Ponseti Technique For Management Of Congenital Idiopathic Club Foot (original) (raw)
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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...
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.
International Journal of Research in Orthopaedics, 2018
Background: Congenital clubfoot also known as CTEV (congenital talipus equinovarus) is a common and debilitating congenital musculoskeletal anamoly affecting the children across the world with a slight preponderence in third world countries. The Ponseti technique of casting has now become the mainstay of treatment of this condition. This method is especially effective in rural and underdeveloped areas with limited health care facilities. The purpose of this study was to evaluate the effectiveness of the Ponsetti technique in the correction of this deformity, thorough the assessment of modified Pirani score. Methods: This was a prospective observational study conducted on 75 patients of either sex with 100 feet, with an average age of 3.6 months presenting to the
"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.
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.
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.
2011
Background Clubfoot or congenital talipes equinovarus is a common congenital abnormality of uncertain etiology. The purpose of this study was to assess the results of the Ponseti method in India and to investigate the demography of relapse and resistant cases. Methods A total of 86 children (146 feet) below 1 year of age who had presented to the paediatric orthopedic outpatient department of our institution between June 2003 and January 2007 with unilateral or bilateral idiopathic clubfoot deformity were included in our study and treated conservatively by use of the Ponseti technique. Results 128 feet responded to the Ponseti casting technique initially and 18 feet were resistant to the conservative treatment. Of the responsive feet, for 20 feet there was a relapse of the deformity. Evaluation of the results showed that poor compliance with splintage was the most common cause of relapse; delayed presentation and atypical clubfeet resulted in high resistance to this technique. Correction achieved at our centre was 82.18%. This is less than in many recent studies and could be attributed to increased incidence of delayed presentation, poorer compliance, and atypical feet in our population. Conclusion We conclude that the Ponseti technique is recommended for management of clubfoot and strict compliance with splintage is essential to prevent relapses. People of lower socioeconomic status are at high risk of relapse and must be targeted to create awareness among them about the importance of compliance with splintage.
Congenital Clubfoot Treated by Ponseti Technique
Gomal Journal of Medical Sciences, 2017
Background: Clubfoot is a disease characterized by complex malformed feet or foot without the malformations of other bones and joints in the body. The objective of the study was to evaluate the conservative treatment of clubfoot in children by Ponseti technique of correction in our population. Material & Methods: To evaluate conservative treatment by Ponseti technique in clubfoot, the study conducted was consecutive case series done in Orthopedics unit District Headquarter Hospital Dera Ismail Khan. Patients presented to OPD from October 2015 to September 2016 were included in this study. Children with clubfoot with no other congenital foot abnormalities and age less than 18 months were included. Children having clubfoot due to neuromuscular disease, arthrogryposis, mielodysplasia and postural clubfoot were excluded. Pirani scoring system was used in this study to see the effects of treatment before and after the procedure Results; A total of 100 patients (146 feet) were treated. Fo...
Idiopathic clubfoot is a complex deformity and is difficult to treat. The goal of the treatment is to reduce or eliminate all components of the deformity so that the patient has a pain free, plantigrade, mobile foot with good function and without callosities. We have treated 31 patients with 45 clubfeet using ponseti technique. Grading system of Dimeglio et al was used to assess the severity of deformity. The average number of costs applied for obtaining correction was 6, ranging from 4 to 9. Tenotomy was done in 40 feet. 40 feet had good results; 3 patients (5 feet) developed recurrence because of non-compliance of use of orthosis.
International Journal of Orthopaedics Sciences
Introduction: Club foot or CTEV (congenital talipes equinus varus) is a complex foot deformity of childhood, which has an emotional and socioeconomic impact to the family. The aim of management should be to gain results in form of painless, plantigrade and functional foot without any disability. With availability of all the treatments modalities, the Ponseti's method of conservative treatment with or without tenotomy is the preferred method in current scenario. We evaluated the effectiveness of Ponseti's technique with reference to functional outcomes in form of Modified Pirani severity scores and goniometric calculations of club feet treated by this method. Material and Methods: We have studied 150 feet (60 bilateral and 30 unilateral) of idiopathic club feet (CTEV) at our tertiary center in the department of Orthopaedics with collaboration of Obstetrics and Gynecology (OBG) department. All the subjects were managed with Ponseti's method of conservative treatment. Results: Out of 150 feet, 140 feet had excellent functional outcome (Pirani score-0 to 0.5), 30 had good (Pirani score-0.5 to 1) and 5 had satisfactory outcomes (Pirani score-1 or more). Conclusions: Ponseti's method has low rate of complications, cost effective and having high success rate among all the modalities of treatment. This method has great potential for the treatment of clubfoot among different cultures in both developed and underdeveloped countries.