Ponseti Method for clubfoot

NewsBot · May 24, 2012

State Track Performer Overcomes Foot Deformity

Des Moines-To watch Iowa City Regina's Chris Nepola run a preliminary heat in the 110 high hurdles at the State Track Meet, you would never know he had been born with a clubfoot.

The deformity was non-surgically corrected at a very young age by Dr. Ignacio Ponseti
Click to expand...

Full story

NewsBot · May 24, 2012

Good results with the Ponseti method.
Sætersdal C, Fevang JM, Fosse L, Engesæter LB.
Acta Orthop. 2012 May 23.

Background and purpose
In 2002-2003, several hospitals in Norway introduced the Ponseti method for treating clubfoot. The present multicenter study was conducted to evaluate the initial results of this method, and to compare them to the good results reported in the literature.

Patients and methods 116 children with 162 congenital idiopathic clubfeet who were born between 2004 and 2006 were treated with the Ponseti method at 8 hospitals in Norway. All children were prospectively registered at birth, and 116 feet were assessed according to Pirani before treatment was started. 63% used a standard bilateral foot abduction brace, and 32% used a unilateral above-the-knee brace. One of the authors examined all feet at a mean age of 4 years. At follow-up, all feet were assessed by Pirani's scoring system, and range of motion of the foot and ankle was measured.

Results At follow-up, 77% of the feet had a Pirani score of 0.5 or better, good dorsiflexion and external rotation, and no forefoot adduction. An Achilles tenotomy had been performed in 79% of the feet. Compliance to any brace was good; only 7% were defined as non-compliant. Extensive soft tissue release had been performed in 3% of the feet. We found no statistically significant differences between the two braces, except a tendency of better Pirani score in the group using the bilateral foot abduction brace, and a tendency of better compliance in patients using the unilateral brace. Better Pirani scores were found in children who were treated at the largest hospitals. Interpretation After introducing the Ponseti method in Norway, the clinical outcome was good and in accordance with the reports from single centers. Only 5 feet needed extensive surgery during the first 4 years of life.
Click to expand...

NewsBot · Jul 21, 2012

Multiple tenotomies after Ponseti method for management of severe rigid clubfoot.
ElTayeby HM.
J Foot Ankle Surg. 2012 Mar-Apr;51(2):156-60.

The purpose of the present study was to evaluate the efficacy of multiple tenotomies performed after application of the Ponseti method in reducing the tendency for recurrence in the severe rigid idiopathic clubfoot and limiting the need for application of the hyperabduction brace in the prewalking age. From November 2002 to December 2004, 30 severe (Pirani >5), rigid (nonresilient), idiopathic clubfeet in newly born infants aged 2 to 24 days were treated by the Ponseti method of weekly manipulations and castings until achieving full correction, apart from equinus. With the patient under general anesthesia, through 2 small incisions (2 cm), tenotomy of the Achilles tendon, tibialis posterior, and flexor digitorum longus was performed, together with posterior capsulotomy of the ankle to achieve >30° dorsiflexion in 26 feet. An above the knee plaster cast in extreme dorsiflexion and 70° hyperabduction was applied for 6 to 8 weeks. This was followed by a hyperabduction brace on a full-time basis (23 hours daily) for an additional 6 months. A satisfactory result was achieved after a follow-up period of 2 to 5 (mean 3.8) years. The Pirani score on initial presentation was 5 to 6 and on the final visit was 0 to 0.25, with 10° to 20° passive dorsiflexion of the ankle in those who underwent posterior capsulotomy compared with 5° to 10° in the 4 patients who had not. The number of manipulations needed before tenotomy was 5 to 7 (mean 5.9), reflecting the rigidity of the studied feet. Active plantarflexion to almost normal power was regained at 18 to 30 months of age. A relapse developed in only 1 foot that failed to respond to manipulation and casting. It required posteromedial release and tibialis anterior transfer at 2 years of age. The proposed minimally invasive procedure of open multiple tenotomies and posterior capsulotomy of the ankle is safe and effective. If performed in newly born infants with severe rigid clubfeet followed by strict application of the hyperabduction brace on a full time basis for 6 months, it will ensure full correction of the deformity. Thus, the brace can be discarded before the infant reaches walking age, with no tendency for relapse.
Click to expand...

NewsBot · Sep 20, 2012

A 14 year longitudinal comparison study of two treatment methods in clubfoot: Ponseti vs traditional
R Boden, G Nuttall and R Paton
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXIX 150

Background The optimal management of idiopathic clubfoot has changed over three decades. Recently there has been an enthusiastic embracing of the Ponseti technique. The purpose of this 14-year comparative prospective longitudinal study was to directly assess the differences in results between these two treatment methods.

Methods Over the period of this study there were 52,514 births in the local population and all newborns with clubfoot were referred directly to the Pediatric Orthopedic Surgeon. Patient demographics, the Harrold & Walker Classification, and associated risk factors for clubfoot were collected prospectively and analyzed. If conservative treatment failed to correct the deformity adequately, a radical subtalar release (RSR) was undertaken (the primary outcome measure of the study).

Results There were 114 feet (80 patients): 64 feet treated ‘traditionally’ and 50 feet with the Ponseti technique. Idiopathic clubfoot was present in 76.25% of patients. Mean time to RSR was 33.3 and 44.1 weeks for the traditional and Ponseti groups respectively. In the traditional group 65.6% (CI: 53.4 to 76.1%) of feet underwent RSR surgery compared to 25.5% (CI: 15.8 to 38.3%) in the Ponseti group. When idiopathic clubfoot alone was analysed, these rates reduce to 56.5% (CI: 42.3 to 69.8%) and 15.8% (CI: 7.4 to 30.4%) respectively. The Relative Risk of requiring RSR in traditional compared to Ponseti groups was 2.58 (CI: 1.59 to 4.19) for all patients and 3.58 (CI: 1.65 to 7.78) for idiopathic clubfoot.

Conclusions Introduction of the Ponseti technique into our institution significantly reduced the need for RSR in fixed clubfoot.
Click to expand...

NewsBot · Oct 2, 2012

CONGENITAL TALIPES EQUINOVARUS – THE SWANSEA EXPERIENCE OF THE PONSETI REGIME
A. Tong, O. Bizby, N. Price, and P. Williams
J Bone Joint Surg Br 2012 94-BSUPP XLIII) 20.

Introduction The Ponseti regime was introduced in Swansea in 2003 for the treatment of congenital talipes equinovarus (CTEV). The aim of this retrospective cohort study was to compare children treated with this regime with a historical group treated traditionally before then.

Materials and Methods Sixty children (89 feet) were treated with the Ponseti regime between 2003 and 2010. Their notes were compared with notes from 12 children (21 feet) treated between 1995 and 2002. Clinic attendance for serial manipulation and immobilisation (strap/cast) was compared using a two-tailed Mann Whitney U test. Major release surgery was compared using a two-tailed Fisher's Exact test.

Results Children in the historical cohort presented when they were 0–174 days old (median 1 day). They attended 3–35 times (median 22) for serial manipulation and strapping/ plasters. Major release surgery was undertaken on 14 feet (66.7%) when the children were 6–39 months old (median 9 months); 7 had revision surgery. The Ponseti cohort presented when they were 0–73 days old (median 10 days) and attended outpatients 2–19 times (median 7) for serial manipulation and casting. An Achilles tenotomy was undertaken in 54 feet (60.7%) when the children were 45–184 days old (median 71 days) and major release surgery in 17 feet (19.1%) when the children were 10–66 months old (median 21 months). Four children had revision surgery.

Discussion There is a significant reduction in outpatient attendances (Ua = 1313, p = <0.0001) for serial manipulation and reduced rate of release surgery (p = 4.56 × 10−5) since the implementation of the Ponseti regime. The rate of revision surgery in both groups was not significant (p = 0.15), although these samples were small.

Conclusion The Ponseti regime is an effective initial treatment for infants with CTEV compared with traditional treatment. It has decreased the number of clinic attendances and the rate of major release surgery.
Click to expand...

NewsBot · Oct 2, 2012

Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up
Hisateru Niki, Hiroshi Nakajima, Takaaki Hirano, Hirokazu Okada, Moroe Beppu
Journal of Orthopaedic Science; September 2012,

Background
Ponseti management usually requires Achilles tenotomy during the final stage of serial casting. However, we lack a good understanding of the sequential tendon healing process after tenotomy in the Ponseti bracing protocol. The purpose of this study was to clarify the ultrasonographic process of tendon healing in the gap for up to two years after Ponseti-type Achilles tenotomy in patients with clubfeet.

Methods
We conducted an ultrasonographic study to clarify the sequential changes in gap healing for up to two years after tenotomy. The subjects were 23 patients with 33 clubfeet. Achilles tenotomy was performed at mean 10.4 (8–16) weeks after birth. Dynamic and static ultrasonography was performed before tenotomy and at 1, 2, 3, 4, 6, 8, and 12 weeks as well as at 4, 6, 12, 18, and 24 months after tenotomy.

Results
Continuity and gliding were noted within four weeks. The united portion continued to thicken for up to three months after tenotomy. Starting from the fourth month, the healed portion began to lose its thickness, and this process continued into the sixth month. At one year, the thickness of the tendon did not differ much from that of the tendon on the opposing foot. In cases where patients had clubfoot on both feet and underwent simultaneous tenotomies, measurement of the tendons could not be accurately compared. At two years after tenotomy, slight irregularity of the internal structure persisted when compared with the unaffected foot. In addition, clinical and X-ray findings were evaluated simultaneously, and no recurrence was confirmed.

Conclusions
To our knowledge, our results are the first to describe the process of gap healing in the tendon after tenotomy up to and beyond two years, as recommended in the Ponseti bracing protocol.
Click to expand...

NewsBot · Oct 12, 2012

Ultrasonographic observation of the healing process in the gap after a Ponseti-type Achilles tenotomy for idiopathic congenital clubfoot at two-year follow-up.
Niki H, Nakajima H, Hirano T, Okada H, Beppu M.
J Orthop Sci. 2012 Sep 28.

BACKGROUND:
Ponseti management usually requires Achilles tenotomy during the final stage of serial casting. However, we lack a good understanding of the sequential tendon healing process after tenotomy in the Ponseti bracing protocol. The purpose of this study was to clarify the ultrasonographic process of tendon healing in the gap for up to two years after Ponseti-type Achilles tenotomy in patients with clubfeet.

METHODS:
We conducted an ultrasonographic study to clarify the sequential changes in gap healing for up to two years after tenotomy. The subjects were 23 patients with 33 clubfeet. Achilles tenotomy was performed at mean 10.4 (8-16) weeks after birth. Dynamic and static ultrasonography was performed before tenotomy and at 1, 2, 3, 4, 6, 8, and 12 weeks as well as at 4, 6, 12, 18, and 24 months after tenotomy.

RESULTS:
Continuity and gliding were noted within four weeks. The united portion continued to thicken for up to three months after tenotomy. Starting from the fourth month, the healed portion began to lose its thickness, and this process continued into the sixth month. At one year, the thickness of the tendon did not differ much from that of the tendon on the opposing foot. In cases where patients had clubfoot on both feet and underwent simultaneous tenotomies, measurement of the tendons could not be accurately compared. At two years after tenotomy, slight irregularity of the internal structure persisted when compared with the unaffected foot. In addition, clinical and X-ray findings were evaluated simultaneously, and no recurrence was confirmed.

CONCLUSIONS:
To our knowledge, our results are the first to describe the process of gap healing in the tendon after tenotomy up to and beyond two years, as recommended in the Ponseti bracing protocol. Level of evidence IV.
Click to expand...

NewsBot · Oct 16, 2012

Comparison of treatment results of idiopathic and non-idiopathic congenital clubfoot : Prospective evaluation of the Ponseti therapy.
Funk JF, Lebek S, Seidl T, Placzek R.
Orthopade. 2012 Sep 30.

BACKGROUND:
Clubfoot deformity is one of the most common congenital musculoskeletal deformities and occurs in newborns with different neuromuscular diseases. To date the Ponseti method is the gold standard for the treatment of idiopathic clubfeet but not for non-idiopathic clubfeet which are associated with neuromuscular diseases. The results of the treatment for congenital idiopathic and non-idiopathic clubfeet according to Ponseti performed in our department since 2004 were compared concerning results and relapse surgery with particular reference to the compliance of the parents concerning the use of an abduction splint.

PATIENTS AND METHODS:
A total of 101 children (28 female and 73 male) with 159 clubfeet were treated with the Ponseti method and included in this prospective non-randomized cohort study. Of these children 27 with 48 affected feet suffered from neuromuscular diseases which are associated with clubfoot deformity, such as myelomeningocele (n=4), arthrogryposis (n=9) and various other syndromes (n=14). The degree of the deformity was evaluated with the Pirani score initially, after casting and at follow-up. Parents were asked at follow-up to state subjectively how compliant they were with the abduction splint treatment. The necessity of surgical treatment of relapses was recorded. Statistical analysis was performed applying χ(2) and Kruskal-Wallis tests for the comparison of idiopathic and non-idiopathic clubfeet.

RESULTS:
The average period of follow-up was 36 month (range 6-75 months) and non-idiopathic clubfeet were initially significantly more severely deformed according to the Pirani-score (p=0.013). Treatment of non-idiopathic clubfeet was started significantly later than that of idiopathic clubfeet (p=0.003) and took significantly longer (p <0.001). A correlation between the initiation of casting and the duration of casting was not found (p=0.399). At the end of the casting period no significant differences were found between correction of idiopathic and non-idiopathic clubfeet with respect to the Pirani score (p=0.8). The mean score after casting was 0.1 in both groups. At mid-term follow-up the score increased in both groups but stayed below 0.5 with non-idiopathic clubfeet showing a significantly higher score than idiopathic clubfeet (p=0.014). Relapse surgery was necessary in 11% of the patients. No significant difference in the revision rate was found between the two groups (p=0.331) and peritalar release was not necessary in either group. The rate of revisions correlated with the compliance concerning the use of the abduction splint (p <0.001). Only 61% of the parents stated that they adhered strictly to the abduction splint treatment recommendations with no significant difference between the groups (p=0.398).

CONCLUSION:
This study shows good initial results after Ponseti treatment for idiopathic as well as non-idiopathic clubfeet. Based on the good functional results all clubfeet should initially be treated with the Ponseti method regardless of the etiology.
Click to expand...

NewsBot · Oct 16, 2012

PREDICTING THE OUTCOME FOR THE PONSETI METHOD: PIRANI SCORING IN THE MANAGEMENT OF CLUBFOOT
Chris Peach and Naomi Davis
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVII 317

Introduction It has been postulated that a mild clubfoot does better than a severe clubfoot no matter what treatment course is taken. There have been previous efforts to classify clubfoot. For units worldwide that use the Ponseti Method of clubfoot management, the Pirani scoring system is widely used. This scoring system has previously been shown to predict the number of plasters required to gain correction. Our study aimed to investigate whether the Pirani score gave an indication of longer-term outcome using tibialis anterior tendon transfer as an endpoint.

Methods A prospectively collated database was used to identify all patients treated in the Ponseti clinic at the Royal Manchester Children's Hospital between 2002 and 2005 with idiopathic clubfoot who had not received any treatment prior to their referral. Rate of tibialis tendon transfer as well as the patient's presenting Pirani score were noted. Feet were grouped for analytical purposes into a mild clubfoot (Pirani score <4) and a severe clubfoot (Pirani score 4) category depending on initial examination. Clinic records were reviewed retrospectively to identify patients who were poorly compliant at wearing boots and bars and were categorised into having “good” or “bad” compliance with orthosis use.

Results 132 feet in 94 children were included in the study. 30 (23%) tibialis tendon transfers were performed at a mean of 4.2 years (range 2.3–5.5 years). Children with severe clubfoot had a significantly higher rate of tendon transfer compared with those with mild clubfoot (28% vs. 6%; p=0.0001). 81% of patients were classified as being “good” boot wearers. Tibialis tendon transfer rates in those who were poorly compliant with boot usage were significantly higher compared with those with good compliance (52% vs. 16%; p=0.0003). There was a significantly higher tendon transfer rate in those with severe disease and poor compliance compared with good compliance (69% vs. 20%; p=0.0002). There was no association between boot compliance and tendon transfer rates in those with mild disease.

Conclusion This study shows that late recurrences, requiring tibialis anterior tendon transfer, are associated with severity of disease at presentation and compliance with use of orthoses. Tendon transfer rates are higher for those with severe disease. We have confirmed previous reports that compliance with orthotic use is associated with recurrence. However, the novel findings regarding recurrence rates in mild clubfeet may have implications regarding usage of orthoses in the management of mild idiopathic clubfeet after initial manipulation using the Ponseti method.
Click to expand...

NewsBot · Nov 22, 2012

Lower Extremity Review have just posted this article:
Benefits of Ponseti method extend to older children

Leigh · Dec 11, 2012

Hi,
Can anyone point me in the right direction? I am trying to find a Ponseti method training course in Spain, or UK.
I am resident in Spain, but happy to travel a reasonable distance
Thanks,

NewsBot · Dec 13, 2012

Achievement of gross motor milestones in children with idiopathic clubfoot treated with the ponseti method.
Sala DA, Chu A, Lehman WB, van Bosse HJ.
J Pediatr Orthop. 2013 Jan;33(1):55-8.

BACKGROUND:
The Ponseti method of idiopathic clubfoot treatment involves a series of weekly casts, a percutaneous Achilles tenotomy if needed, followed by wearing a foot abduction orthosis (FAO). Gross motor development of children with idiopathic clubfoot has not been examined. The purposes of this study were to determine the ages of achievement of gross motor milestones in children with clubfoot treated with Ponseti method and to compare those ages with historical normative developmental data.

METHODS:
In this prospective study, 51 children with idiopathic clubfoot who had their first cast applied when ≤90 days old, were full-term with no other orthopaedic conditions or previous clubfoot treatment, and were compliant with wearing FAO were enrolled. Parents were interviewed repeatedly to acquire the ages of achievement of 8 gross motor milestones.

RESULTS:
Fifteen children were excluded for reasons such as noncompliance with FAO, and not returning for follow-up. Thirty-six children, mean age of 15.2 days at first casting, achieved rolling prone to supine at a mean age of 5.1 months, rolling supine to prone at 5.1 months, sitting without support at 6.6 months, crawling on stomach at 7.1 months, crawling on hands and knees at 8.6 months, pull-to-stand at 9.0 months, cruising at 10.2 months, and ambulating independently at 13.9 months. When compared with previously published values for unaffected children, the mean ages of achievement for 6 of 8 milestones were significantly greater (P<0.05) for the children with clubfoot. The preambulatory milestones were achieved from 0.7 to 1.5 months later and independent ambulation up to 2.2 months later. Fifty percent of children with clubfoot were ambulating at 13.8 months; 90% at 17.7 months.

CONCLUSIONS:
Minimal delays in gross motor milestone achievement were found in children with idiopathic clubfoot treated with the Ponseti method. Delays were, at most, 1.5 months, except for independent ambulation, which was approximately 2 months. These findings should enable pediatric clinicians to alleviate the concerns of parents of children with idiopathic clubfoot regarding gross motor milestone achievement.
Click to expand...

NewsBot · Jan 5, 2013

Results of the Ponseti Treatment Evaluated at Four to Six Years after it Started
Poul J.
Acta Chir Orthop Traumatol Cech. 2012;79(6):524-8.

PURPOSE OF THE STUDY To assess outcomes of the Ponseti method for treatment of talipes equinovarus in relation to patient age at its start.

MATERIAL AND METHODS In the 2006-2010 period, 115 children (163 feet) with talipes equinovarus were treated using the principles of Ponseti. The right foot was affected in 44, the left foot in 23, and the bilateral form was treated in 48 patients. In order to obtain results for at least 3 years of follow-up, we included the patients treated by the Ponseti method between 2006 and 2008, in whom 83 affected feet were analysed (23 isolated right feet, 14 left feet, 23 bilateral forms). According to the Dimeglio scoring system used to assess the severity of clubfoot deformity, there were four feet in group II, 37 feet in group III and 42 feet in group IV.

RESULTS Subtalar release was performed in 29 feet (34.9%), in two feet being only posterior. Moreover, foot deviations, e.g. adduction of the forefoot less than 10° (5 feet, 6%), varus deformity of the heel less than 5° (6 feet, 7.2%), and failure to complete the Ponseti treatment (3 feet, 3.6%) were recorded. For assessment of the effect of age at start of casting on the outcome, two patient subgroup were distinguished: group 1, the treatment stared and continued in the first 8 postnatal weeks; group 2, the treatment was initiated and carried out between 9 and 20 weeks postnatally. Subsequently, subtalar release was performed in 18 of 61 feet (29.5%) in group 1, and in 11 of 21 feet (52.4 %) in group 2. Using Fischer's exact test, the difference was found statistically significant. (p<0.05). Of the three patients with an unfinished course of initial treatment, two underwent subtalar release later and one was lost to follow-up.

DISCUSSSION Contrary to many recent reports, the frequency of Ponseti treatment failure in this study is substantially higher. Nevertheless, we adhered strictly to the Ponseti protocol of treatment, tenotomy was performed under general anaesthesia and Ponseti splinting was maintained properly in all but seven patients (8.4%).

CONCLUSIONS Irrespective of rather frequent failure of the initial Ponseti treatment, its contribution for the patient is beneficial as it can reduce the extent of subtalar release required. However, a modern family will hardly accept several years of applying splints every night, irrespective of maximally sophisticated bracing. This becomes critical usually at the age when the child starts walking. Nowadays, families cooperate quite well due to the fact that a new method with high mass-media coverage has been offered to them. Key words: talipes equinovarus congenitus, Ponseti treatment, follow-up, critical analysis, failure of Ponseti treatment.
Click to expand...

NewsBot · Jan 22, 2013

Management of congenital adduct clubfoot with the Ponseti technique.
Méndez-Tompson M, Olivares-Becerril O, Preciado-Salgado M, Quezada-Daniel I, Vega-Sánchez JG
Experience at «La Perla» General Hospital

The purpose of this paper is to present the experience of the hospital using the Ponseti method in patients with congenital adduct clubfoot.

Material and methods: The study was conducted between January 2007 and December 2009. Children of both sexes were included; the Dimeglio classification was applied before surgery and their course was later assessed with the Simons scale when they resumed gait. Patients with postural clubfoot (Dimeglio I) and those with neuromuscular disease (Dimeglio IV) were excluded. Casts were placed as of 15 days of age using the Ponseti technique and then percutaneous tenotomy of the calcaneous tendon was performed in the operating room.

Results: Twenty patients (9 girls, 11 boys) and 28 feet were included in the study; they were Dimeglio II (8 children) and III (12 children). Mean age at the time of surgery was 2 months, and mean age at the time of gait assessment was 2 years. Upon applying the Simons scale, 25 feet (89.3%) had satisfactory results and 3 feet (10.7%) unsatisfactory results. Two of the latter underwent percutaneous tenotomy again and in one case the cast was applied again; they evolved properly.

Conclusions: We found in our series that the Ponseti technique is appropriate as definitive treatment for Dimeglio II and III congenital adduct clubfoot.
Click to expand...

NewsBot · Feb 1, 2013

Creep evaluation of (orthotic) cast materials during simulated clubfoot correction.
Cohen TL, Altiok H, Tarima S, Smith PA, Harris GF.
Conf Proc IEEE Eng Med Biol Soc. 2012 Aug;2012:3352-5.

The Ponseti method is a widely accepted and highly successful conservative treatment of pediatric clubfoot that relies on weekly manipulations and cast applications. However, the material behavior of the cast in the Ponseti technique has not been investigated. The current study sought to characterize the ability of two standard casting materials to maintain the Ponseti corrected foot position by evaluating creep response. A dynamic cast testing device (DCTD) was built to simulate a typical pediatric clubfoot. Semi-rigid fiberglass and rigid fiberglass casting materials were applied to the device, and the rotational creep was measured at various constant torques. The movement was measured using a 3D motion capture system. A 2-way ANOVA was performed on the creep displacement data at a significance level of 0.05. Among cast materials, the rotational creep displacement was found to be significantly different (p-values ≪ 0.001). The most creep displacement occurs in the semi-rigid fiberglass (approximately 1.0 degrees), then the rigid fiberglass (approximately 0.4 degrees). There was no effect of torque magnitude on the creep displacement. All materials maintained the corrected position with minimal change in position over time.
Click to expand...

NewsBot · Mar 2, 2013

A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms.
Church C, Coplan JA, Poljak D, Thabet AM, Kowtharapu D, Lennon N, Marchesi S, Henley J, Starr R, Mason D, Belthur MV, Herzenberg JE, Miller F.
J Child Orthop. 2012 Mar;6(1):51-9.

PURPOSE:
Isolated congenital clubfoot can be treated either operatively (posteromedial release) or conservatively (Ponseti method). This study retrospectively compared mid-term outcomes after surgical and Ponseti treatments to a normal sample and used multiple evaluation techniques, such as detailed gait analysis and foot kinematics.

METHODS:
Twenty-six children with clubfoot treated surgically and 22 children with clubfoot treated with the Ponseti technique were evaluated retrospectively and compared to 34 children with normal feet. Comprehensive evaluation included a full gait analysis with multi-segment and single-segment foot kinematics, pedobarograph, physical examination, validated outcome questionnaires, and radiographic measurements.

RESULTS:
The Ponseti group had significantly better plantarflexion and dorsiflexion range of motion during gait and had greater push-off power. Residual varus was present in both treatment groups, but more so in the operative group. Gait analysis also showed that the operative group had residual in-toeing, which appeared well corrected in the Ponseti group. Pedobarograph results showed that the operative group had significantly increased varus and significantly decreased medial foot pressure. The physical examination demonstrated significantly greater stiffness in the operative group in dorsiflexion, plantarflexion, ankle inversion, and midfoot abduction and adduction. Surveys showed that the Ponseti group had significantly more normal pediatric outcome data collection instrument results, disease-specific indices, and Dimeglio scores. The radiographic results suggested greater equinus and cavus and increased foot internal rotation profile in the operative group compared with the Ponseti group.

CONCLUSIONS:
Ponseti treatment provides superior outcome to posteromedial release surgery, but residual deformity still persists.
Click to expand...

NewsBot · Mar 14, 2013

Surgical Versus Ponseti Approach for the Management of CTEV: A Comparative Study.
Duffy CM, Salazar JJ, Humphreys L, McDowell BC.
J Pediatr Orthop. 2013 Apr;33(3):326-332.

BACKGROUND:: Results from a comparative study of Ponseti versus surgical management for congenital talipes equino varus (CTEV), using historically managed patients, are presented. No bias existed in terms of management choice or participants recruited.

METHODS:: Twenty-three surgically treated children (31 club feet; mean age 9.1 y) and 29 treated by the Ponseti technique (42 club feet; mean age 6.5 y) agreed to participate in the study. Twenty-six typically developing children (mean age 7.9 y) were also recruited as a control group. A physical examination and 3-dimensional gait analyses were carried out on all participants, and each child and his/her parent also, independently, completed the Oxford Ankle Foot Questionnaire (OxAFQ).

RESULTS:: The Ponseti group underwent fewer joint-invasive procedures than the surgical group. Passive range of dorsiflexion and plantarflexion were significantly less in the CTEV groups when compared with the control group (P<0.001), and plantarflexion was also significantly less in the surgical than in the Ponseti group (P<0.05). The bimalleolar axis was found to be significantly less in the CTEV groups than in the control group (P<0.001) and also significantly less in the surgical than in the Ponseti group (P<0.05). The gait deviation index, a gait score based on kinematics, showed a more normal gait pattern in the Ponseti group compared with the surgical group (P<0.001). The CTEV groups did not differ significantly from each other in terms of ankle sagittal and transverse plane kinematics or kinetics, but foot progression angle for the Ponseti group was external, whereas that for the surgical group was internal. The Ponseti group also scored higher than the surgical group in terms of patient satisfaction, with significantly better parent-rated OxAFQ scores in the "emotional" and "school and play" domains.

CONCLUSIONS:: The adoption of the Ponseti technique has resulted in fewer and less-invasive operations for our CTEV population, with accompanying improvement in the overall gait pattern (gait deviation index) and parent satisfaction (OxAFQ).
Click to expand...

NewsBot · Apr 6, 2013

Management of Congenital Talipes Equino Varus (CTEV) by Ponseti Casting Technique in Neonates: Our Experience
Md. Saif Ullah, Kazi Md. Noor-ul Ferdous, Md. Shahjahan, Sk. Abu Sayed
Journal of Neonatal Surgery Volume 2, Issue 2, 2013, (Apr-Jun)

Objective: The purpose of this study is to evaluate the results of Ponseti technique in the management of congenital Talipes Equino Varus (CTEV) in neonatal age group.

Methods: It is a prospective observational study, conducted during the period of July 2010 to December 2011 at the Department of Pediatric Surgery in a tertiary hospital. All the neonates with CTEV were treated with Ponseti casting technique. Neonates with other congenital deformities, arthrogryposis and myelomeningocele were excluded.

Results: Total 58 CTEV feet of 38 neonates were treated. Twenty six were males and 12 were females. Thirty seven (63.8%) feet were of rigid variety and 21(36.2 %) feet were of non-rigid variety. Twenty patients had bilateral and 18 had unilateral involvement. Mean pre-treatment Pirani score of study group was 5.57. Mean number of plaster casts required per CTEV was 3.75 (range: 2-6). Thirty five rigid and 15 non-rigid (total 86.2%) feet required percutaneous tenotomy. Out of 58 feet 56 (96.6%) were managed successfully. Three (5.2%) patients developed complications like skin excoriation and blister formation. Mean post-treatment Pirani score of the study group was: 0.36 ± 0.43.

Conclusion: The Ponseti technique is an excellent, simple, effective, minimally invasive, and inexpensive procedure for the treatment CTEV deformity. Ideally it can be performed as a day case procedure without general anesthesia even in neonatal period.
Click to expand...

NewsBot · Apr 15, 2013

Ponseti method for management of neglected idiopathic clubfoot
Hassan, Mohamed Khaled; Ibrahim, Abdelkhalek Hafez; Mostafa, Maged Mohamed; Bakr, Hatem
Current Orthopaedic Practice: 8 April 2013

Background: Although the Ponseti method has been effective in early presented clubfoot, limited information is available on the use of this method in older patients.

Methods: We prospectively followed 20 children (30 feet) with neglected idiopathic clubfoot. We sought to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 12-36 months.

Results: Older children needed more casts than younger children. Twenty-one of 30 (70%) feet needed percutaneous tendo-Achilles tenotomy for residual equinus deformity. The mean dorsiflexion after removal of the last cast was 12.5[degrees]. Six feet relapsed (20%) and were treated with recasting and tibialis anterior transfer in four feet, and two feet needed limited medial release, tendo-Achilles tenotomy, abductor hallucis tenotomy, and tibialis anterior transfer.

Conclusion: The Ponseti technique was effective in treatment of neglected clubfoot in patients between the ages of 12-36 months.
Click to expand...

NewsBot · May 4, 2013

Evaluation of cast creep occurring during simulated clubfoot correction.
Cohen TL, Altiok H, Wang M, McGrady LM, Tarima S, Krzak J, Graf A, Smith PA, Harris GF.
Proc Inst Mech Eng H. 2013 Apr 26.

The Ponseti method is a widely accepted and highly successful conservative treatment of pediatric clubfoot involving weekly manipulations and cast applications. Qualitative assessments have indicated the potential success of the technique with cast materials other than standard plaster of Paris. However, guidelines for clubfoot correction based on the mechanical response of these materials have yet to be investigated. The current study sought to characterize and compare the ability of three standard cast materials to maintain the Ponseti-corrected foot position by evaluating cast creep response. A dynamic cast testing device, built to model clubfoot correction, was wrapped in plaster of Paris, semi-rigid fiberglass, and rigid fiberglass. Three-dimensional motion responses to two joint stiffnesses were recorded. Rotational creep displacement and linearity of the limb-cast composite were analyzed. Minimal change in position over time was found for all materials. Among cast materials, the rotational creep displacement was significantly different (p < 0.0001). The most creep displacement occurred in the plaster of Paris (2.0°), then the semi-rigid fiberglass (1.0°), and then the rigid fiberglass (0.4°). Torque magnitude did not affect creep displacement response. Analysis of normalized rotation showed quasi-linear viscoelastic behavior. This study provided a mechanical evaluation of cast material performance as used for clubfoot correction. Creep displacement dependence on cast material and insensitivity to torque were discovered. This information may provide a quantitative and mechanical basis for future innovations for clubfoot care.
Click to expand...

NewsBot · May 20, 2013

Osteopathic manipulative treatment of congenital talipes equinovarus: A case report
Elda Andreoli
Journal of Bodywork and Movement Therapies; Available online 17 May 2013

Background
Treatment recommendations for congenital talipes equinovarus are focused on conservative treatments.

Objectives
The aim of this paper is to present a case report of bilateral congenital talipes equinovarus treated with two short-leg serial casting in combination with osteopathic manipulative treatment.

Methods
A newborn, 12 days old, with severe bilateral congenital talipes equinovarus entered to the Department of Orthopedics at the University of Chieti, Italy.

The pediatric orthopedic surgeon applied two single series of short-leg casts, at 12 and 20 days of age. The osteopath scheduled 4 indirect myofascial release techniques sessions.

Results
At day 33 the newborn achieved a complete correction of the congenital talipes equinovarus deformity and there was no need to apply a third series of casts.

Conclusions
Results from this single case study create an interesting and clear precedent for considering OMT in future clinical trials.
Click to expand...

NewsBot · Jun 12, 2013

The use of the ponseti method to treat clubfeet associated with congenital annular band syndrome.
Zionts LE, Habell B.
J Pediatr Orthop. 2013 Jul-Aug;33(5):563-8.

BACKGROUND:
A clubfoot deformity may be associated with congenital annular band syndrome (CABS), and has, until recently, been thought to be resistant to nonoperative management. The purpose of this report was to describe the use of the Ponseti method in the treatment of 5 patients whose clubfeet were associated with this syndrome.

METHODS:
All patients with a diagnosis of clubfoot, who were treated at the Orthopaedic Hospital Clubfoot Clinic, over a period of 4 years, were reviewed. During that period, a total of 131 infants with 194 clubfeet were treated. We identified 5 infants (3.8%) with 6 clubfeet associated with CABS. The patients were managed using the Ponseti method. One of the patients, with a contralateral amputation of the limb opposite to the side with a clubfoot, required the use of a unilateral foot abduction orthosis rather than a conventional foot abduction orthosis. The outcomes evaluated included: the number of casts needed to obtain correction, the percentage of patients requiring a tendo-Achilles tenotomy, the number of relapses, and the need for additional secondary procedures.

RESULTS:
The mean age at presentation for the 5 patients was 6.2 weeks. Four of the clubfeet had an ipsilateral band and 2 did not. None of the patients had a neurological deficit distal to a band. The mean number of casts used to correct the deformity was 6, and a percutaneous tendo-Achilles tenotomy was done in all cases. All of the feet achieved initial correction. Four patients (5 feet) experienced a relapse attributed to failure to use the postcorrective brace as prescribed. Correction of the foot in 3 of these patients was regained and maintained by another series of manipulation and cast application followed by resumption of bracing. One patient underwent an anterior tibial tendon transfer. The patients were followed for an average of 32.6 months (21 to 49 mo). All feet were supple and plantigrade at latest follow-up evaluation.

CONCLUSIONS:
The Ponseti method may be successfully applied to clubfeet associated with CABS.
Click to expand...

NewsBot · Jun 18, 2013

THE IMPACT OF A DEDICATED PONSETI SERVICE ON OUTCOMES OF IDIOPATHIC CLUBFOOT TREATMENT
A. I. W. Mayne, A. Bidwai, N. K. Garg and C. E. Bruce
Bone Joint J 2013 vol. 95-B no. SUPP 24 7

Aim To compare outcomes for children treated for idiopathic clubfeet with the Ponseti regimen before (2002–2004) and after (2005–2006) implementation of a dedicated Ponseti service.

Method A retrospective analysis of outcomes for all patients with idiopathic clubfeet treated in the 2 years before and after implementation of a dedicated Ponseti service was undertaken. Results were statistically analysed using Fisher's exact t-test.

Results In the original cohort treated between 2002–2004, with an ad-hoc service where children were treated in general paediatric orthopaedic clinics by a number of different consultants, 100 feet in 66 children were treated. 96 feet (96%) responded to initial casting. 85 feet (85%) required tendo-achilles tenotomy. 31 feet had a recurrence within the first 2 years (16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior, the remaining 15 requiring extensive soft tissue release). Between 2005–2006, with a dedicated Ponseti service, 72 feet in 53 children were treated. 72 (100%) responded to initial casting. 60 feet (83.3%) required tendo-achilles tenotomy. Relapse of the initial deformity occurred within 2 years in 11 feet – 4 children required repeat serial casting, 3 feet required tendon of tibialis anterior transfer, 3 required repeat tenotomy of tendo-achilles and one foot required extensive soft tissue release.

Conclusion Our results have shown that a dedicated Ponseti service leads to improved outcomes in the treatment of idiopathic clubfeet. We have shown a statistically significant reduction of recurrence (p=0.02) and extensive soft tissue release (0.002) in those children treated in a specialist service compared to an earlier ad hoc treatment programme.
Click to expand...

NewsBot · Jun 19, 2013

Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot: a retrospective review of 50 cases followed for median 2 years.
Noh H, Park SS.
Acta Orthop. 2013 Apr;84(2):213-7

BACKGROUND AND PURPOSE:
There is no consensus on how to predict residual equinovarus deformities after application of the Ponseti method. We assessed the prognostic value of clinical scoring systems, and also radiographic parameters that can be measured just before percutaneous Achilles tenotomy (PAT).
METHOD:
We reviewed 50 cases of clubfoot in 35 patients who were treated using the Ponseti method, including PAT, to analyze the factors that are predictive of residual equinovarus deformities. Mean age at the time of PAT was 2.4 (1.4-3.5) months, and the mean follow-up period was 23 (9-61) months. We divided these cases into 2 groups according to the need for further surgery to treat the residual deformities.
RESULTS:
40 feet with satisfactory results were included in group 1, whereas the remaining 10 feet that required further surgery for unsatisfactory residual deformities were included in group 2. We compared the initial Dimeglio and Pirani scores obtained before the first Ponseti casting, follow-up Pirani scores, and radiographic parameters determined just before PAT between these 2 groups. There was no statistically significant difference between the groups in terms of the initial Dimeglio and Pirani scores, although the follow-up Pirani scores and lateral tibiocalcaneal angle were higher and the lateral talocalcaneal angle was lower in group 2 at the time of PAT.
INTERPRETATION:
We conclude that the Pirani score, lateral tibiocalcaneal angle, and talocalcaneal angle, when assessed immediately before PAT, might be predictive factors for residual equinovarus deformity following Ponseti treatment for severe idiopathic clubfoot.
Click to expand...

NewsBot · Jun 19, 2013

Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method.
Sala DA, Chu A, Lehman WB, van Bosse HJ.
J Pediatr Orthop. 2013 Jan;33(1):55

BACKGROUND:
The Ponseti method of idiopathic clubfoot treatment involves a series of weekly casts, a percutaneous Achilles tenotomy if needed, followed by wearing a foot abduction orthosis (FAO). Gross motor development of children with idiopathic clubfoot has not been examined. The purposes of this study were to determine the ages of achievement of gross motor milestones in children with clubfoot treated with Ponseti method and to compare those ages with historical normative developmental data.
METHODS:
In this prospective study, 51 children with idiopathic clubfoot who had their first cast applied when ≤90 days old, were full-term with no other orthopaedic conditions or previous clubfoot treatment, and were compliant with wearing FAO were enrolled. Parents were interviewed repeatedly to acquire the ages of achievement of 8 gross motor milestones.
RESULTS:
Fifteen children were excluded for reasons such as noncompliance with FAO, and not returning for follow-up. Thirty-six children, mean age of 15.2 days at first casting, achieved rolling prone to supine at a mean age of 5.1 months, rolling supine to prone at 5.1 months, sitting without support at 6.6 months, crawling on stomach at 7.1 months, crawling on hands and knees at 8.6 months, pull-to-stand at 9.0 months, cruising at 10.2 months, and ambulating independently at 13.9 months. When compared with previously published values for unaffected children, the mean ages of achievement for 6 of 8 milestones were significantly greater (P<0.05) for the children with clubfoot. The preambulatory milestones were achieved from 0.7 to 1.5 months later and independent ambulation up to 2.2 months later. Fifty percent of children with clubfoot were ambulating at 13.8 months; 90% at 17.7 months.
CONCLUSIONS:
Minimal delays in gross motor milestone achievement were found in children with idiopathic clubfoot treated with the Ponseti method. Delays were, at most, 1.5 months, except for independent ambulation, which was approximately 2 months. These findings should enable pediatric clinicians to alleviate the concerns of parents of children with idiopathic clubfoot regarding gross motor milestone achievement.
Click to expand...

NewsBot · Jul 3, 2013

Report of the 1st European consensus meeting on Ponseti clubfoot treatment : Karolinska Institutet Stockholm, July 6th 2012 (Meeting Reports)
Böhm Stephanie & Sinclair Marc
Journal of children's orthopaedics 2013, vol. 7, no3, pp. 251-254

IntroductionStandards for treating idiopathic clubfoot are still under discussion. Over the last 10–15 years the Ponseti method has been widely accepted as the treatment of choice, but the method has been modified very often, and the original protocol is not always properly performed. A consensus group was set up in the UK in 2011 to define standards for Ponseti clubfoot treatment, and the purpose of our meeting is to extend these standards to the European level. Clubfoot experts from 12 countries met at Karolinska University in Stockholm to discuss goals, standards, challenges and treatment outcome, based on literature review and personal experience.

Items discussedThe ambitious agenda included most aspects of clubfoot treatment. Discussion following an intensive literature review was constructive, and the group was able to carry out discussions on defining the goal of clubfoot treatment and the preferred standard of treatment.

ConclusionIn order to establish the Ponseti method as the most effective treatment in the European context a methodological approach and analysis of existing literature remain crucial. Focus should hereby remain on defining outcome measures, the evaluation and comparison of all available methods over the long term and ease of implementation in the different healthcare environments across Europe.
Click to expand...

NewsBot · Jul 20, 2013

Classification of relapse pattern in clubfoot treated with Ponseti technique

Atul Bhaskar, Piyush Patni
Indian Journal of Orthopedics 2013 | Volume : 47 | Issue : 4 | Page : 370-376

Background: Relapse of clubfoot deformity following correction by Ponseti technique is not uncommon. The relapsed feet progress from flexible to rigid if left untreated and can become as severe as the initial deformity. No definitive classification exists to assess a relapsed clubfoot. Some authors have used the Pirani score to rate the relapse while others have used descriptive terms. The purpose of this study is to analyze the relapse pattern in clubfeet that have undergone treatment with the Ponseti method and propose a simple classification for relapsed clubfeet.

Materials and Methods: Ninety-one children (164 feet) with idiopathic clubfeet who underwent treatment with Ponseti technique presented with relapse of the deformity. There were 68 boys and 23 girls. Mean age at presentation for casting was 10.71 days (range 7-22 days). Seventy three children (146 feet, 80%) had bilateral involvement and 18 (20%) had unilateral clubfeet. The mean Pirani Score was 5.6 and 5.5 in bilateral and unilateral groups respectively. Percutaneous heel cord tenotomy was done in 65 children (130 feet, 89%) in the bilateral group and in 12 children (66%) with unilateral clubfoot.

Results: Five relapse patterns were identified at a mean followup of 4.5 years (range 3-5 years) which forms the basis of this study. These relapse patterns were classified as: Grade IA: decrease in ankle dorsiflexion from15 degrees to neutral, Grade IB: dynamic forefoot adduction or supination, Grade IIA - rigid equinus, Grade IIB - rigid adduction of forefoot/midfoot complex and Grade III: combination of two or more deformities: Fixed equinus, varus and forefoot adduction.
In the bilateral group, 21 children (38 feet, 28%) had Grade IA relapse. Twenty four children (46 feet, 34%) had dynamic intoeing (Grade IB) on walking. Thirteen children (22 feet, 16%) had true ankle equinus of varying degress (Grade IIA); eight children (13 feet, 9.7%) had fixed adduction deformity of the forefoot (Grade IIB) and seven children (14 feet, 10.7%) had two or more fixed deformities. In the unilateral group seven cases (38%) had reduced dorsiflexion (Grade IA), six (33%) had dynamic adduction (Grade IB), two (11%) had fixed equinus and adduction respectively (Grade IIA and IIB) and one (5%) child had fixed equinus and adduction deformity (Grade III). The relapses were treated by full time splint application, re-casting, tibialis anterior transfer, posterior release, corrective lateral closing wedge osteotomy and a comprehensive subtalar release. Splint compliance was compromised in both groups.

Conclusion: Relapse pattern in clubfeet can be broadly classified into three distinct subsets. Early identification of relapses and early intervention will prevent major soft tissue surgery. A universal language of relapse pattern will allow comparison of results of intervention.
Click to expand...

NewsBot · Jul 23, 2013

Creep evaluation of (orthotic) cast materials during simulated clubfoot correction.
Cohen TL, Altiok H, Tarima S, Smith PA, Harris GF.
Conf Proc IEEE Eng Med Biol Soc. 2012;2012:3352-5.

The Ponseti method is a widely accepted and highly successful conservative treatment of pediatric clubfoot that relies on weekly manipulations and cast applications. However, the material behavior of the cast in the Ponseti technique has not been investigated. The current study sought to characterize the ability of two standard casting materials to maintain the Ponseti corrected foot position by evaluating creep response. A dynamic cast testing device (DCTD) was built to simulate a typical pediatric clubfoot. Semi-rigid fiberglass and rigid fiberglass casting materials were applied to the device, and the rotational creep was measured at various constant torques. The movement was measured using a 3D motion capture system. A 2-way ANOVA was performed on the creep displacement data at a significance level of 0.05. Among cast materials, the rotational creep displacement was found to be significantly different (p-values ≪ 0.001). The most creep displacement occurs in the semi-rigid fiberglass (approximately 1.0 degrees), then the rigid fiberglass (approximately 0.4 degrees). There was no effect of torque magnitude on the creep displacement. All materials maintained the corrected position with minimal change in position over time.
Click to expand...

NewsBot · Aug 2, 2013

Midterm results of the Ponseti method in the treatment of congenital clubfoot.
Radler C, Mindler GT, Riedl K, Lipkowski C, Kranzl A.
Int Orthop. 2013 Jul 31.

PURPOSE:
The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery.
METHODS:
Patients from our prospective database of clubfeet treated with the Ponseti method with a minimum age of three years were identified. Exclusion criteria were syndrome or neurogenic association, address in a foreign country, presentation after six weeks of age, more than three casts applied elsewhere and correction with less than three casts. A total of 125 patients met the inclusion criteria. The Pediatric Outcomes Data Collection Instrument (PODCI), the disease-specific instrument (DSI) questionnaire and an invitation for a clinical examination were sent out. For patients not presenting for evaluation, data from the last follow-up were extracted.
RESULTS:
Seventy questionnaires (56 %) of patients with a mean age of 5.7 years (3.3-8.9 years) were returned. The DSI score (n = 65) was 85.3 (± 13.01 SD) and the PODCI score (n = 59) was 95.5 (± 6.3 SD). A total of 113 of 125 patients (90.4 %) with 182 clubfeet were examined in the study or seen in follow-up. During a mean follow-up of 5.2 years (range 3-8.5 years) a repeat tenotomy was performed in 4 % of cases, a percutaneous Achilles tendon lengthening in 3 %, a tibialis anterior tendon transfer in 13 % and open joint surgery in 5 %. The mean dorsiflexion with knee extended was 15.9° (range 0-32°; SD ±5.5) with 16 feet (9 %) presenting less than 10°.
CONCLUSIONS:
The functional scores indicate that the Ponseti method results in mostly pain-free feet not limiting age-appropriate activity. In this consecutive case series open joint surgery could be avoided in 95 % of cases with a good functional and anatomic outcome.
Click to expand...

NewsBot · Aug 5, 2013

Treatment of idiopathic congenital talipes equino varus deformity by ponseti technique in rural population
Sharma Gaurav, Balkrushna Mangukiya, Prasad DV, Abhishek Pandey, Anish Kumar Singh, Rakesh Singh, Suraj Gharat, Krishna Badgire.
IJMRHS. 2013; 2(3): 363-366

Background: Congenital talipes equinovarus is one of the commonest congenital anomaly of the foot with an incidence of 1 to 2 per 1000 live births. Most of the Clubfoot deformities are not recognized at birth and when recognized, there is no treatment available due to lack of awareness among the people. Nonoperative correction of the Clubfoot by Ponseti is an effective modality of treatment with excellent results.

Methods: 38 feet of Idiopathic Congenital Talipes Equinus Varus Deformity were treated in children between the age group of 1 month- 1.8 months. The severity of foot deformity was assessed as per the Pirani scoring system.

Results: 16 Males (66.66 %) and 8 Females (33.33 %) patients were included in the study with 10 (41.7%) Unilateral and 14 (58.3 %) bilateral cases. The mean of Pirani scores after the final cast was 3.02 and at 1,2 and 6 months are 0, 0 and 0.08 respectively. Standard deviation and Standard error were 0.070 and 0.014 respectively. Therefore p = 0.01, that is highly significant

Conclusion: Treatment of Idiopathic clubfoot by Ponseti technique is an effective, time tested, simple technique with a low learning curve and minimizing the need for extensive surgeries.
Click to expand...

NewsBot · Aug 10, 2013

The Ponseti method for the treatment of congenital club foot: review of the current literature and treatment recommendations.
Radler C.
Int Orthop. 2013 Aug 9.

The Ponseti method has become the gold standard of care for the treatment of congenital club foot. Despite numerous articles in MEDLINE reporting results from around the globe there are still crucial details of the Ponseti method which seem to be less commonly known or considered. The Ponseti method is not only a detailed method of manipulation and casting but also of preventing and treating relapse. Recommendations on how to correct complex club foot have resulted in an almost 100 % initial correction rate. The foot abduction brace is crucial for preventing relapse and is still a challenge for families and sometimes doctors alike. Experience and knowledge on how to support the parents, how to set and apply the brace in the best possible way and how to solve problems that can be encountered during the bracing period are essential to ensure compliance. Regular follow-up visits are necessary to be able to detect early signs of recurrence and prevent full relapse by enforcing abduction bracing, recasting or performing tibialis anterior tendon transfer. Recent midterm outcome studies have shown that by following the Ponseti treatment regime in all aspects it is possible to prevent open joint surgery in almost all cases. The body of literature of the last decade has evaluated many steps and aspects of the Ponseti method and gives valuable answers to questions encountered in daily practice. This review of the current literature and recommendations on the different aspects of the Ponseti method aims to promote understanding of the treatment regime and its' details.
Click to expand...

NewsBot · Aug 13, 2013

Midterm results of the Ponseti method in the treatment of congenital clubfoot
Christof Radler, Gabriel T. Mindler, Karin Riedl, Charlotte Lipkowski, Andreas Kranzl
International Orthopaedics; July 2013

Purpose
The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery.

Methods
Patients from our prospective database of clubfeet treated with the Ponseti method with a minimum age of three years were identified. Exclusion criteria were syndrome or neurogenic association, address in a foreign country, presentation after six weeks of age, more than three casts applied elsewhere and correction with less than three casts. A total of 125 patients met the inclusion criteria. The Pediatric Outcomes Data Collection Instrument (PODCI), the disease-specific instrument (DSI) questionnaire and an invitation for a clinical examination were sent out. For patients not presenting for evaluation, data from the last follow-up were extracted.

Results
Seventy questionnaires (56 %) of patients with a mean age of 5.7 years (3.3–8.9 years) were returned. The DSI score (n = 65) was 85.3 (± 13.01 SD) and the PODCI score (n = 59) was 95.5 (± 6.3 SD). A total of 113 of 125 patients (90.4 %) with 182 clubfeet were examined in the study or seen in follow-up. During a mean follow-up of 5.2 years (range 3–8.5 years) a repeat tenotomy was performed in 4 % of cases, a percutaneous Achilles tendon lengthening in 3 %, a tibialis anterior tendon transfer in 13 % and open joint surgery in 5 %. The mean dorsiflexion with knee extended was 15.9° (range 0–32°; SD ±5.5) with 16 feet (9 %) presenting less than 10°.

Conclusions
The functional scores indicate that the Ponseti method results in mostly pain-free feet not limiting age-appropriate activity. In this consecutive case series open joint surgery could be avoided in 95 % of cases with a good functional and anatomic outcome.
Click to expand...

NewsBot · Aug 21, 2013

Classification of relapse pattern in clubfoot treated with Ponseti technique.
Bhaskar A, Patni P.
Indian J Orthop. 2013 Jul;47(4):370-6.

BACKGROUND:
Relapse of clubfoot deformity following correction by Ponseti technique is not uncommon. The relapsed feet progress from flexible to rigid if left untreated and can become as severe as the initial deformity. No definitive classification exists to assess a relapsed clubfoot. Some authors have used the Pirani score to rate the relapse while others have used descriptive terms. The purpose of this study is to analyze the relapse pattern in clubfeet that have undergone treatment with the Ponseti method and propose a simple classification for relapsed clubfeet.
MATERIALS AND METHODS:
Ninety-one children (164 feet) with idiopathic clubfeet who underwent treatment with Ponseti technique presented with relapse of the deformity. There were 68 boys and 23 girls. Mean age at presentation for casting was 10.71 days (range 7-22 days). Seventy three children (146 feet, 80%) had bilateral involvement and 18 (20%) had unilateral clubfeet. The mean Pirani Score was 5.6 and 5.5 in bilateral and unilateral groups respectively. Percutaneous heel cord tenotomy was done in 65 children (130 feet, 89%) in the bilateral group and in 12 children (66%) with unilateral clubfoot.
RESULTS:
Five relapse patterns were identified at a mean followup of 4.5 years (range 3-5 years) which forms the basis of this study. These relapse patterns were classified as: Grade IA: decrease in ankle dorsiflexion from15 degrees to neutral, Grade IB: dynamic forefoot adduction or supination, Grade IIA - rigid equinus, Grade IIB - rigid adduction of forefoot/midfoot complex and Grade III: combination of two or more deformities: Fixed equinus, varus and forefoot adduction. In the bilateral group, 21 children (38 feet, 28%) had Grade IA relapse. Twenty four children (46 feet, 34%) had dynamic intoeing (Grade IB) on walking. Thirteen children (22 feet, 16%) had true ankle equinus of varying degress (Grade IIA); eight children (13 feet, 9.7%) had fixed adduction deformity of the forefoot (Grade IIB) and seven children (14 feet, 10.7%) had two or more fixed deformities. In the unilateral group seven cases (38%) had reduced dorsiflexion (Grade IA), six (33%) had dynamic adduction (Grade IB), two (11%) had fixed equinus and adduction respectively (Grade IIA and IIB) and one (5%) child had fixed equinus and adduction deformity (Grade III). The relapses were treated by full time splint application, re-casting, tibialis anterior transfer, posterior release, corrective lateral closing wedge osteotomy and a comprehensive subtalar release. Splint compliance was compromised in both groups.
CONCLUSION:
Relapse pattern in clubfeet can be broadly classified into three distinct subsets. Early identification of relapses and early intervention will prevent major soft tissue surgery. A universal language of relapse pattern will allow comparison of results of intervention.
Click to expand...

NewsBot · Aug 26, 2013

Plantar pressures in children with congenital talipes equino varus—A comparison between surgical management and the Ponseti technique
J.J. Salazar-Torres, B.C. McDowell, L.D. Humphreys, C.M. Duffy
Gait & Posture; Article in Press

The Ponseti technique for treatment for Congenital Talipes Equinovarus (CTEV) was introduced in the authors’ institution in 2001, substituting a more traditional orthopaedic approach which involved surgery. There is currently limited published information regarding the differences in clinical outcomes between these two techniques, particularly in relation to plantar pressure analysis. This study aims to determine differences in pedobarographic outcome in children with CTEV, treated with either a surgical or Ponseti approach.

A high resolution pedobarograph was used to record plantar pressure distribution in 52 children with CTEV and 26 children with typical development. Data were imported into Matlab where a custom programme was developed for processing and analysing pedobarographic recordings.

There were significant differences in both treatment groups compared to the typically developed group (p<0.05) for most measurements. The most salient differences between treatment groups were (i) at the hind-foot where the Ponseti group had significantly lower maximum peak pressures (p<0.05); (ii) at the lateral mid-foot where children treated by the Ponseti approach showed significantly larger peak force (p<0.001), average peak pressure (p<0.001) and maximum peak pressure (p<0.01); (iii) at the lateral fore-foot where the surgical group showed lower average peak pressure (p<0.05); and (iv) in the medial/lateral fore-foot ratio where the Ponseti group showed significantly lower values (p<0.05).

Plantar pressure analysis is a complementary measurement for the assessment of gait in children with CTEV. Data presented in this study showed that while there were deviations in children with CTEV, the differences observed between treatment groups suggest children in the Ponseti group have some level of under correction or recurrence.
Click to expand...

Highlights
•Pedobarographic analysis provides added value regarding foot functionality.
•Increased pressure under the lateral midfoot suggests a degree of undercorrection in the Ponseti group.
•Increased force at the medial midfoot in the surgical group suggests some degree of overcorrection in the surgical group.
Click to expand...

NewsBot · Aug 27, 2013

Management of Congenital Idiopathic Club Foot with Ponseti Technique at GMMMC Sukkur
ZULFIQAR A. SOOMRO, ZAMIR A. SOOMRO, SAEED A. SAMO
Source

Objective: To assess the out come of the management of congenital idiopathic club foot with Ponseti technique by using the Pirani scoring system.

Patients and methods: This prospective study was conducted at department of Orthopaedic Ghulam Muhammad Mahar Medical College (GMMMC) Sukkur from April 2011 to March 2012. A total number of 50 cases with 79 feet of congenital idiopathic clubfoot up to the age of one year of either sex were included in this study.

Results: The correction was obtained in 47 (94%) cases but three infants required PMR. Average number of casts applied was 5.7 (range: 4-8), average time for full correction was 10 weeks (range: 4-12 weeks), percutaneous Achilles tenotomy was required in 84% of cases. Mean comparison of Pirani score was significantly decreased at final stage.

Conclusion: The Ponseti method is a safe and effective treatment for the management of congenital idiopathic club foot, that PMR surgery is no longer necessary for the majority of congenital idiopathic clubfeet.
Click to expand...

NewsBot · Sep 4, 2013

PONSETI TECHNIQUE IN THE MANAGEMENT OF CLUBFOOT DEFORMITY- A STUDY
NAYEEM ALI, MD
Thesis; Rajiv Gandhi University of Health Sciences,Karnataka,Bangalore; 2013

Clubfoot deformity is among the commonest congenital anomaly. Its incidence is 2 per 1000 live births per year. Its incidence is more in developing nations. Male to female ratio is about 2:1. It has been treated since many years by conservative and surgical methods. Investigators did research and has better understanding of CTEV, in regards of anatomy, pathoanatomy and biokinematics which led to better conservative management.

AIMS AND OBJECTIVES: To evaluate the effectiveness of Ponseti technique, by Pirani severity scoring, this study was done to reproduce the clinical results, in terms of mobility, flexibility, cosmetically acceptable and plantigrade foot, and the technique.

MATERIAL AND METHOD: This prospective study was conducted during September 2010 to September 2012 in Al Ameen medical college, Bijapur, and the cases were selected on OPD basis. Total 29 patients with 38 clubfoot entered in study. Our study was completed by 34 foot. There were 3 foot (2 patients) dropout, and 1 foot was reffered for posteromedial soft tissue release. Our treatment was by Ponseti technique, and severity asscssment was done by Pirani severity scoring. Equinus correction was done by cast application or by percutaneous tenotomy.

RESULTS: Average number of cast applied was 7.97, and before tenotomy it was 6.41. Average number of cast increases with increase in age and Pirani severity score. 80.00% of patient had no residual deformity at the time of follow up. The p-value (<0.0005) showed high significance of treatment. 17.41% had statistically insignificant residual deformity. The failure was 2.86%.

CONCLUSION: Ponseti technique of treatment for clubfoot deformity is very effective, and produces painless, mobile, flexible, plantigrade and cosmetically acceptable foot without need of any major surgical intervention.
Click to expand...

NewsBot · Sep 14, 2013

The ponseti method of treatment for clubfoot in Brazil: barriers to bracing compliance.
Nogueira MP, Fox M, Miller K, Morcuende J.
Iowa Orthop J. 2013;33:161-6.

BACKGROUND:
Clubfoot is the most common extremity birth defect. It causes the feet of affected individuals to point inward and downward, preventing them from walking normally. Neglected clubfoot causes disabilities that result in a lack of social integration, creating a psychological and financial burden for the family and community. Clubfoot has been effectively treated through the Ponseti method, a treatment utilizing serial casts to correct the deformity followed by use of an abduction brace for approximately 2-4 years. sustained use of the brace is necessary to prevent relapse and ensure a successful outcome. Brace compliance in the setting of limited resources in the developing world can be challenging. The purpose of this study was to identify the barriers to bracing compliance in southeastern Brazil. In addition to socioeconomic and cultural barriers, this study also looked at improper prescribing practices by physicians as a potential cause of noncompliance. The study sought to identify the role of physician education in the use of the Ponseti method and physicians' knowledge of the bracing process.
PURPOSE OF THE STUDY:
Identify the barriers to bracing adherence that could negatively impact the treatment of children with clubfoot.
METHODS:
Forty-five orthopedists from several centers in southeastern Brazil were interviewed. Physicians were asked about their training in the Ponseti method, their protocol when prescribing the brace, their evaluation of its importance, and a series of open-ended questions designed to identify the positive and negative qualities of local braces. They were also asked what they perceived to be the biggest challenges to sustained brace use.
RESULTS:
sixteen of the physicians interviewed were orthopedic residents, and 29 had completed their residencies. Of these two groups, only 25% and 65%, respectively, appropriately prescribe the abduction brace for patients, with the majority recommending use of the brace for an inadequate period of time. The high costs and delays in acquisition of the brace and a lack of orthopedic stores able to adequately construct the orthotic, also present considerable barriers to sustained brace use.
CONCLUSIONS:
Many of the causes of noncompliance with bracing protocol stem from systemic inequities and challenges, rather than a lack of collaboration from the families themselves. Furthermore, insufficient prescription of the brace by physicians may represent a major barrier to bracing compliance in southeastern Brazil. This research indicates a need to evaluate physician training and continuing medical education in order to ensure that physicians are adequately utilizing the brace.
Click to expand...

NewsBot · Sep 17, 2013

Efficacy of Ponseti Manipualtion and Casting in Management
of Idiopathic Clubfoot: Early Results
MUHAMMAD IRFAN ZIA, MUHAMMAD ZUBAIR JAVAID, OBAID UR REHMAN
Journal of Pakistan Orthopaedic Association 2013 VOL.25 (2)

Objective: To evaluate the efficacy of Ponseti method for treatment of idiopathic clubfoot by correction of
all deformities in terms of Pirani score 1 after completion of treatment.
Study Design: Prospective descriptive case series study.
Material and Methods: 55 patients of either gender from birth till two years of age were included. Children
older than 2 years, those with secondary clubfeet and those who were operated upon before were
excluded from study. Clubfeet were graded according to the Pirani scoring system and serial manipulations
followed by weekly above-knee casting was done in the sequential order as described by Ponseti.
Results: The study was conducted for 15 months. Mean number of casts required was 5.25. Achilles
tenotomy was required in 78.18% patients. Correction of deformities was achieved in 96.4% patients. Final
Pirani score was documented to assess the success of treatment in terms of Pirani score 1. Patients
were followed every week for casting and then every 6 weeks after completion of treatment for observation
of maintenance of correction.
Conclusion: The Ponseti method is safe and effective treatment for congenital idiopathic clubfoot, and
radically decreases the need for extensive corrective surgery.
Click to expand...

NewsBot · Oct 3, 2013

Treatment of idiopathic congenital clubfoot using the Ponseti method: ten years of experience
Luiz Carlos Ribeiro Lara, Delmo João Carlos Montesi Neto, Fagner Rodrigues Prado, Adonai Pinheiro Barreto
Revista Brasileira de Ortopedia Volume 48, Issue 4, July–August 2013, Pages 362–36

Objective
To evaluate outcomes of 229 idiopathic clubfeet (ICF) treated using the Ponseti method, from 2001 to 2011, comparing two groups with different follow-ups.
Method
155 patients (229 ICF) were treated separated in two groups: Group I: 72 patients (109 ICF – 47.6%) with a follow up of 62 to 128 months (mean of 85). Group II: 83 patients (120 ICF – 52.4%) with a follow up of 4 to 57 months (mean of 33.5). We have considered satisfactory outcomes for cases which correction of all deformed components, without surgery.
Results
Mean age for the initial assessment was 5.4 months in Group I and 3.2 in Group II. Satisfactory outcomes were obtained in 85.4% in Group I and 97.5% in Group II. Mean cast placements were 9.5 in Group I and 7 in Group II. 67% were submitted to percutaneous Achilles tenotomy in Group I and 65% in Group II. Deformity relapses, when using abducted braces, occurred in 41 (37.6%) feet from Group I; 11 were treated surgically. In Group II, 17 feet relapsed (14.1%); three of them were submitted to surgery.
Conclusion
The method was successful in both groups, in low number of complications. The results were statistically superior in Group II when deformity correction, cast placements, relapses and surgery indication.
Click to expand...

NewsBot · Oct 4, 2013

‘Fast Casts’: Evidence Based and Clinical Considerations for Rapid Ponseti Method
April Sutcliffe, Kolini Vaea, John Poulivaati, Angela Margaretpdflrg Evans
The Foot and Ankle Online Journal 6 (9): 2

The Ponseti method of correction of congenital clubfoot is recognized as the preferred management technique for this pediatric deformity. The original method has been subtly modified over time in response to clinical experience and research findings. Most recently, two randomized controlled trials have shown that less time is needed for each serial cast immobilization. Clinical cases from the Kingdom of Tonga are presented to illustrate the clinical use of more rapid plaster cast changes – the ‘fast casts’ modification incorporating increased manual manipulation time, within the Ponseti method. The Pirani score was used to monitor the clubfoot correction between each plaster cast change for each baby. In all feet the Pirani scores reduced sequentially with shorter periods of casting. Shorter duration of cast immobilization – ‘fast casts’ – can be used with many advantages for the clinical setting. Less time in plaster can at least halve the corrective phase of Ponseti management without compromising results. In addition, there are possible benefits for families from distant locations, for babies being less prone to skin irritations, and less difficult day-to-day baby care related to long leg plaster casts. These factors may benefit compliance and overall treatment outcomes.
Click to expand...

Ponseti Method for clubfoot

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Leigh Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Looking for Forensic Podiatry: Principles and Methods, Second Edition

LQDCELL Method from Puma

Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers

Lacuna method of treatment for onychomycosis

Slower runners benefit most from elite methods

Sand box, wax sheet casting method

SVM Classification in the Success of Wart Treatment Methods

Share This Page

Useful Searches