Early Radiographic Changes in the Lateral Talocalcaneal Angle Following Achilles Tenotomy in Children With Idiopathic Clubfoot

2019 ◽  
Vol 41 (3) ◽  
pp. 350-355
Author(s):  
Jingchun Li ◽  
Yuanzhong Liu ◽  
Yiqiang Li ◽  
Zhe Yuan ◽  
Hongwen Xu ◽  
...  
Keyword(s):  
Correlation Coefficients ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Neutral Position ◽  
Level Of Evidence ◽  
Positive Correlation ◽  
Achilles Tenotomy ◽  
Severity Of The Disease ◽  
The Relationship ◽  
Radiographic Changes

Background: Percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method and is performed in 85% to 90% of patients. However, there is a lack of objective data assessing early radiographic changes in children undergoing PAT. Methods: Forty-nine patients with idiopathic clubfoot treated by Ponseti casting were prospectively enrolled between October 2017 and October 2018. Preoperative and postoperative ankle dorsiflexion (pre-ADFmax, post-ADFmax) and lateral talocalcaneal angle (pre-LTCAmax, post-LTCAmax) values with the ankle in maximal dorsiflexion as well as postoperative LTCA values with the ankle in the neutral position (post-LTCAneutral) were measured. The relationship between the preoperative and postoperative ADF and LTCA values was studied using Pearson or Spearman correlation coefficients. Forty-nine patients (72 feet) were included; the mean age at initial treatment was 32.2 ± 24.1 days. Results: Post-LTCAmax improved significantly from 18.6 ± 9.2 degrees to 25.1 ± 10.5 degrees ( P < .0001). Pre-ADF and pre-LTCAmax showed a positive correlation in both the less than 28-day group ( r = 0.42; P = .015) and the Dimeglio III group ( r = 0.29; P = .035). However, post-ADF and post-LTCAmax showed a positive correlation in the Dimeglio III group ( r = 0.30; P = .028). The degree of improvement in post-LCTAmax in the Dimeglio III group was similar to that in the Dimeglio IV group ( P = .28). Conclusion: The LTCA increased immediately after PAT in clubfoot, although the improvement seemed to be unrelated to the severity of the disease. PAT led to an increase in both ADF and the LTCA, and it contributed to the improvements in subtalar joint motion and alignment. Level of Evidence: Level III, comparative study.

scholarly journals Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: a need for improved scoring systems

2019 ◽  
Vol 13 (5) ◽  
pp. 478-485
Author(s):  
C. Bettuzzi ◽  
C. N. Abati ◽  
G. Salvatori ◽  
A. Zanardi ◽  
M. Lampasi
Keyword(s):  
Clinical Setting ◽  
Interobserver Reliability ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Scoring Systems ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Prevalence Index ◽  
Level I

Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. Conclusions In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. Level of Evidence Level I – Diagnostic studies

Relationship amongst ResearchGate altmetric indicators and Scopus bibliometric indicators

2015 ◽  
Vol 116 (9/10) ◽  
pp. 564-577 ◽  
Author(s):  
RISHABH SHRIVASTAVA ◽  
Preeti Mahajan
Keyword(s):  
Sample Size ◽  
Correlation Coefficients ◽  
Strong Positive Correlation ◽  
Bibliometric Indicators ◽  
Pearson’S Correlation ◽  
Content Type ◽  
Positive Correlation ◽  
Pearson's Correlation ◽  
Different Characteristics ◽  
The Relationship

Purpose – The purpose of this paper is twofold. First, the study aims to investigate the relationship between the altmetric indicators from ResearchGate (RG) and the bibliometric indicators from the Scopus database. Second, the study seeks to examine the relationship amongst the RG altmetric indicators themselves. RG is a rich source of altmetric indicators such as Citations, RGScore, Impact Points, Profile Views, Publication Views, etc. Design/methodology/approach – For establishing whether RG metrics showed the same results as the established sources of metrics, Pearson’s correlation coefficients were calculated between the metrics provided by RG and the metrics obtained from Scopus. Pearson’s correlation coefficients were also calculated for the metrics provided by RG. The data were collected by visiting the profile pages of all the members who had an account in RG under the Department of Physics, Panjab University, Chandigarh (India). Findings – The study showed that most of the RG metrics showed strong positive correlation with the Scopus metrics, except for RGScore (RG) and Citations (Scopus), which showed moderate positive correlation. It was also found that the RG metrics showed moderate to strong positive correlation amongst each other. Research limitations/implications – The limitation of this study is that more and more scientists and researchers may join RG in the future, therefore the data may change. The study focuses on the members who had an account in RG under the Department of Physics, Panjab University, Chandigarh (India). Perhaps further studies can be conducted by increasing the sample size and by taking a different sample size having different characteristics. Originality/value – Being an emerging field, not much has been conducted in the area of altmetrics. Very few studies have been conducted on the reach of academic social networks like RG and their validity as sources of altmetric indicators like RGScore, Impact Points, etc. The findings offer insights to the question whether RG can be used as an alternative to traditional sources of bibliometric indicators, especially with reference to a rapidly developing country such as India.

Frequency of percutaneous achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method

2018 ◽  
Vol 27 (2) ◽  
pp. 163
Author(s):  
ChukwuemekaOkechukwu Anisi ◽  
JosephEffiong Asuquo ◽  
InnocentEgbeji Abang
Keyword(s):  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy

scholarly journals Bracing in clubfoot: do we know enough?

2019 ◽  
Vol 13 (3) ◽  
pp. 258-264 ◽  
Author(s):  
C. Alves
Keyword(s):  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Ponseti Method ◽  
Level Of Evidence ◽  
Achilles Tenotomy ◽  
Advantages And Disadvantages ◽  
Serial Casting ◽  
Custom Made ◽  
The Individual

Purpose The Ponseti method is widely used in clubfoot treatment. Long-term follow-up shows high patient satisfaction and excellent functional outcomes. Clubfoot tendency to relapse is a problem yet to solve. Given the importance of bracing in relapse prevention, we ought to discuss current knowledge and controversies about bracing. Methods We describe types of braces used, with its advantages and disadvantages, suggesting bracing schedules and duration. We identify bracing problems and pinpoint strategies to promote adherence to bracing. Results When treating a clubfoot by the Ponseti method, the corrected foot should be held in an abducted and dorsiflexed position, in a foot abduction brace (FAB), with two shoes connected by a bar. The brace is applied after the clubfoot has been completely corrected by manipulation, serial casting and possibly Achilles tenotomy. Bracing is recommended until four to five years of age and needs to be fitted to the individual patient, based on age, associated relapse rate and timing when correction was finished. Parental non-adherence to FAB use can affect 34% to 61% of children and results in five- to 17-fold higher odds of relapse. In patients who have recurrent adherence problems, a unilateral lower leg custom-made orthosis can be considered as a salvage option. Healthcare providers must communicate with patients regarding brace wearing, set proper expectations and ensure accurate use. Conclusion Bracing is essential for preventing clubfoot relapse. Daily duration and length of bracing required to prevent recurrence is still unknown. Prospective randomized clinical trials may bring important data that will influence clinicians’ and families’ choices regarding bracing. Level of Evidence V

scholarly journals Additional challenges in children with idiopathic clubfoot: is it just the foot?

2019 ◽  
Vol 13 (3) ◽  
pp. 245-251 ◽  
Author(s):  
E. Lööf
Keyword(s):  
Motor Skills ◽  
Developmental Disorders ◽  
Ponseti Method ◽  
Control Group ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Gross Motor ◽  
Assessment Protocol ◽  
Related Quality ◽  
Health Related

Purpose Treatment of idiopathic clubfoot (IC) has improved since the introduction of the Ponseti method. However, relapses are still common and primarily related to non-adherence to the brace regime. Our hypothesis was that IC might be more than just a structural deformity. Based on three studies, the aim of this paper was to provide an overview of findings regarding additional challenges within IC. Methods In total, 153 children with IC and 137 control children participated in the studies. The first study assessed gross motor skills in six motor tasks using the Clubfoot Assessment Protocol. The second and third studies surveyed neurodevelopmental difficulties (NDDs) using the Five to Fifteen (FTF) questionnaire and health-related quality of life (HRQoL) using the EuroQol-5D youth. Results A high percentage of gross motor deviations were found in children with IC compared with controls, and those correlated poorly with clubfoot severity and foot movement. Children with IC had a higher prevalence of NDDs on the FTF compared with the control group, including the domains: motor skills, perception and language. One-third of children with IC were defined as at risk of developmental disorders. In this subgroup, parents were less satisfied with the outcome of clubfoot treatment and the children reported worse HRQoL than those without NDDs. Conclusion The findings suggest additional challenges in children with IC, such as NDDs, apparently affecting both clubfoot treatment outcome and HRQoL. Thus, awareness of these challenges could be vital to further optimize treatment and support, for example, with regards to brace adherence. Level of Evidence II - Prognostic study

scholarly journals Effectiveness of achillotomy in children with arthrogryposis

2019 ◽  
Vol 7 (2) ◽  
pp. 51-60
Author(s):  
Svetlana I. Trofimova ◽  
Denis V. Derevianko ◽  
Evgeniia A. Kochenova ◽  
Ekaterina V. Petrova
Keyword(s):  
Open Surgery ◽  
Ponseti Method ◽  
Lateral View ◽  
Neutral Position ◽  
X Ray ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Equinus Contracture ◽  
The Mean ◽  
Equinus Deformity

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles. Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis. Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined. Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively. Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.

scholarly journals The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091510
Author(s):  
Takao Kaneko ◽  
Norihiko Kono ◽  
Yuta Mochizuki ◽  
Masaru Hada ◽  
Shinya Toyoda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Patient Reported Outcome ◽  
Neutral Position ◽  
Positive Correlation ◽  
Outcome Measurements ◽  
Patient Reported ◽  
Total Knee ◽  
The Relationship

Objective: Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs). Methods: Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA. Results: Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores ( r = 0.60, p < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores ( r = 0.49, p < 0.05; r = 0.51, p < 0.05). Conclusion: The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA. Level of Evidence: II

Mini-Open Technique for the Achilles Tenotomy in Correction of Idiopathic Clubfoot

2008 ◽  
Vol 98 (5) ◽  
pp. 414-417 ◽  
Author(s):  
Ali Dogan ◽  
Ali Murat Kalender ◽  
Ebubekir Seramet ◽  
Mustafa Uslu ◽  
Ahmet Sebik
Keyword(s):  
Present Article ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Open Technique ◽  
Achilles Tenotomy ◽  
Neurovascular Injury ◽  
Equinus Deformity ◽  
Mini Open

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30°) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced. (J Am Podiatr Med Assoc 98(5): 414–417, 2008)

scholarly journals Relapse following use of Ponseti method in idiopathic clubfoot

2018 ◽  
Vol 12 (6) ◽  
pp. 566-574 ◽  
Author(s):  
S. Chand ◽  
A. Mehtani ◽  
A. Sud ◽  
J. Prakash ◽  
A. Sinha ◽  
...  
Keyword(s):  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Strict Adherence ◽  
Percutaneous Tenotomy ◽  
The Mean ◽  
Group 2 ◽  
Relapse Rates ◽  
Group 1

Purpose We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well. Methods We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol. Results Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%. Conclusion We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol. Level of evidence: IV

scholarly journals The influence of laterality, sex and family history on clubfoot severity

2020 ◽  
Vol 14 (2) ◽  
pp. 145-150
Author(s):  
Giada Salvatori ◽  
Camilla Bettuzzi ◽  
Caterina Novella Abati ◽  
Giuseppe Cucca ◽  
Alessandro Zanardi ◽  
...  
Keyword(s):  
Family History ◽  
Epidemiological Studies ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Degree Relative ◽  
Level Of Evidence ◽  
Female Ratio ◽  
Significant Difference ◽  
Initial Severity ◽  
The Right

Purpose Epidemiological studies on idiopathic clubfeet have shown a typical distribution consistent across ethnic groups: bilaterality in about 50% of cases and a male to female ratio of 2:1. Whether this corresponds also to differences in severity according to laterality and sex has been poorly evaluated. As well, the correlation between family history and severity has not been previously investigated. The aim of this study was to investigate how laterality, sex and family history influence severity and treatment. Methods In all, 97 infants with idiopathic clubfoot (81 male, 16 female; 55 unilateral, 42 bilateral; 19 with a first or second-degree relative affected) consecutively treated with Ponseti method were prospectively enrolled. Initial severity (according to Dimeglio and Pirani scores) and treatment (number of casts and need for tenotomy) were analyzed in the different subgroups. Results Initial severity according to Pirani (p = 0.020) and Dimeglio score (p = 0.006), number of casts (p = 0.000) and tenotomy (p = 0.045) were significantly higher in bilateral than in unilateral cases. In bilateral cases, a significant correlation was found between the right and left foot of each patient in terms of initial severity, number of casts and tenotomy performed. No statistically significant difference was found according to sex and family history. Conclusions This study has confirmed the different behaviour of bilateral cases reported by previous studies; bilateral cases are more severe and show similar features in their right and left foot. This could be the result of different pathogenic mechanisms, likely on a genetic basis. Sex and family history did not seem to influence severity. Level of Evidence Level of evidence II

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