Treatment Of Idiopathic Clubfoot Research Articles

Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot.

Talipesequinovarus is a congenital ankle/foot malformation that commonly affects newborns. In its treatment using the Ponseti method, an Achilles tenotomy is frequently needed to correct residual equinus deformity. Percutaneous (PC) tenotomy is the most commonly used technique and needs to be thoroughly evaluated. The question we needed to answer was: "Does PC Achilles tenotomy result in complete tendon sectioning"? This clinical study included 56 idiopathic clubfeet in 36 patients who presented during the first 6 months of life and were treated with Ponseti manipulation and casting followed by PC Achilles tenotomy. PC tenotomy was done under general anesthesia, and Thompson's calf squeeze test was performed intraoperatively just after tenotomy. In case of a negative test (ie, ankle plantar flexion with calf squeeze), the percutaneous incision was extended to assess the cause of the negative test. Forty-nine feet (87.5%) had a complete tenotomy, as evidenced by a positive Thompson's calf squeeze test. While 7 feet (12.5%) showed a negative test, and therefore the percutaneous incision was extended and all were found to have an incompletely divided Achilles tendon. The tendons were then completely divided, after which Thompson's test became positive in all. Percutaneous Achilles tenotomy is a reliable procedure, but was found to result in incomplete tendon sectioning in 12.5% of cases, affecting the range of ankle dorsiflexion. Thompson's squeeze test is reliable in picking up cases of incomplete tenotomy after the PC technique, and in these cases the incision should be extended for complete sectioning. Level I.

PONSETI VERSUS KITE'S METHOD OF TREATMENT FOR IDIOPATHIC CLUBFOOT.

Introduction : Idiopatic congenital talipes equinovarus deformities in infants are difcult to treat due to its complicated pathoanatomy of the growing foot. As clubfoot deformities are pliable in the early weeks of life, treatment preserved is always conservative. Both manipulation and casting methods of Kite and Ponseti are commonly used with good outcomes 1. Though most orthopaedicians prioritize using Ponseti method, advantages and disadvantages of both treatment should be taken into consideration when selecting the treatment. So, we have decide to carry out a comparative study between Kite's and Ponseti method in the treatment of idiopathic clubfoot. 33 patients (48 feets) having idiopathic CTEV were randomized and divided into Materials and methods : two groups. 18 infants (26 feet) were selected and treated by Ponseti method and 15 infants (22 feet) were treated by Kite's method. The results of both group were compared based on Pirani score, time and number of casts required for correction, relapse and percentage of feet corrected. Ponseti Results : method had higher satisfactory correction rate (91.67% versus 80.95%), required less number of casts ( 7.57 versus 11.76), less duration of cast ( 53 days versus 82.35 days) and lesser percentage of relapse ( 8.33 % versus 9.52%). The relapse were corrected by remanipulation in both the groups. In case of bilateral idiopathic CTEV mean Pirani score decreased faster in the Ponseti group compared to Kite's group. The difference was statistically signicant 3rd week onwards in left sided CTEV and 4th week onwards in right sided CTEV. In case of unilateral idiopathic CTEV, the mean Pirani score in Ponseti group decreased faster in Ponseti group compared to Kite's group and the difference was statistically signicant 3rd week onwards. Both Ponseti and Kite's method of casting are effe Conclusion : ctive in correcting idiopathic CTEV deformities. Though correction rate was almost similar in both methods, Ponseti method proved slightly better than Kite's in correcting deformities faster with relatively lesser number and duration of casts. The Kite's method had an advantage of not needing any minor surgical procedure for the correction of deformity.

Complications of Ponseti Technique in Treatment of Idiopathic Club Foot

Background: Clubfoot, or talipes equinovarus, is a congenital deformity that consist of; supination and adduction of the forefoot and midfoot; equinus of hindfoot and varus. It was found that more than 100,000 babies are born each year with congenital clubfoot Objectives: The purpose of this study was to investigate the complications of ponseti method for treatment of children with idiopathic club foot. Subjects and Methods: 50 children with 74 clubfeet were managed by Ponseti method from May 2019 to July 2020 in Al-Wasity teaching hospital with primary correction of the deformity followed sometimes by elongation of Achilles tendon then the patients were followed up till June 2021 and the complications were calculated. Results: complications were 10.8% incomplete correction (mostly equinus) and it was corrected by surgery, 6.7% ulcer on the medial surface of head of 1st metatarsal , 9.4% cast falling and 18.9% relapse. Conclusions: Ponseti technique is a safe and effective method for correction of clubfoot and decreases the need for corrective surgery with minimal complications that can be easily managed.

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

Concomitant Talocalcaneal Coalition as a Risk Factor for Early Relapse Following Ponseti Treatment of Idiopathic Clubfoot.

Concomitant talocalcaneal coalition (TCC) in idiopathic clubfeet is not well documented in the literature. The purpose of this study was to describe our experience with very early relapsing idiopathic clubfeet associated with TCC. Although cases have been successfully treated with the Ponseti casting method, all recurred within 2 months of removing the final cast. A single-centre cohort of twelve feet in eight patients treated by a single surgeon between 2006 and 2020 was investigated retrospectively. Recurred cavus with variable degrees of equinus was the earliest findings noted. TCC was incidentally detected during the open reduction of the earliest three feet in our series. Afterwards, ultrasonography was advised as a screening tool for detecting an associated anomaly; however, only the use of magnetic resonance imaging (MRI) was 100% accurate in diagnosing concurrent TCC. All coalitions were cartilaginous and the posterior facet was most commonly involved facet. The average age was 18 months for the coalition resection and open reduction of a dislocated talonavicular joint, and the average duration of follow-up was 52 months. None of the patients showed clinical signs of relapse at the latest follow-up. We recommend that an associated TCC should be considered in very early relapsing idiopathic clubfoot cases.

Unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with Ponseti technique: a systematic review.

The systematic review study aimed to investigate the following details in the clubfoot children treated with the Ponseti technique: (1) to review the various designs and prescriptions of unilateral limb orthosis described in literature; (2) to find the outcome following use of this orthosis, especially patient adherence and recurrence; (3) comparison with standard bilateral limb foot abduction orthosis. A literature search was performed for articles published in 'Pubmed (includes Medline indexed journals)' electronic databases for broad key words: 'Clubfoot or CTEV or congenital talipes equinovarus', 'orthosis or brace or splint'. Included were studies that addressed the treatment of idiopathic clubfoot in children up to 2 years of age using the Ponseti technique and use of unilateral limb orthosis for the subsequent maintenance phase. We excluded studies reporting Ponseti technique for nonidiopathic clubfoot, child age older than 2 years at the time of primary treatment, studies where unilateral limb orthosis was used as a tool for primary correction of all or some components of clubfoot and design descriptions of orthosis without practical usage data. Of the 1537 articles from the database, 10 articles were included in the final review. Most studies were retrospective, underpowered and had a short term follow-up. In some series, the use of this orthosis was driven by personal experiences and regional preferences rather than a just scientific explanation. The tested designs were variable and nonstandardized. Being less restrictive, unilateral limb orthosis may have an edge over bilateral limb orthosis in terms of patient adherence. The available comparative studies however showed inferiority of unilateral orthoses when compared to the bilateral limb orthosis in preventing recurrences in clubfoot treatment. There is insufficient evidence to support use of unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with the Ponseti technique. Their use was found associated with high recurrence rates.

Idiopathic clubfoot treatment and heterogeneity of current therapeutic strategies: The Ponseti method versus the French functional method (a systematic review)

BackgroundSince Hippocrates, the treatment of idiopathic clubfoot has undergone many changes, with surgical techniques and conservative approaches evolving over the centuries. Today, a wide variety of practices exist in France and throughout the world; consequently, the treatment of idiopathic clubfoot remains controversial, but the Ponseti method and the functional method seem to stand out. Nevertheless, has one of them demonstrated superiority? MethodsThe purpose of this review is to compare these two methods. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 recommendations, this research was conducted on Pubmed, Web of Science, and 1Findr. Only articles concerning patients with moderate or severe idiopathic clubfoot (10–17 on the Dimeglio scale) treated early using the Ponseti method or the functional method were eligible. ResultsAfter reviewing 49 studies, seven published between 2008 and 2018 were selected: five prospective cohort studies, one retrospective cohort study, and one meta-analysis. Each method, according to morphological and kinetic criteria, seems to have advantages that the other does not have. ConclusionsAlthough the Ponseti method is becoming the gold standard and appears more appropriate in poor countries, it is impossible to affirm its superiority over the functional method. Therefore, the combination of their advantages deserves attention: a hybrid method could be an appealing prospect for the future.

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.

Predictive factors for tenotomy in ponseti method for idiopathic clubfoot

Background: Clubfoot occurs in approximately 1 in 1000 live births and is one of the most congenital birth defects. The Non operative technique for the treatment of idiopathic club foot is described by Ponesti as a popular method. Tenotomy is on integral step of this method. The purpose of this study was to evaluation of predictive factors for tonotomy at the initiation of the Ponesti treatment. Methods: In this descriptive cross-sectional study, all patients with idiopathic clubfoot under the age of 6 months who had referred to the orthopedic clinic of Imam Khomeini Hospital in Urmia from April 1 to March 2017, and were treated by pontic method, were included in the study. Parametric statistical tests such as chi-square and t-test were used. The significance level for all tests was below 0.05. All analyzes were performed using SPSS software version 21. Results: Tenotomies were performed in 39 feet of 52 feet (75%). Of 22 feet with initial Pirani scores ≥ 5.0, 95.5% required a tonotomy. Of 11 feet with an initial scores≤2.5, only 18.2% required a tenotomy. There was a significant difference between the need for tenotomy and severity of the deformity at onset of treatment (P<0.001). Removal of the last cast, there was no significant difference between those that did and did not have a tenotomy (P=0.789). Those that underwent tenotomy did not require more casts. Casting began in the newborn period (≤ 30days) on 34 feet. Tenotomy was not needed in 11 feet. There was a significant difference between the need for tonotomy and age at beginning of treatment (P=0.018). Conclusion: Tenotomy is not required in all cases. Severity of the deformity at presentation, especially hindfoot contracture and age at the beginning of treatment can predict the need for tenotomy.

Successful Ponseti-treated Clubfeet at Age 2 Years: What Is the Rate of Surgical Intervention After This?

In recent decades, nonoperative Ponseti casting has become the standard of care in the treatment of idiopathic clubfoot. However, the rate of recurrence, even after successful Ponseti treatment is not insignificant. The purpose of this study was to determine the future rate, timing, and type of surgery needed in patients whose idiopathic clubfeet treated by Ponseti casting were considered successful at the age of 2 years. Inclusion criteria for this retrospective study were patients under 3 months with idiopathic clubfoot treated exclusively by Ponseti casting, who had successful outcomes at 2 years of age without surgery, and who had at least 5 years of follow-up. The total number of surgical interventions in the age range 2 to 5 and above 5 years, the number and type of procedures performed, and the timing of surgery were reviewed. Three hundred thirty-six patients with a total of 504 clubfeet fulfilled the inclusion criteria. One hundred twenty-two of these 336 patients (36.3%) eventually underwent surgical intervention. Between 2 and 5 years of age, 79 patients (23.5%) with 104 feet (20.6%) underwent surgery. The most common procedures performed between 2 and 5 years were limited (a la carte) in scope: tibialis anterior tendon transfer, posterior release, plantar fascia release, and repeat tendo-Achilles lengthening. At age above 5 years, 53 patients (20.1%) with 65 feet (16.9%) underwent surgery. Ten of these 53 patients had already undergone surgery between 2 and 5 years of age. The procedures most commonly performed were similar. In patients with idiopathic clubfoot who reached 2 years of age with successful outcomes from Ponseti cast treatment, ∼35% eventually underwent surgical intervention, mostly limited (a la carte), to regain or maintain a plantigrade foot. The most commonly performed procedures include tibialis anterior tendon transfer, posterior capsular release, plantar fascia release and repeat tendo-Achilles lengthening, either in isolation or in combination. However, before considering surgery, the need for these procedures can, and should, be minimized by recasting recurrent deformities using Ponseti method. Level III.

The Influence of Achilles Tenotomy and Compliance with Foot Abduction Orthosis on the Relapse Rate of Ponseti Treatment for Idiopathic Clubfoot: A Regional Study

The Ponseti method for treating idiopathic clubfoot is based on gradual manipulations and corrective plaster castings followed by a years-long period of use of a foot orthosis. The role of surgery is limited. The factors that may affect outcome and their influence are subject of controversy. The aim of the study is to systematically and objectively evaluate the results of Ponseti treatment in our region of Southern Israel and focus on the role of the Achilles tenotomy and compliance to foot orthosis as factors that may influence outcome. The use of Ponseti method was retrospectively studied (level of evidence IV) by searching computerized medical files and clinical photos. The severity of deformity was evaluated by Dimeglio score (D-score) at baseline and at last examination. During 2006-2014, 57 children with idiopathic clubfoot (total 90 feet) were enrolled. An Achilles tenotomy was performed in 55/90 (61.1%) of the feet. If the D-score was 15 or higher there was a 20% increase in the incidence of Achilles tenotomy. The parental compliance had a weak protective effect against relapse. The treatment of idiopathic clubfoot by the Ponseti method was successful and reliable, proving efficiency and universality of the method. A dominant predictor for relapse was not seen. An incidental observation was that extended time in cast may buffer the adverse effects of low compliance rate. Although the initial severity, or compliance to braces are important, there may be other factors that affect the outcome such as, accuracy of the casting technique, time in the cast, access to a dedicated clubfoot clinic, cooperation with nurses and pediatricians, economic status that allows purchase of new generation of braces, cultural perception, and education level of the patient population are some examples.

A comparative study to assess idiopathic clubfoot treatment between less than 3 month and more than 3 months of age by Ponseti’s Technique in a tertiary care hospital in Udaipur (southern Rajasthan)

A comparative study to assess idiopathic clubfoot treatment between less than 3 month and more than 3 months of age by Ponseti’s Technique in a tertiary care hospital in Udaipur (southern Rajasthan)

ЗАСТОСУВАННЯ МЕТОДИКИ І.PONSETI ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ВРОДЖЕНОЇ КЛИШОНОГОСТІ У ДІТЕЙ

У цьому документі висвітлюється сучасний досвід застосуванняметодики I.Ponseti при хірургічному лікуванні вродженої клишоногості у дітей.Основна мета дослідження – це зниження частоти ускладнень при хірургічномулікуванні вродженої клишоногості шляхом застосування методики І.Ponseti під часпередопераційної підготовки.Актуальність рішення цієї наукової проблеми полягає в тому, що частотаускладнень в різних дослідженнях становить від 3% до 10, а їх причиноюнайчастіше є надмірне перерозтягнення м’яких тканин з подальшим порушенням їхтрофіки. У відстроченому періоді основним ускладненням є виникнення рецидивудеформації, що також безумовно пов’язано з ходом хірургічного втручання. Зметою зниження частоти таких ускладнень та кращої адаптації м’яких тканин мипочали застосовувати методику І. Ponseti під час передопераційної підготовки удітей з вродженою клишоногістю.Було використано загально-клінічні, лабораторні, інструментальні(рентгенологічний), а також статистичні методи обробки отриманихрезультатів.Оцінка результатів враховувала відсоток післяопераційних ускладнень таоцінку тяжкості деформації за шкалою Pirani (2004) перед та через 1 рік післяхірургічного лікування, за такими критеріями: менше 0,5 – добрі, менше 1,5 –задовільні, менше 2,5 – незадовільні. Статистичну обробку даних проводилиметодом описової статистики в програмі SPSS 17,0. За достовірну різницю бралирезультат при p &amp;lt; 0,05.Проведений аналіз лікування 62 дітей (74 стопи) з ідіопатичною вродженоюклишоногістю, що знаходились на стаціонарному та амбулаторному лікуванні вНДСЛ «Охматдит» з вересня 2015 по серпень 2018 років.Всі пацієнти розподілені на дві групи: I група – 27 пацієнтів (32 стопи), якимбезпосередньо перед хірургічним лікуванням не застосовувались етапні гіпсування пометодиці І.Ponseti; II група – 35 пацієнтів (42 стопи), яким на етапахпередопераційного планування виконувались етапні гіпсування. Середній вік пацієнтів – 4±0,85 років. Пацієнтам II групи виконувались етапні гіпсування заметодикою І.Ponseti. Середня кількість склала від 4 до 7 гіпсувань. Завдякизастосуванню даної методики вдалося частково скоригувати аддукцію тасупінацію стопи.Пацієнтам в обох клінічних групах було виконане хірургічне втручання нам’яким тканинах стопи: задньо-медіальний реліз та/або плантарний реліз зфіксацією шпицями Кіршнера та гіпсовою іммобілізацією. Через 3 міс. післяхірургічного втручання виконувалось видалення фіксаторів під загальнимзнеболенням. Надалі всім пацієнтам були дані рекомендації щодо ортопедичноговзуття, використання ортезів на час сну та періодичне спостереження.Враховуючи результати лікування в обох клінічних групах, можна зробитивисновок, що використання методики І.Понсеті на етапах передопераційноїпідготовки при лікуванні вродженої клишоногості, дає змогу значно знизитичастоту післяопераційних ускладнень, почати ранню реабілітацію та зменшитиліжко день.

Outcomes After Nonoperative Treatment of Idiopathic Clubfoot

Outcomes After Nonoperative Treatment of Idiopathic Clubfoot

Oral Sucrose for Pain Relief During Clubfoot Casting: A Double-Blinded Randomized Controlled Trial

Idiopathic clubfoot treatment is treated by manipulation and casting utilizing the Ponseti technique which can make the infant fussy and irritable. The goal of this study was to determine which intervention could decrease this pain response in infants undergoing Ponseti casting for idiopathic clubfeet. Our hypothesis was that the administration of oral sucrose solution or milk would be the most effective in accomplishing that goal. We conducted a double-blinded randomized controlled trial at a tertiary pediatric orthopaedic center on 33 children (average age=17.94 d; SD=20.51 d) undergoing clubfoot manipulation and casting and their guardians. Each cast was considered a new event and was randomized to an oral 20% sucrose solution (S), water (W), or milk (M) in a bottle (breast or nonbreast). We assessed the Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation before, during, and after the casting. A total of 131 casts were randomized and 118 analyzed (37 M, 42 S, 39 W). Each child underwent an average of 3.97 casts (SD=1.74). There were no significant differences seen between the groups before casting in their mean NIPS score (M=2.2; SD=2.38, S=1.84, SD=2.18, W=1.61, SD=2.12). However during casting, mean NIPS score for both milk, 0.91 (SD=1.26, P=0.0005) and sucrose, 0.64 (SD=1.27, P<0.0001) were significantly less than water, 2.27 (SD=2.03) but not different from each other (P=0.33). Postcasting, the sucrose NIPS score, 0.69 (SD=1.53) continued to be significantly less than milk, 2.11 (SD=2.37, P=0.0065. There was no correlation between heart rate or oxygen saturation and NIPS. Sucrose solution and milk during Ponseti casting and manipulation were effective in decreasing the pain response in children undergoing manipulation and casting for clubfeet. The sucrose solution administration continued the pain relief into the postcasting period. In addition to the benefits of improving the patient experience during casting, a less irritable child may result in better casting. Level 1 evidence.

The development of a training course for clubfoot treatment in Africa: learning points for course development

BackgroundClubfoot is a common congenital musculoskeletal disorder that causes mobility impairment. There is a lack of trained mid-level personnel to provide clubfoot treatment in Africa and there is no standard training course. This prospective study describes the collaborative and participatory approach to the development of a training course for the treatment of clubfoot in children in resource constrained settings.MethodsWe used a systems approach to evaluate the development of the training course.Inputs: The research strategy included a review of context and available training materials, and the collection of data on current training practices. Semi-structured interviews were conducted with seven expert clubfoot trainers. A survey of 32 international and regional trainers was undertaken to inform practical issues. The data were used to develop a framework for training with advice from two technical groups, consisting of regional and international stakeholders and experts.Process: A consensus approach was undertaken during workshops, meetings and the sharing of documents. The design process for the training materials took twenty-four months and was iterative. The training materials were piloted nine times between September 2015 and February 2017. Processes and materials were reviewed and adapted according to feedback after each pilot.ResultsFifty-one regional trainers from Africa (18 countries), 21 international experts (11 countries), 113 local providers of clubfoot treatment (Ethiopia, Rwanda and Kenya) and local organising teams were involved in developing the curriculum and pilot testing. The diversity of the two technical advisory groups allowed a wide range of contributions to the collaboration.Output: The resulting curriculum and content comprised a two day basic training and a two day advanced course. The basic course utilised adult learning techniques for training novice providers in the treatment of idiopathic clubfoot in children under two years old. The advanced course builds on these principles.ConclusionFormative research that included mixed methods (both qualitative and quantitative) was important in the development of an appropriate training course. The process documentation from this study provides useful information to assist planning of medical training programmes and may serve as a model for the development of other courses.

Frequency of percutaneous achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method

Background: Percutaneous Achilles tenotomy is an integral component of congenital clubfoot treatment using the Ponseti method. This study was designed to assess the frequency and outcome of percutaneous Achilles tenotomy in the conservative treatment of congenital clubfoot by the Ponseti method.Patients and methods: A prospective study of all congenital clubfoot patients between the ages of zero and two years who attended our clubfoot clinic between January, 2013 and December, 2017 was carried out. At presentation, each clubfoot was assessed clinically and scored using the Pirani scoring system, and treated using the Ponseti method. Percutaneous Achilles tenotomy was performed for feet with persistent equinus deformity. Statistical analysis of the distribution and associations of percutaneous Achilles tenotomy was done using IBM SPSS version 22 was done.Results: A total of 97 patients with 147 clubfeet were studied. The median total Pirani score (TPS), midfoot contracture score (MFCS) and hindfoot contracture score (HFCS) at presentation were 4.5, 2.5 and 2.5 respectively. Percutaneous Achilles tenotomy was performed on 97 (66.4%) feet belonging to 63 patients. Eighty five out of 108 feet with initial total Pirani score of 3.0 and above required percutaneous Achilles tenotomy to achieve correction (p < 0.001).Conclusion: Treatment of congenital clubfoot using the Ponseti method was associated with a tenotomy rate of 66.4%. High Pirani scores as well as increasing age at presentation were associated with the need for percutaneous Achilles tenotomy.Keywords: Congenital, Clubfoot, Pirani scoring system, Ponseti method, Achilles tenotomy

Comparative study of accelerated ponseti method versus standard ponseti method for the treatment of idiopathic clubfoot

Introduction: Clubfoot is a common congenital deformity with incidence of one in thousand live births. Ponseti method is currently the gold standard for treatment of clubfoot which conventionally involves weekly plaster changes. A prospective comparative study was carried out at our institute where we compared one group with weekly plaster change to other group with triweekly plaster change using the classical Ponseti protocol of manipulation. Methods: A total of 40 feet, divided into two groups, were randomly allocated to either Group A – 20 feet (standard Ponseti) or Group B – 20 feet (accelerated Ponseti). Group A underwent serial manipulations and casting once a week and Group B received manipulations and castings thrice a week. Pirani score was documented at presentation, at each cast, and at the time of removal of final cast to assess the success of treatment in terms of Pirani score ≤1. Results: The average number of casts needed for correction in accelerated group was 7 (16 patients, 20 feet) and in standard group was 6.35 (15 patients, 20 feet). The mean follow-up in accelerated group was 7.84 months whereas in standard group was 6.66 months. Tendoachilles tenotomy was required in 65% feet in accelerated group and 55% in standard group. Conclusion: Both methods standard and accelerated Ponseti have proven to be equally efficacious for the management of clubfoot in our study. However, the accelerated method has a overall shorter treatment duration making it more cost effective and convenient for the parents. As patient is under direct observation of surgeons, any complications are detected early and easily. Overall, the accelerated technique is more practical, beneficial, and labor-saving for poor patients from rural part of India where recurrent visit to tertiary government care center is inconvenient and troublesome.

Ponseti method is superior to surgical treatment in clubfoot – Long-term, randomized, prospective trial

Treatment of idiopathic clubfoot has shifted from extensive surgical release to conservative Ponseti method; however, randomized prospective trials to compare both methods are lacking. The goal of this study was to compare the long-term results of Ponseti method with those of surgery in terms of morphology, function, X-rays, overall health and gait.In 2001, a single center, prospective, randomized, and controlled trial with a parallel design was started. Twenty-four feet of 15 patients were randomly assigned to two groups: 12 feet each to a Ponseti and surgical group. Mean follow-up was 10 years. International Clubfoot Study Group score (ICFSG), the Pediatric Outcomes Data Collection Instrument (PODCI) and the Functional Rating System (FRS) were used to compare morphology, functional, radiological and subjective outcomes, and the Oxford Foot Model (OFM) was used to evaluate foot kinematics.No significant difference was seen between groups in the initial Pirani scores (p=0.618). Ponseti group had more favorable long-term outcomes according to the FRS (p=0.005), higher ICFSG, scores for morphology (p=0.021), function (p=0.005) and X-rays (p=0.02), and better parent reported functional status according to the PODCI (p=0.018). Surgically treated clubfeet were stiffer – ankle dynamic range of motion (p=0.015) and the maximal hindfoot dorsiflexion during gait were limited as measured by OFM (p=0.039). This was compensated by an increase in motion between the hindfoot and forefoot. Furthermore, these children had more difficulty playing sports and experienced more pain, which might have led to inferior results in the happiness domain of the PODCI.These results suggest that the Ponseti method provides superior long-term outcomes for idiopathic clubfoot deformity.

Treatment of idiopathic clubfoot by Ponseti method: a prospective evaluation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; From long time clubfoot has been a clinical challenge to orthopaedic surgeons. It is one of the commonest congenital deformity of the musculoskeletal system in children. Each year more than 1,00,000 babies are born with congenital clubfoot. 80% of which occur in developing countries.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 feet in 40 children were treated by the Ponseti method from September 2014 to august 2016. Prospective follow up for a mean duration of 18 months was undertaken. The deformity was evaluated by Pirani score before and after the treatment. At the end of treatment all feet were functionally classified into good, fair and poor.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average number of casts applied before full correction was 8. 21.66% of the feets needed tenotomy before full correction. 90% of the patients showed good results, 3.3% had fair results and 6.6% of patients had poor results. There was a significant difference in the pre-treatment and post-treatment pirani score values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Ponseti method of manipulation and plaster casting is very effective to correct club foot deformity. &lt;/p&gt;