Factors Predictive of Outcome after Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet (original) (raw)
Related papers
Asian Journal of Pharmaceutical and Clinical Research, 2018
Objective: The earliest non-surgical treatment for the correction of congenital idiopathic talipes equinovarus (CTEV) deformity was described by Ignacio Ponseti. He suggested gentle manipulation and serial applications of casts followed by a period of bracing to maintain the correction. The main objective of this study was to evaluate the result of the Ponseti method with a subjective clinical scoring system using Pirani score, to compare the results with the published literature and to evaluate the effectiveness of foot abduction orthosis (FAO) or ankle-foot orthoses (AFO) in preventing relapse following correction.Methods: A cross-sectional study which was conducted at the Paediatric Orthopaedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A minimum of 12 months follow-up casting was observed before the patient was subjected to the subjective clinical scoring system. A total of 25 patients which included 5 right feet, 9 left feet, and 10 bilateral feet with idio...
Outcomes of Congenital Talipes Equinovarus Treated with Ponseti Method
International Journal of Contemporary Medical Research [IJCMR], 2019
Idiopathic clubfoot or congenital talipes equinovarus is characterized by an excessively turned-in foot and a high medial longitudinal arch is the commonest congenital foot deformities having 1 in every 1000 children born worldwide. Though described long back, there has been an interest towards Ponseti method of conservative treatment of clubfoot recently. Our study was aimed to assess the efficacy of Ponseti technique in correcting congenital talipes equinovarus deformity of foot. Material and methods: 65 patients were enrolled in the study out of which 47 patients were available for final follow-up. All patients presenting with CTEV with age up to 2 years were included and patients more than 2 years, operated cases and syndromic clubfoot were excluded. We treated all patients with Ponseti method of serial casting and tenotomy. results: Out of the total 65 feet studied, 42 feet (64.62%) required tendo achilles tenotomy and 23 feet (35.38%) were treated with casting alone and tenotomy was not required. In our study, there were 8 cases of relapes (12.31%).Out of these, 7 were idiopathic and 1 was syndromic. Out of these 8 relapses, 2 required repeat tenotomy and 6 were treated with casting as per ponseti technique. Complications due to plaster were minimal in our study. Incidence of rocker bottom feet in our study is nil because of dedicated clubfoot manipulation in clubfoot clinic and patients were followed up regularly. Conclusion: To conclude, this study showed that clubfoot deformity can be managed successfully provided the technique and details of manipulation described by Ponseti are followed strictly and patients can be followed up regularly by a team of dedicated orthopedic surgeons.
Journal of Pediatric Orthopaedics B, 2009
The Ponseti method has become a well-established technique for the treatment of clubfoot presenting in the neonatal period. A few reports have discussed the result of this method in older age group. The purpose of this study is to present the results and clinical experience of using the Ponseti method in the treatment of idiopathic congenital talipes equinovarus in infants presented between 4 and 13 months of age with a history of failed manipulations. Thirty-two feet in 20 infants (12 males; eight females) with idiopathic congenital clubfeet were treated using the Ponseti method with minor modifications. The average age at presentation was 7 months (range from 4 to 13 months). We used the Pirani scoring system to assess the feet. After an average follow-up of 19 months, the ultimate overall results were satisfactory in 31 feet. The Pirani score improved from an average of 4.3 (range: 3-6) at presentation to a final follow-up average of 0.5 (range: 0-1). One foot had unsatisfactory result with a pretreatment score of 5.5 and a final score of 3. The results were also presented in terms of the number of casts applied, the need for tenotomy of tendo Achillis, recurrence of the deformity and the ultimate requirement for surgical release. The use of the Ponseti method in older-aged infants with idiopathic congenital clubfoot seems to be an effective method of treatment, obviating the need for extensive surgery.
Idiopathic Congenital Talipes Equinovarus: An Evaluation in Children Treated by the Ponseti Method
Journal of Evidence Based Medicine and Healthcare, 2016
BACKGROUND Long-term success reports by Dr. Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among paediatric orthopaedists. The purpose of this study is to evaluate mid-term effectiveness of Ponseti method for the treatment of congenital idiopathic clubfoot. MATERIALS AND METHODS Of 93 babies (26 girls, 67 boys) with idiopathic clubfoot who began treatment at Assam Medical College and Hospital between April 2014 and June 2016. 85 patients (22 girls and 63 boys) with 127 clubfeet (71 right feet, 56 left feet) were included in the study. 42 cases were bilateral and 43 were unilateral. Minimum age 6 days and maximum age 3 years (SD 0.64 years). Presentation was categorised as either early or late. 26 (30.59%) of 85 babies who presented for treatment were 28 days or younger versus 59 (69.41%) of 85 babies who presented for treatment were late presenters. RESULTS Mean no. of cast required was 5.1. 26 feet (20%) did not require Achilles tenotomy. Higher initial severity scores at presentation were associated with the need for tenotomy. 31 (36%) had poor brace use and 54 (63%) had good brace use. Of 26 babies who presented early for treatment (28 days or younger), 11 (42.3%) had poor brace use and 15 (57.7%) had good brace use. However, in 59 babies who presented late, a larger percentage had good brace use (39 babies) than poor brace use (20 babies). No additional surgery was required for 60% of the brace intolerant patients. Final dorsiflexion was adequate for 117 (92%) of 127 feet. The final ankle motion (i.e., plantar flexion, dorsiflexion) was no different between early and late presenters. CONCLUSION Ponseti method is a safe and satisfactory treatment for congenital idiopathic clubfoot with mid-term effectiveness.
"An Evaluation of Ponseti Method for the Treatment of Congenital Idiopathic Clubfoot."
IOSR Journals , 2019
Clubfoot, or talipes equinovarus, is a congenital deformity consisting of cavus, forefoot adduction, heel varus, ankle equinus and internal tibial torsion. The overall prevalence of clubfoot was 1.29 per 1000 livebirths; 1.38 among non-Hispanic whites, 1.30 among Hispanics, and 1.14 among non-Hispanic blacks or African Americans. 1 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 for the treatment of congenital idiopathic clubfoot. This was a descriptive cross-sectional study conducted in the dept. of Orthopaedics, Jashore Medical College Hospital during the period from January 2017 to June 2018. Data was collected from patients with idiopathic clubfoot, presenting at selected hospital. Both, unilateral, bilateral were included in the study. In this study, we have treated 46 children with idiopathic clubfoot by Ponseti Method of correction of serial manipulation and casting. Among the 46 children, 24 had unilateral and 22 bilateral involvement. Male were 26 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 5.66 (4 to 10). Tenotomy was required for 17 patients (37%). The scores for the entire group ranged from 4.0 to 7.0 (of 18) and 4 to 19 (of 28) in the Dimeglio classification. Pirani scores for the age group 0-6 months were 4.44, 6 months to 1 year were 5.28 and 1-2 years were 5.64 respectively. The results were excellent in 36 (82%), good in 7 (15%) and inefficient in 3 (6.52%). 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 93.5% and in terms of the number of feet the success rate is 94%. This study demonstrates that treatment of congenital talipes equine varus by conservative management of Ponseti Method can considered as one of the most effective treatment method.
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.
Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method
Journal of Foot & Ankle Surgery, 2003
The initial treatment of congenital idiopathic talipes equinovarus (clubfoot) is most often nonsurgical. However, surgical treatment in the form of posteromedial release is often undertaken after failure of conservative measures. The prevalence of both immediate and long-term complications in surgically treated clubfeet has cultivated a renewed interest in nonsurgical treatment. The Ponseti method for treating clubfoot has seen a revived interest among those caring for infantile clubfeet. We report on our first 34 infants (57 clubfeet) treated by using the techniques and principles described by Ponseti. Using a standard scoring system, 54 of 57 clubfeet were successfully corrected without requiring posteromedial release. Only 2 patients (3 clubfeet) required extensive surgical correction. There were 6 relapses. In all recurrent cases, there was a lack of compliance with the straight-last shoe and foot abduction bar regimen. Based on this level of initial success, we believe that posteromedial release is no longer necessary for the majority of cases of congenital clubfeet.
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.
Ponseti Technique For Management Of Congenital Idiopathic Club Foot
Journal of Ayub Medical College, Abbottabad : JAMC
Clubfoot or congenital talipes equinovarus, is a congenital deformity of the foot. It consists of cavus, adduction, varus and equinus. This is due to medial displacement of navicular and calcaneus around the talus. Talus is in equinus. Medial deviation of the head and neck of talus is due to force of calcaneus on talus. This descriptive case series study was conducted at Orthopaedic unit, Ayub Teaching Hospital, Abbottabad from 1st August 2015 to 31st January 2016 to determine the frequency of idiopathic clubfoot correction, by using the Ponseti method. A total of 177, unilateral and bilateral clubfeet, from both genders were studied. Patients between age of 2 weeks to 2 years were included in the study. Basic pirani score six (06) who were previously untreated were included in the study. Syndromic patients, previously treated and patients with associated neuro-mascular disorders were excluded from the study. Patients who were corrected with serial castings, were put in foot abducti...