rank correlation coefficient. Differences were considered significant at p 0.05. RESULTS: Significant differences were found in all clinical and dynamometric parameters between congenital clubfoot of I–II, III, and IV degrees (p ≤ 0.05). Generally, the higher the degree of deformity, the more effort required to eliminate it, the smaller angle of simultaneous correction, and the higher index of foot rigidity. The results of Spearman’s correlation analysis of clinical dynamometric examination indicators in children with congenital clubfoot of I–II degree may indicate the mobile nature of the foot deformity; III degree, a rigid version of the deformity; and IV degree, an extremely rigid degree of deformity. CONCLUSIONS: Rigidity of the foot deformity is a crucial clinical sign that characterizes the severity of the foot deformity, which has a quantitative characteristic — the rigidity index. Initial data on foot rigidity enables objective assessment of the severity of the deformity and selecting an individual approach to its elimination when applying staged plaster casts using the Ponseti method.

Assessing the Influence of Age, Weight, and Pirani Score on the Number of Casts During the Initial Phase of Clubfoot Treatment Using the Ponseti Method: A Prospective Study.

Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment. A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction. The majority of participants were male infants aged 4-6months, with a median age of 4.5months. Half of them weighed between 3.00 and 4.99kg at their first hospital visit, with a median weight of 3.20kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0-3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3-9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts. The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy.

Role of Multiple Serial Casting beyond Standard Casting Technique in Managing Club Feet

Aim: To find the role of multiple serial casting beyond standard casting technique in managing club feet. Methodology: Cohort prospective study. Department of Orthopaedic, Chandka Medical College Hospital Larkana from July 1, 2021 to June 30, 2022. One hundred cases were enrolled. The Pirani scoring system was applied for detailed monitoring of the severity and treatment of clubfoot, and the Ponseti method technique was performed. Foot or feet were cast and fastened in an abduction brace at 95% of the correction rate being achieved. All children below two years of age who had one or both feet clubbed were included in this study. Results: The majority of the children visiting the hospital setting for treatment of clubfoot were within the age group of 0–5 months, followed by 6–12 months in 55% and 31% of the children, respectively. About 70% of the children with club feet were boys, with only 30% being girls. The baseline Pirani score was 3.47±0.523, while it decreased significantly to 0.0321±0.135 as the final Pirani score. The outcomes of the study showed that 68% of the children had excellent treatment, 10% had really good treatment, and 18% had fair treatment. Conclusion: Serial casting is a favourable technique for the treatment of clubfoot, wherein it assists in the maintenance of foot balance and proper development. Keywords: Multiple serial casting, Standard casting, Club feet

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<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.

Association of maternal age and order of pregnancy with prevalence and severity of clubfoot- A single-center observational study

Association of maternal age and order of pregnancy with prevalence and severity of clubfoot- A single-center observational study

Assessment of the COL9A1 Single Nucleotide Polymorphism with Severity of clubfoot in a paediatric population along with their biological mothers

BackgroundA frequent birth abnormality known as congenital talipes equinovarus (CTEV) results in severe abnormalities of one or both feet. The risk of CTEV has been shown to be significantly influenced by genetics. It is a typical congenital malformation. Diseases involving the articular cartilage and COL9A1 polymorphisms are linked. Materials and methodThis case parent dyad research was conducted in a premier care medical and educational facility by the Departments of Paediatric Orthopedics and Biochemistry. Children who had been diagnosed with clubfoot as well as their biological mothers took part in the study. 125 kids were able to join in the research when all the screening, inclusion, and exclusion criteria were met. Baseline demographic information was collected, including the child's age and sex, the kind of clubfoot, any family members who have the condition, and whether or not the mothers smoke or drink. Pirani score is used to clinically evaluate every case. Only one peripheral blood sample was taken from each patient, including their Biological Mothers. Resultsout of 125 children enrolled with biological mothers, Col9A1 SNP rs1135056 is substantially related. ConclusionAdditionally, patients with the GG genotype for rs592121 have a higher chance of developing CTEV than those with other genotypes. In this investigation, we found possible associations between COL9A1 gene polymorphisms in the mother and offspring with the risk of CTEV. Our research may help us comprehend the genetic makeup of CTEV better and lay the groundwork for creative intervention strategies.

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.

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.
 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 & 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.
 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
 Conclusion: Our study primarily tries to evaluate clubfoot by using 3D scanner and get the quantification of the disease

Epidemiology of clubfoot in Sweden from 2016 to 2019: A national register study.

BackgroundThis study aimed to estimate the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden using a national clubfoot register. Secondarily we aimed to describe the clubfoot population with respect to sex, laterality, severity of deformity, comorbidity and geographic location.MethodsA national register, the Swedish Pediatric Orthopedic Quality register, was used to extract data on newborn children with clubfoot. To calculate the birth prevalence of children with isolated or non-isolated clubfoot between 1st of January 2016 and 31st of December 2019, we used official reports of the total number of Swedish live births from the Swedish Board of Statistics. The Pirani score and predefined signs of atypical clubfoot were used to classify clubfoot severity at birth.ResultsIn total 612 children with clubfoot were identified. Of these, 564 were children with isolated clubfoot, generating a birth prevalence of 1.24/1000 live births (95% confidence interval 1.15–1.35). About 8% were children with non-isolated clubfoot, increasing the birth prevalence to 1.35/1000 live births (95% confidence interval 1.25–1.46). Of the children with isolated clubfoot, 74% were boys and 47% had bilateral involvement. The children with non-isolated clubfoot had more severe foot deformities at birth and a greater proportion of clubfeet with atypical signs compared with children with isolated clubfoot.ConclusionWe have established the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. Moreover, we have estimated the number of children born with atypical clubfeet in instances of both isolated and non-isolated clubfoot. These numbers may serve as a baseline for expected birth prevalence when planning clubfoot treatment and when evaluating time trends of children born with clubfoot.

Syndromic clubfoot beyond arthrogryposis and myelomeningocele: Orthopedic treatment with Ponseti method

IntroductionTalipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It is one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Material and methodsRetrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2–18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. ResultsOf the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. ConclusionsThe Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

Nail changes in children with idiopathic congenital clubfoot deformity.

Nail alterations are commonly seen in cases of idiopathic clubfoot and may cause parental concern. The nature of and whether these changes are congenital or develop secondary to treatment has been poorly investigated. The aim of this study was to evaluate toenail morphology in clubfoot patients at presentation, to re-evaluate them during the course of treatment for the clubfoot, and to analyze findings in the light of the few literature reports for healthy children of the same age. Thirty infants (21 males and 9 females) with idiopathic clubfoot were prospectively enrolled at the Anna Meyer Children's University Hospital. Nails of affected and non-affected feet were evaluated by a team of pediatric dermatologists at presentation and re-evaluated once per patient during the bracing period of Ponseti treatment. Toenails of affected (47) and non-affected (13) feet were abnormal at presentation in 43.3% of patients, in both clubfeet (40.4%) and non-affected feet (38.5%), but most changes were physiologic or transitory alterations, commonly found in healthy children, with nail concavity (koilonychia) being the most common finding (29.7%). Changes were not related to clubfoot severity or laterality (P>.05). In most (76.9%) unilateral cases, there was concordance of nail changes between clubfoot and non-affected foot. At re-evaluation (follow-up time 410±207days), nail problems were more frequent (53.3%); ingrown toenail was the most common (21.6%). The presence of nail alterations seems not to be caused by clubfoot pathology and could be related to unfavorable local condition in the brace.

Pie zambo sindrómico más allá de la artrogriposis y el mielomeningocele: tratamiento ortopédico con el método de Ponseti

IntroductionTalipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Material and methodsRetrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. ResultsOf the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. ConclusionsThe Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

559 Predicting the severity of clubfoot using novel antenatal sonographic markers

To assess the accuracy of a novel sonographic angle and cavus in the fetus to predict the severity of neonatal clubfoot, quantified by grade-stratified Dimeglio scores. We identified 563 infants seen at a pediatric orthopedics clinic with a diagnosis of clubfoot between September 2010 and September 2019. A prenatal orthopedic consultation occurred in 223 of those cases based upon abnormal ultrasound findings. Corresponding maternal-fetal dyad records were identified for 179 infants. Of those, 84 were excluded due to inadequate pediatric or antenatal data, leaving 95 subjects to be analyzed. Maternal and neonatal demographics and medical history were gathered by chart review. Dimeglio scores were calculated for each extremity by a pediatric orthopedic specialist and stratified by grade (Figure A). A sonographic medial tibial-pedal (MTP) angle was calculated and cavus was assessed by an MFM specialist for each extremity (Figure B). ANOVA and Chi Squared tests were performed to assess the relationship between the sonographic measures and postnatal assessment. 141 club feet were diagnosed sonographically among 95 fetuses (190 feet). Of those, 135 were confirmed postnatally (true positive rate 95.7%); 10 did not meet criteria for clubbing on postnatal evaluation (false positive rate 4.3%). An additional 8 were diagnosed postnatally despite a normal-appearing ultrasound (false negative rate 5.7%). The MTP angle was not calculable for 12 patients due to image quality. 48% of postnatal cases were bilateral and 92% were idiopathic, consistent with prior studies. There was no significant interaction between MTP angle and postnatal Dimeglio grade (ANOVA, p=0.33). Secondary analysis of MTP restricted to idiopathic cases remained nonsignificant (ANOVA, p=0.67). Presence of sonographic cavus did not reliably predict postnatal cavus (Χ2, p=0.35). Use of a novel sonographic angle was not reliably predictive of postnatal clubfoot severity by Dimeglio grade. This points to limitations in counseling prenatal patients on the anticipated severity of and course of treatment for clubfoot.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A Community Audit of 300 "Drop-Out" Instances in Children Undergoing Ponseti Clubfoot Care in Bangladesh-What Do the Parents Say?

Introduction: Drop-out before treatment completion is a vexing problem for all clubfoot clinics. We and others have previously identified better engagement with parents as a crucial method of ameliorating incomplete clubfoot treatment, which increases deformity relapse. Materials and methods: The novel use of community facilitators enabled an audit of over 300 families who had dropped-out from a child’s clubfoot treatment. A questionnaire standardized the parent interviews. Parents were encouraged to present for clinical review of their child’s clubfeet. Results: When treatment was discontinued for six months, 309 families were audited. A social profile of families was developed, showing that most lived in tin houses with one working family member, indicating low affluence. Family issues, brace difficulty, travel distances, and insufficient understanding of ongoing bracing and follow-up were the main reasons for discontinuing treatment. Overt deformity relapse was found in 9% of children, while half of the children recommenced brace use after review. Conclusions: Identifying families at risk of dropping out from clubfoot care enables support to be instigated. Our findings encourage clinicians to empathize with parents of children with clubfoot deformity. The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support.

Predictive ability of scoring systems towards casting in treatment of idiopathic clubfoot by the Ponseti method in infants.

A prospective study to find a correlation between the severity of clubfoot and the number of casts required for the correction was conducted. The relationship of early relapse with the severity of the deformity was also studied. A total of 42 infants (61 feet) with primary and idiopathic clubfeet were included in the study. Previously treated and clubfeet due to secondary causes were excluded. All clubfeet were treated by the Ponseti method, and the Pirani score, Dimeglio score and Foot Bimalleolar (FBM) angle were taken at presentation and before every casting and at 6 months of follow-up. The average age of the child at presentation was 24 days, the average initial Pirani score was 4.172, the average initial Dimeglio score was 14.36 and the average FBM angle was 63.87 degrees. The average number of corrective casts given was 5.08 (range 2-8). The regression analysis showed a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Eleven of the 61 feet had a relapse (18%). Ten of 11 relapsed feet had a midfoot Pirani score of equal to or more than 2. The regression analysis shows a low correlation between Pirani and Dimeglio scores with the number of casts. There was no correlation between FBM angle and casting. Midfoot score equal to or more than 2 is a significant risk factor for relapse.

Assessment of severity of clubfoot in walking children by combined multiple tools: A new classification system

IntroductionClubfoot is one of the most common congenital deformities that cause mobility impairment. In developing countries, however, due to lack of appropriate medical care, treatment is either not initiated or incompletely performed. Due to lack of consensus for evaluation of deformities in such patients, there is no standardized treatment protocol yet developed. So, a new evaluation system is devised to assess the deformity in untreated or previously managed conservatively clubfoot of walking children. MethodsIt was a prospective, observational study, conducted from December 2017 to July 2019. Patients from age 1–5 years, with unilateral deformity and previously managed conservatively were included. Patients having atypical clubfoot, syndromic clubfoot, or previously surgically intervened were excluded. Pre-treatment severity was graded with Diméglio score. Anthropometric, Foot Imprinting, Radiographic angles, and Ultrasonographic measurements were taken. Parameters taken were assessed and correlated with gradings of Diméglio score. Results37 patients with mean age of 2.14 ± 0.87 years were included. Diméglio score was 11.57 ± 2.15 with 28 patients in ‘severe’ category. Talocalcaneal index and Tibiocalcaneal angle were correlating with the equinus whereas Bean shape ratio and Talocalcaneal index were correlating with varus deformity. Derotation of calcaneoforefoot block gradings correlating with Foot bimalleolar angle, Talo-first metatarsal angle, and MMN (medial malleolus to navicular distance) Ratio. FBM (Foot Bimalleolar) Angle, Talo-first metatarsal angle, MMN Ratio, and Medial soft tissue thickness were correlating with forefoot adduction. Following the correlation, a new classification system was devised to assess the severity of deformity at presentation. ConclusionIt is essential to develop an objective methodology to evaluate the severity of the clubfoot; whether the foot is responding to manipulation and casting; to detect the early signs of recurrences and predict the outcomes. The evaluation system should take into consideration the complex characteristics of the deformity and its three-dimensional aspects.

The influence of laterality, sex and family history on clubfoot severity.

PurposeEpidemiological studies on idiopathic clubfeet have shown a typical distribution consistent across ethnic groups: bilaterality in about 50% of cases and a male to female ratio of 2:1. Whether this corresponds also to differences in severity according to laterality and sex has been poorly evaluated. As well, the correlation between family history and severity has not been previously investigated. The aim of this study was to investigate how laterality, sex and family history influence severity and treatment.MethodsIn all, 97 infants with idiopathic clubfoot (81 male, 16 female; 55 unilateral, 42 bilateral; 19 with a first or second-degree relative affected) consecutively treated with Ponseti method were prospectively enrolled. Initial severity (according to Dimeglio and Pirani scores) and treatment (number of casts and need for tenotomy) were analyzed in the different subgroups.ResultsInitial severity according to Pirani (p = 0.020) and Dimeglio score (p = 0.006), number of casts (p = 0.000) and tenotomy (p = 0.045) were significantly higher in bilateral than in unilateral cases. In bilateral cases, a significant correlation was found between the right and left foot of each patient in terms of initial severity, number of casts and tenotomy performed. No statistically significant difference was found according to sex and family history.ConclusionsThis study has confirmed the different behaviour of bilateral cases reported by previous studies; bilateral cases are more severe and show similar features in their right and left foot. This could be the result of different pathogenic mechanisms, likely on a genetic basis. Sex and family history did not seem to influence severity.Level of EvidenceLevel of evidence II

Influence of Beginning Time of Casting for Clubfoot Treatment by Ponseti Method in Different Age Group Infants: A Retrospective Study.

The clubfoot is one of the commonly found congenital deformities in newborn. The Ponseti method is the most effective nonoperative clubfoot management method. It is based on understanding of pathoanatomy of clubfoot. For classifying severity of clubfoot, Pirani score is used. The number of cast required for clubfoot correction is dependent on its initial Pirani score. This study aimed on how the number of cast for correction of clubfoot deformity depends on starting time of casting and pretreatment Pirani score. This study comprises of 200 patients with 297 affected foot nonoperatively managed with Ponseti technique of casting. We measured initial and final Pirani scores of patients with different age groups. We found that initial severity was less in 0-1month age group children but mean casting number was more while initial severity was more in 1-2month age group, the mean number of casting was less. Tenotomy requirement was also less in 1-2month age group. We concluded that casting according to the Ponseti method should be started in 1-2months age group which shows better results than the other age groups in clubfoot.

Change in the severity of congenital clubfoot in the first week of life

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction.
 Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment.
 Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores.
 Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth.
 Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.