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 (original) (raw)
Related papers
Management of idiopathic clubfoot in toddlers by Ponseti's method
Journal of Pediatric Orthopaedics B, 2012
The Ponseti method has been reported to have successful results in clubfoot patients less than 6 months of age but the literature on its efficacy in older clubfoot patients still remains sparse. In our study, we prospectively evaluated 55 clubfeet (37 patients) to determine clinically whether the Ponseti method is effective in the management of clubfoot in older children between the age of 12 and 36 months (mean: 24.8 months). All the patients belonged to moderate or severe grades of deformity as per the Pirani scoring. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 49 clubfeet. Seven patients (seven feet) developed recurrence of adduction, varus and equinus deformity whereas three patients (five feet) developed isolated recurrence of equinus deformity. These seven patients responded to repeat treatment and obtained satisfactory outcome. Four of these seven patients underwent tibialis anterior transfer to third cuneiform for dynamic supination. Three patients, those developed isolated recurrence of equinus deformity, underwent repeat tenotomy. One foot achieved satisfactory amount of dorsiflexion, three feet underwent tendoachilles lengthening whereas another foot underwent posterior release to obtain satisfactory dorsiflexion. Six to 12 numbers of casts (mean: 10) were required to obtain correction of clubfoot deformities. Mean period of immobilization in a cast was 13.9 weeks (10-15 weeks). We found that the Ponseti method is effective in children between the age of 12 and 36 months.
A mini-open technique for Achilles tenotomy in infants with clubfoot
Journal of Children's Orthopaedics, 2016
Purpose A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR). Methods The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015. Results Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5–48 weeks). The average weight at the time of surgery was 7...
Objectives: To analyze and evaluate functional and clinical results in patients with congenital clubfoot treated with Ponseti's technique. Methods: This study evaluated 31 patients diagnosed with 51 congenital clubfeet, treated between April 2006 and September 2011 with Ponseti's technique. The patients who did not achieve an equinus correction with manipulation were treated with Achilles tenotomy. An anterior tibial tendon transfer was performed in patients who maintained residual adduction. All plasters were made by fellows and supervised by Ankle and Foot Chiefs. The technique was performed without the need for physical therapists, orthotics, and plaster technicians. Patients were submitted to pre-and post-treatment examination and evaluated under Pirani's classification. Results: Male patients had an increased incidence and the right side was more affected, while bilateral involvement was observed in 64.5% of the cases. The mean number of cast changes was 5.8, and Achilles tenotomy was necessary in 26 patients. There were significant deformity improvements in 46 of the 51 treated feet (90.2%); Pirani's mean score improved from 5.5 to 3.6 after treatment. Conclusion: The Ponseti method was effective in both functional and clinical evaluation of patients, with significant statistical relevance (p = 0.0001), with a success rate of 90.2% and mean improvement in the Pirani's index of 65.5%.
Correction of clubfoot by ponseti method -Our experience
International Journal of Orthopaedics Sciences, 2021
Background: Congenital idiopathic clubfoot is a complex deformity which occurs in an otherwise normal child. The Ponseti method of clubfoot management has been shown to be effective, producing better results and fewer complications than traditional surgical methods. Weekly manipulation and plaster casting reduce the deformity. Most feet also require a percutaneous Achilles tenotomy. The correction is maintained by a foot abduction brace (Dennis Browne splint). Recent studies suggest that the Ponseti method can be successful in up to 98% of feet. Objective: The purpose of this study was to assess the results of correction of idiopathic clubfoot by Ponseti method and its complications in children below 2 years of age. Methodology: It is a prospective study in 37 children below 2 years of age with idiopathic clubfoot treated by Ponseti method. The study was conducted from august 2016 to august 2018 in Yashoda Superspeciality Hospital, Hyderabad. Observation and Analysis: The mean age of the patient's was 35 weeks (0-120). Of 37 patients, 25 children presented between 0-6 months, 6 between 6 to 12 months and 6 between 1-2 years. Among 37 children, 29 were male and 8 were female. Most children had grade III and grade IV (Dimeglio et al. grading) deformity. The average number of casts was 5.1, 5.5 and 7.4 for the age groups 0-6 months, 6 months to 1 year and 1-2 years respectively. The mean number of casts required was 5.76 (4 to 10). Tenotomy was required in 51 feet (100%). The scores for the entire group ranged from 4.0 to 7.0 (of 10) and 4 to 19 (of 20) in the Dimeglio classification. Pirani scores for the age group 0-6 months were 4.46, 6 months to 1 year were 5.36 and 1-2 years were 5.75 respectively. The results were excellent in 88.3% and good in 11.7%. The mean of initial and final Pirani score is 3.52083 with a 'p' value is 0.000 which is less than 0.01 hence they are statistically significant. Conclusion: Congenital talipes equinovarus (C.T.E.V) is the commonest of all the foot deformities being commoner in male children and bilateral in 66% of cases, idiopathic type being the commonest form. We conclude that the Ponseti method is safe and effective treatment for congenital idiopathic clubfoot in children up to 6 years of age.
Clubfoot Correction in Walking-age Children: A Review
Journal of Foot and Ankle Surgery (Asia Pacific), 2021
Children with clubfoot often present after the walking age, especially in low- and middle-income countries where approximately 80% of children with clubfoot are born. With advancing age, there is increased stiffness of the soft tissue structures and decreased remodeling potential of the bones of the foot. Not all clubfeet in older children are rigid—some are flexible and amenable to stretching and conservative treatment. Hence, the initial evaluation of the deformity must include an assessment of correctability. The treatment of clubfoot in the older child is challenging and was traditionally performed using complex soft tissue and bony surgeries, often with poor outcomes in the long term. Recent literature has focused on the role of conservative treatment utilizing Ponseti principles of serial manipulation and casting, combined with limited surgery. The purpose of this review is to report the changing trends in the management of clubfoot in the walking child, to review the current ...
Treatment of idiopathic club foot using the Ponseti method
The Journal of Bone and Joint Surgery. British volume, 2006
We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/o...
Evaluation and outcome of ponseti method in the form of treatment of congenital idiopathic clubfoot
Talipes equinovarus or clubfoot, in the definition is a congenital deformity concludes of cavus, forefoot adduction, heel varus, ankle equinus and internal tibial torsion. The overall demographic prevalence of clubfoot was 1.30 per 1000 live births; 1.37 among non-Hispanic whites, 1.30 among Hispanics, and 1.14 among non-Hispanic blacks or African Americans. Unilateral clubfoot is somewhat more common than bilateral clubfoot and may occur as an isolated defect or in association with other disorders (eg, chromosomal aberrations, cerebral palsy, spina bifida, arthrogryposis). Our study aim was to evaluate Ponseti Method in the form of treatment of congenital idiopathic clubfoot. This was a quasi-experimental study was conducted in the department of Orthopaedic Surgery in Rajshahi Medical College Hospital, Rajshahi, Bangladesh during the period from January 2018 to December 2019. Data were collected non prospectively in randomized pattern from patients with idiopathic clubfoot, presenting in this hospital. Both, unilateral, bilateral were included in the study. In this study, we have treated 47 children with idiopathic clubfoot by Ponseti Method of correction of serial manipulation and casting. Among the 47 children, 24 had unilateral and 23 bilateral involvement. Male were 27 and remaining 20 were female. Most children had grade III and grade IV (Dimeglio et al grading) deformity. The mean number of casts required was 5.67 (4 to 10). Tenotomy was required for 18 patients (38.29%). The scores for the entire group ranged from 4.0 to 7.0 (of 19) and 4 to 19 (of 28) in the Dimeglio classification. Pirani scores for the age group 0-6 months were 4.45, 6 months to 1 year were 5.29 and 1-2 years were 5.65 respectively. The results were excellent in 37 (79 %), good in 7 (14 %) and inefficient in 3 (6 %). Initial and final scores were statistically evaluated with paired " T" test with a " T" value of 37.13 with a " P" value of less than 0.001. Thus there was a significant reduction in the score from the pre level because of intervention. Results: Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found. In terms of number of patients, the success rate is 93.6% and in terms of the number of feet the success rate is 93.6%. This study demonstrates that treatment of congenital talipes equine varus by conservative management of Ponseti Method can considered as one of the most common and effective treatment method.
Medical research archives, 2023
Background context: All patients with clubfoot, regardless of age, are treated by the Ponseti or Bensahel technique as the first conservative therapeutic method. These techniques have greatly increased the success rate, which still remains at a good level even if the recurrence rate has recorded an increase from 5% to 40%. Thus, interventions for medial and dorsal release have also increased in number. When the decision to treat complications is resumed, it is good to start with one of these methods to ensure tissue flexibility and consolidate favorable outcomes. Purpose: The purpose of the new eclectic procedure is to reduce or eliminate recurrence and obtain a stable and pain-free foot. The article presents a new eclectic technique to analyze the outcomes of medial and dorsal release using this surgical technique for recurrent, residual, or neglected clubfoot in children 6 months to 8 years of age. The study aims to standardize an effective treatment solution for clubfoot after the treatment of choice and non-idiopathic feet in genetic syndromes. The therapeutic orientation focuses on the medial and dorsal approach and establishes the limits between this approach and the use of an external fixator. Design: This is a project study that analyzes statistical data from three graduation theses. The paper is actually a meta-analysis that compares various published procedures and presents the results obtained from both independent studies conducted by various authors and our own study to illustrate the most relevant data. Patient sample: All patients included in the study were personally operated on in two periods of time as follows: 2008-2016, in public clinics, and 2018-2022, in private clinics. Outcome measures: The preoperative evaluation was performed after completion of the Ponseti or Bensahel technique and consisted of an X-ray examination (CT and 3D-CT). After this scan, those who needed CT and MRI were selected. Methods: Radiologically measured talonavicular-cuneometatarsal 1 alignment was invariably fixed on the splint within the talus range and restored the tibial radius of the foot. The plantar arch was normal, and the talocalcaneal divergence in the coronal and sagittal planes was within normal limits. Results: The mentioned results showed an excellent correlation between the plantar arch configuration and the three essential clinical elements of the foot: shape, direction, and position. In the support phase, the operated foot moves normally from the contact point on the calcaneus to the digital support phase. The comparison with the normal foot indicated a similarity of 89%, meaning 25 out of 28 feet. The results of the study can bring improvements to the statics and dynamics of children with severe complications after the initial treatment but especially to non-idiopathic deformities. Conclusions: The properly aligned and reconfigured tibial (medial) radius of the foot allows the biomechanics of the foot to regain a mobility pattern that is almost similar to that of the normal foot. Keywords: medial and dorsal release, transposition of plantar insertions of the tibialis posterior to the navicular, syndesmolysis, musculoaponeurotic plantar disinsertion, reconfiguration of the plantar arch on the talonavicular-cuneometatarsal 1 splint
Effectiveness of Ponseti Technique in Treatment of Idiopathic Clubfoot in age of 2 to 5 Years
Pakistan Journal of Medical and Health Sciences, 2022
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...