Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis

Introduction: Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot. Material and methods: We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe. Results: There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet. Conclusions: Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.

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Perception of Unilateral Weightbearing during Unilateral and Bilateral Upright Stance

Perceptual and Motor Skills ◽

10.2466/pms.1990.71.1.123 ◽

1990 ◽

Vol 71 (1) ◽

pp. 123-128 ◽

Cited By ~ 6

Author(s):

Lori Schaefer ◽

Richard W. Bohannon

Keyword(s):

Analysis Of Variance ◽

Assistive Device ◽

Target Level ◽

Upright Stance ◽

Absolute Value ◽

Bilateral Group ◽

Single Scale ◽

Group A ◽

The Mean ◽

Unilateral Group

To compare the effect of stance (unilateral vs bilateral) and of weightbearing target (25%, 50%, 75%) on error in weightbearing perception, two groups, unilateral and bilateral, of 30 comparable subjects were tested. Weightbearing was measured while subjects stood on digital scales; bilateral stance was accomplished using two scales, and unilateral stance was accomplished using a walker and a single scale. The subject's error in perceiving weightbearing at each target level was assessed by taking the absolute value of the target percent weightbearing minus the mean actual percent weightbearing. The mean errors at the 25, 50 and 75% targets were 6.5, 3.2, 17.6% for the unilateral group and 3.1, 1.4, 3.8% for the bilateral group. A two-way analysis of variance indicated the magnitude of error differed between groups and target levels, with a greater over-all error displayed by the unilateral weightbearing group. Our results suggest that adults are less accurate in judging weightbearing while standing on one, rather than on two, lower extremities. Clinicians should not expect patients to follow accurately instructions to weightbear at a specific percentage of full weight, particularly when using an assistive device to adjust weightbearing.

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Clubfoot treatment with Ponseti method – Parental distress during plaster casting

10.21203/rs.3.rs-21711/v1 ◽

2020 ◽

Author(s):

Christian Walter ◽

Saskia Sachsenmaier ◽

Markus Wünschel ◽

Martin Teufel ◽

Marco Götze

Keyword(s):

Ponseti Method ◽

Long Term Results ◽

Congenital Defects ◽

Idiopathic Clubfoot ◽

Parental Distress ◽

Achilles Tenotomy ◽

Pirani Score ◽

Plaster Casting ◽

Initial Hypothesis ◽

Mental Resilience

Abstract Background: Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results: High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25) and. During treatment, mental resilience improved (p = 0.015) significantly. The Spearmann correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected. Conclusion: The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

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Relapse Pattern in Club Foot Treated with Ponseti Technique - A Prospective Observational Study from Kerala, India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/206 ◽

2021 ◽

Vol 8 (16) ◽

pp. 1068-1073

Author(s):

Vishnu M ◽

Jacob Mathew ◽

Raju Karuppal ◽

Amarnath Prasad

Keyword(s):

Observational Study ◽

Club Foot ◽

Prospective Observational Study ◽

Ponseti Method ◽

Ankle Dorsiflexion ◽

Idiopathic Clubfoot ◽

Bilateral Group ◽

Relapse Pattern ◽

Relapse Patterns ◽

Unilateral Group

BACKGROUND Though the Ponseti method has become the popular and standard of care for clubfoot correction, relapse of clubfoot deformity following correction is not uncommon. The relapsed feet can progress from flexible to rigid if left untreated and can become as severe as the initial deformity. The purpose of this study was to analyse the relapse pattern in clubfeet that have undergone treatment with the Ponseti method. METHODS Between 2015 and 2017, 78 children (134 feet), 58 boys and 20 girls were included in this study. It was a prospective observational study of relapse patterns in idiopathic clubfoot after one year of completion of the Ponseti method of treatment. Pirani scoring system was used to identify the relapse. RESULTS Dynamic, fixed, and complete relapse patterns were observed in this study. Patients were categorised into two groups - bilateral and unilateral. In the bilateral group, 18 children (36 feet i.e. 23 %) had decreased ankle dorsiflexion, 5 had (10 feet i.e. 6 %) rigid equinus, 22 had (44 feet i.e., 29 %) dynamic forefoot adduction or supination and 5 had (10 feet i.e. 6 %) fixed adduction in forefoot and midfoot. Six children from the bilateral group showed complete relapse. Among the unilateral group, 8 children (8 feet i.e. 36 %) presented with decreased ankle dorsiflexion, 4 had (4 feet i.e. 18 %) rigid equinus relapse, 6 had (6 feet i.e. 27 %) dynamic forefoot adduction or supination and 4 had (4 feet i.e. 18 %) showed fixed forefoot adduction. CONCLUSIONS Dynamic forefoot adduction or supination pattern is common to relapse pattern in the bilateral group and dynamic hind-foot relapse was common in the unilateral group. Age at initial presentation, initial Pirani score, and the number of casts required were not significantly related to the incidence of relapse. KEYWORDS Club Foot, CTEV, Ponseti Method, Relapse Pattern

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Clubfoot treatment with Ponseti method – Parental distress during plaster casting

10.21203/rs.3.rs-21711/v2 ◽

2020 ◽

Author(s):

Christian Walter ◽

Saskia Sachsenmaier ◽

Markus Wünschel ◽

Martin Teufel ◽

Marco Götze

Keyword(s):

Ponseti Method ◽

Long Term Results ◽

Congenital Defects ◽

Idiopathic Clubfoot ◽

Parental Distress ◽

Achilles Tenotomy ◽

Pirani Score ◽

Plaster Casting ◽

Initial Hypothesis ◽

Mental Resilience

Abstract Background Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. The Spearman correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected.Conclusion The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

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Comparison of plaster-of-Paris casts and Woodcast splints for immobilization of the limb during serial manipulation and casting for idiopathic clubfoot in infants

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2020-0181.r4 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1399-1404

Author(s):

Kumar Amerender Singh ◽

Hitesh Shah ◽

Benjamin Joseph

Keyword(s):

Confidence Interval ◽

Prospective Trial ◽

Lower Limbs ◽

Idiopathic Clubfoot ◽

Plaster Of Paris ◽

Pirani Score ◽

Full Correction ◽

Randomized Prospective Trial ◽

The Mean ◽

Time Required

Aims The study was undertaken to compare the efficacy of Woodcast splints and plaster-of-Paris casts in maintaining correction following sequential manipulation of idiopathic clubfeet. Methods In this randomized prospective trial, 23 idiopathic clubfeet were immobilized with plaster-of-Paris casts and 23 clubfeet were immobilized with a splint made of Woodcast that encircled only two-thirds the circumference of the limb. The number of casts or splints needed to obtain full correction, the frequency of cast or splint-related complications, and the time taken for application and removal of the casts and splints were compared. Results The mean number of casts required to obtain full correction of the deformity (Pirani Score 0) was 4.35 (95% confidence interval (CI) 3.74 to 4.95) when plaster-of-Paris was used and 4.87 (95% CI 4.33 to 5.41) when the Woodcast splint was used (p = 0.190). The time required for application and removal of the Woodcast splint were significantly less than that required for application and removal of plaster-of-Paris casts (p < 0.001). Woodcast splint-related complications were not more frequent than plaster-of-Paris cast related complications. Conclusion Though Woodcast splints covering two-thirds of the circumference of the lower limbs of infants were effective in maintaining the correction of clubfoot deformity during serial manipulation and casting treatment, the superiority of Woodcasts over plaster-of-Paris could not be established. Cite this article: Bone Joint J 2020;102-B(10):1399–1404.

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Bilateral idiopathic club foot in baby of a rheumatoid mother: A rare case report and its management

IP International Journal of Orthopaedic Rheumatology ◽

10.18231/j.ijor.2021.011 ◽

2021 ◽

Vol 7 (1) ◽

pp. 46-49

Author(s):

Ranjeet Choudhary ◽

Alok Chandra Agrawal ◽

Anupam Pradip Inamdar ◽

Pandya Raj ◽

Shilp Verma

Keyword(s):

Rheumatoid Arthritis ◽

Club Foot ◽

Rare Case ◽

Deformity Correction ◽

Idiopathic Clubfoot ◽

Casting Method ◽

Congenital Clubfoot ◽

Pirani Score ◽

Serial Casting ◽

Female Baby

Congenital clubfoot has a multifaceted etiology, with several hypotheses offered in its etiopathogenesis. The clubfoot has rarely been reported in babies born to women who have rheumatoid arthritis (RA). We present a rare case of a 31-year-old lady with RA on disease-modifying anti-rheumatoid drugs who delivered a child with bilateral congenital clubfoot. She had previously been using Methotrexate, Hydroxychloroquine, and Sulfasalazine regularly, but Methotrexate was stopped seven months before pregnancy. A full-term female baby was born through the cesarean section with bilateral clubfoot deformity and a modified Pirani score of eight out of 10. The deformity correction was done with the Ponseti serial casting method. The final modified Pirani score was two out of ten. In newborns born to rheumatoid arthritis mothers, the club foot deformity was effectively treated with serial Ponseti corrective casts, as was idiopathic clubfoot in babies born to non-rheumatoid mothers. Our findings validate the Ponseti serial casting method for these kinds of patients.

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Ponseti treated idiopathic clubfoot - outcome predictive factors in the test of time: analysis of 500 feet followed for five to 20 years

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210156 ◽

2021 ◽

pp. 1-7

Author(s):

Yoram Hemo ◽

Ariella Yavor ◽

Meirav Kalish ◽

Eitan Segev ◽

Shlomo Wientroub

Keyword(s):

Cost Effective ◽

Functional Score ◽

Idiopathic Clubfoot ◽

Level Of Evidence ◽

Achilles Tenotomy ◽

Pirani Score ◽

Institutional Review ◽

Level Ii ◽

Chi Squared ◽

Initial Correction

Purpose To investigate a set of risk factors on the outcome of Ponseti treated idiopathic clubfeet (ICF). Methods This study was approved by the institutional review board. A retrospective analysis of prospectively gathered data over a 20-year period, at a single dedicated clubfoot clinic. Records of 333 consecutive infants with 500 ICF were analyzed. Initial Pirani score, number of casts, need for tenotomy, foot abduction brace compliance and functional score had been documented. The need for surgery after initial correction was the outcome measure. All children were followed by the same team throughout the study period. Descriptive statistics, chi-squared and multivariate analysis were performed. Results In total, 82 children (24%) with 119 feet (23.8%) were operated on, with 95.1% of feet being operated up to the age of nine years. There was a significant correlation between the Pirani score at presentation and the number of surgical procedures (chi-squared = 79.32; p < 0.001). Achilles tenotomy was done in 94.8% of patients. Pirani score of > 4.5 before casting was strongly associated with increased surgical risk (odds ratio = 1.95). When six to eight cast changes were needed, surgical prospect was 2.9 more, increasing to 11.9 when nine or more casts were needed. Conclusion Foot severity and number of cast changes were the strongest predictors for future surgery. Estimation of the risk of deformity recurrence after initial correction may help in tailoring a cost-effective personal treatment and follow-up protocol. Personalized focused protocol will help patients and caregivers and will reduce expenses. Level of Evidence Level II - prognostic study.

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Idiopathic clubfoot treated by Ponseti method: a series of 300 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184383 ◽

2018 ◽

Vol 4 (6) ◽

pp. 954

Author(s):

Sunil Kumar Bhatiwal ◽

B. L. Chopra ◽

B. L. Khajotia ◽

Shakti Chauhan

Keyword(s):

Prospective Study ◽

Clinical Evaluation ◽

Excellent Result ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Congenital Deformities ◽

Pirani Score ◽

The Mean

Background: Clubfoot is a complicated deformity of the foot. It is one of the commonest congenital deformities in children. The main aim of this study was to evaluate the efficacy management of clubfoot by Ponseti method.Methods: This prospective study included 300 children (456 club feet) below the age of 2 years with idiopathic clubfeet from January 2013 to December 2017. In all the cases the Ponseti method was used for the management. The severity of the deformity was assessed with the help of the Pirani score and clinical evaluation of the foot was done.Results: Out of 300 patients 204 patients were male and 96 patients were female and 144 were unilateral clubfoot and 156 were bilateral cases of clubfoot. The mean number of casts required for correction was 5.4 (4–10). Out of 456 clubfeet 356 (78%) feet were required tenotomy. There was relapse seen in 36 (7.9%) feet which had to be managed with 2–3 serial manipulations and casting and these resolved. Excellent result found in our study in 92% cases, good results were found in 5% cases and poor results were found in 3% cases.Conclusions: Ponseti technique is a very useful and effective method of management of idiopathic clubfoot up to 2 year of age.

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Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02261-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Mohammad Ali Tahririan ◽

Mohammadreza Piri Ardakani ◽

Sara Kheiri

Keyword(s):

English Literature ◽

Scoring Systems ◽

Ponseti Method ◽

Term Treatment ◽

Classification Systems ◽

Idiopathic Clubfoot ◽

Short Term Treatment ◽

Pirani Score ◽

Treatment Parameter ◽

The Mean

Abstract Background Congenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial. Methods Patients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented. Results One hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %( n = 12). The mean initial Pirani score (P < 0.001) and the mean initial Dimeglio score (P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) (P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction. Conclusion In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature.

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Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

The Journal of Knee Surgery ◽

10.1055/s-0040-1716381 ◽

2020 ◽

Author(s):

Vicente Jesús León-Muñoz ◽

Mirian López-López ◽

Alonso José Lisón-Almagro ◽

Francisco Martínez-Martínez ◽

Fernando Santonja-Medina

Keyword(s):

Computed Tomography ◽

Deformity Correction ◽

Patient Specific ◽

Control Group ◽

X Rays ◽

Varus Alignment ◽

Patient Specific Instrumentation ◽

Conventional Instrumentation ◽

The Mean ◽

Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

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