Management of Idiopathic Clubfoot by Ponseti Technique in Children Presenting After One Year of Age (original) (raw)
Related papers
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...
"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.
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...
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 treated by Ponseti method: a series of 300 cases
International Journal of Research in Orthopaedics
Background: Clubfoot is a complicated deformity of the foot. It is one of the commonest congenital deformities in children. The main aim of this study was to evaluate the efficacy management of clubfoot by Ponseti method.Methods: This prospective study included 300 children (456 club feet) below the age of 2 years with idiopathic clubfeet from January 2013 to December 2017. In all the cases the Ponseti method was used for the management. The severity of the deformity was assessed with the help of the Pirani score and clinical evaluation of the foot was done.Results: Out of 300 patients 204 patients were male and 96 patients were female and 144 were unilateral clubfoot and 156 were bilateral cases of clubfoot. The mean number of casts required for correction was 5.4 (4–10). Out of 456 clubfeet 356 (78%) feet were required tenotomy. There was relapse seen in 36 (7.9%) feet which had to be managed with 2–3 serial manipulations and casting and these resolved. Excellent result found in o...
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.
Evaluation of Early Treatment of Idiopathic Clubfoot Using the Ponseti Method
Acta Ortopedica Brasileira, 2023
Congenital clubfoot is one of the most common congenital deformities of the lower limbs, with an estimated incidence of 1 for every 1,000 live births. Its treatment is controversial, and currently the Ponseti method has been widespread, showing promising results and decreasing the need for extensive surgical releases, as was usually done until the introduction of the technique. Currently used in approximately 55 countries, the method has changes and scopes that vary according to the society in which it is applied, with the results and peculiarities of the method molded according to the sample studied. Objective: To evaluate the clinical outcome of clubfoot treatment using the Ponseti method under local conditions. Methods: The clinical evaluation will include a descriptive analysis of the sample, as well as radiographic evaluation and family satisfaction with the treatment. Results: In total, 46% of the patients had good results and no family was dissatisfied with the treatment results. No statistically relevant relationships were found between the studied variables. Conclusion: The results are good and generally similar to those in the literature. Our epidemiological data generally agree with those reported by other authors. Level of Evidence IV, Case Series.
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.