Mid-term Results of Ponseti Method for the treatment of Congenital Idiopathic Clubfoot - (A Study of 67 Clubfeet with Mean Five Year Follow-Up)

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

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Congenital talipes equinovarus

The Bone & Joint Journal ◽

10.1302/0301-620x.101b6.bjj-2018-1421.r1 ◽

2019 ◽

Vol 101-B (6) ◽

pp. 639-645 ◽

Cited By ~ 9

Author(s):

Y. Gelfer ◽

S. Wientroub ◽

K. Hughes ◽

A. Fontalis ◽

D. M. Eastwood

Keyword(s):

Systematic Review ◽

Ponseti Method ◽

Assessment Methods ◽

Major Surgery ◽

Idiopathic Clubfoot ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Minor Surgery ◽

Meta Analyses

AimsThe Ponseti method is the benchmark treatment for the correction of clubfoot. The primary rate of correction is very high, but outcome further down the treatment pathway is less predictable. Several methods of assessing severity at presentation have been reported. Classification later in the course of treatment is more challenging. This systematic review considers the outcome of the Ponseti method in terms of relapse and determines how clubfoot is assessed at presentation, correction, and relapse.Patients and MethodsA prospectively registered systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported idiopathic clubfoot treated by the Ponseti method between 1 January 2012 and 31 May 2017 were included. The data extracted included demographics, Ponseti methodology, assessment methods, and rates of relapse and surgery.ResultsA total of 84 studies were included (7335 patients, 10 535 clubfeet). The relapse rate varied between 1.9% and 45%. The rates of relapse and major surgery (1.4% to 53.3%) and minor surgery (0.6% to 48.8%) both increased with follow-up time. There was high variability in the assessment methods used across timepoints; only 57% of the studies defined relapse. Pirani scoring was the method most often used.ConclusionRecurrence and further surgical intervention in idiopathic clubfoot increases with the duration of follow-up. The corrected and the relapsed foot are poorly defined, which contributes to variability in outcome. The results suggest that a consensus for a definition of relapse is needed. Cite this article: Bone Joint J 2019;101-B:639–645.

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Ponseti technique: efficacy in idiopathic clubfoot in Indian population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182734 ◽

2018 ◽

Vol 4 (4) ◽

pp. 614

Author(s):

Neetin Mahajan ◽

Ujwal Ramteke ◽

Sandeep Gavhale ◽

Nikhil Palange ◽

Akash Mane ◽

...

Keyword(s):

Low Cost ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Acceptable Result ◽

Short Period ◽

Strict Compliance ◽

Analysis Of Results ◽

One Year ◽

Non Surgical Treatment

Background: The number of operations for clubfoot is many, but the results are not encouraging and more complications are encountered after operative treatment. Most surgeons believe manipulation to be easy; however they rarely complete the treatment and abandon it and go on to surgery. In the confusing scenario Ponseti Method evolved and proved across the world to be one of the most promising ways to correct club foot with low cost minimum surgery and good result in short period of time.Methods: 50 cases of idiopathic clubfeet (76 feet) were enrolled from a period of May 2006 to May 2008 in the department of Orthopaedic. Out of 50, 42 patients were followed-up for two years. Post tenotomy follow-up done every monthly for 3 months. At every visit babies were checked for any relapse and parents were counselled for the strict compliance with Foot Abduction Brace. The results of correction in 42 patients (64 feets) evaluated and compared with Ponseti's observation and other form of conservative management.Results: The analysis of results of correction of clubfeet deformity by Ponseti's method reveals around 95.30% of good to acceptable result as compared with Ponseti’s observation of around 99% which is comparable. We have observed 4.69% of poor result as compared with 1% observed by Ponseti.Conclusions: It is safe, efficient, Economical and most effective treatment for clubfoot which decreases the need for extensive corrective surgery. This technique can be used in children up to one year of age even after previous unsuccessful non-surgical treatment.

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Comparison of ponseti method versus surgical treatment in congenital idiopathic clubfoot: A 5-year follow up study

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i3l.1610 ◽

2019 ◽

Vol 5 (3) ◽

pp. 666-669

Author(s):

Chatupon Chotigavanichaya ◽

Jidapa Wongchareonwatana ◽

Charikdhamma Saelim ◽

Thanase Ariyawatkul ◽

Kamolporn Kaewpornsawan ◽

...

Keyword(s):

Surgical Treatment ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Follow Up Study

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Relapse following use of Ponseti method in idiopathic clubfoot

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.180117 ◽

2018 ◽

Vol 12 (6) ◽

pp. 566-574 ◽

Cited By ~ 5

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

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Transfer of technology regarding correction of congenital talipesequinovarus by ponseti method of treatment to doctors working at peripheral hospitals of eastern region of Nepal covered by BPKIHS, Dharan.

Health Renaissance ◽

10.3126/hren.v13i2.17564 ◽

2017 ◽

Vol 13 (2) ◽

pp. 144-152

Author(s):

R Rijal ◽

B P Shrestha ◽

G P Khanal ◽

P Chaudhary ◽

R Maharjan ◽

...

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot ◽

Eastern Region ◽

Operative Method ◽

Transfer Of Technology ◽

District Hospitals ◽

Before And After ◽

Knowledge And Practice ◽

Paired T Test

Background: Ponseti method of manipulation and casting has been standard non operative method of treatment for idiopathic clubfoot. We have conducted this study to find out whether Ponseti method of correction can be taught to doctors working at district hospital.Objective: To assess the knowledge, familiarize the Ponseti method of correction and to decrease the need of surgery regarding the congenital talipesequinovarus.Method: We conducted prospective study among doctors working in the district hospitals of eastern Nepal. We assessed knowledge and practice regarding clubfoot management before and after the intervention by questionnaire based method. The data were analyzed using before and after difference for magnitude and paired t test for significance.Result: 13 doctors were included in the study. Among 13 participants, one (7.69%) had formal orthopedic training. Only 30% of the participants had more than 60% correct response regarding questionnaires regarding knowledge of clubfoot. 40% of participants had done referral of cases to orthopedic centre. One (7.69%) of the participants had applied Ponseti cast. 61% percent of the participants responded more than 60% correctly at the final follow up at one year.Conclusion: The study shows that the knowledge and practice regarding Clubfoot correction is inadequate and hence teaching of Ponseti method was useful in the district hospital.Health Renaissance 2015;13(2): 144-152

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Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0b013e32801048bb ◽

2007 ◽

Vol 16 (2) ◽

pp. 98-105 ◽

Cited By ~ 83

Author(s):

Amr Atef Abdelgawad ◽

Wallace B. Lehman ◽

Harold J.P. van Bosse ◽

David M. Scher ◽

Debra A. Sala

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot

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Foot abduction brace noncompliance in children with idiopathic clubfoot: how the deep squatting posture might help

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors25856 ◽

2020 ◽

Vol 8 (3) ◽

pp. 241-248

Author(s):

Pipattra Sailohit ◽

Noppachart Limpaphayom

Keyword(s):

Exercise Group ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Routine Practice ◽

Group A ◽

Metatarsus Adductus ◽

Noncompliance Rate ◽

Group B ◽

Recent Evaluation

Background. Compliance with the foot abduction brace (FAB) is essential for idiopathic clubfoot (ICF) managed by the Ponseti method. The deep squatting posture (DSP) was correlated with favorable outcomes in ICF. Aim. The aims of the study were to identify the noncompliance rate with the FAB, and assess how the routine practice of ankle stretching and Asian-style DSP affected the ICF correction during the Ponseti method. Materials and methods. Of 42 children with ICF, 63 ICF underwent the Ponseti method at an average age of 8.7 12.6 weeks using an average of 5.4 1.7 casts followed by FAB wear. The children practiced the DSP exercise as an adjunct to the FAB protocol. Children noncompliant with the FAB protocol but compliant with the DSP exercise (group A) were compared with children noncompliant with both FAB protocol and DSP exercise (group B). Results. At an average follow-up of 3.5 1.4 years, 8 of 42 children compliant with the FAB protocol. The FAB protocol deviation was documented at an average of 10.3 4.8 months. Children who did not adhere to the practice of the DSP exercise had a higher recurrent rate of any ICF deformity (OR 7.82, 95% CI 1.3553.79, p = 0.003). Of the 34 children (48 feet) noncompliant with FAB, the children in group A (39 feet) had lower recurrence rate (p = 0.02), a better Dimeglio grade (p = 0.005), and a better Pirani score (p 0.001) at the most recent evaluation than children in group B (nine feet). However, recurrent metatarsus adductus was more prevalent in group A. Conclusion. The DSP exercise should be advocated as a supplemental modality but cannot substitute the regular use of FAB.

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Evaluation of effectiveness of Ponseti's method in the clubfoot management under 1-year children: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210042 ◽

2021 ◽

Vol 7 (2) ◽

pp. 228

Author(s):

Prateek Girotra ◽

K. Prashanth Kumar ◽

Rejo Varghese Jacob

Keyword(s):

Treatment Compliance ◽

Ponseti Method ◽

Successful Outcome ◽

Idiopathic Clubfoot ◽

Clear Understanding ◽

Full Compliance ◽

Serial Casting ◽

Reproducible Method ◽

A Prospective Study

Background: Congenital talipes equino Varus is common congenital orthopedic foot deformity in children characterized by hindfootequinus, hind foot varus, midfoot cavus, and forefoot adduction deformities. There is a necessity to analyze the number of casts employed in the treatment, compliance of bracing, relapse pattern and percentages of surgical referral under 1 year of age for clear understanding and better practice to achieve successful outcomes. This study aimed to judge the effectiveness of Ponseti in the treatment of clubfoot under 1-year old children. Methods: The patients were selected in the OPD and evaluated for virgin idiopathic clubfoot under 1-year age. Serial casting done weekly by Ponseti method after assessing Pirani and Demeglio score before every cast.Results: In our study all 29 clubfeet that were treated by Ponseti method showed complete correction. Minimum cast being 5 and maximum being 10 casts. Corrected feet were supple, plantigrade and painless of which 1 foot had relapse<3weeks due to ill-fitting shoes. Which was subsequently corrected with repeat tenotomy and cast application.Conclusions: The Ponseti method is a safe, effective, cheap and reproducible method for correction of CTEV which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot under 1-year age. For successful outcome and to prevent relapse, this technique must be applied strictly in accordance to the protocol and parents must be taught the importance of full compliance with bracing. Our series has a short follow up. Longer follow-up is needed for further evaluation of effectiveness of Ponseti method.

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