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

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.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> Ponseti technique is a very useful and effective method of management of idiopathic clubfoot up to 2 year of age.</p>

scholarly journals RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY

2020 ◽  
Vol 73 (12) ◽  
pp. 2640-2643
Author(s):  
Oleksii O. Holubenko ◽  
Anatolii F. Levytskyi ◽  
Oleksandr V. Karabenyuk
Keyword(s):  
Soft Tissue ◽  
Recurrence Rate ◽  
Primary Treatment ◽  
Nonparametric Tests ◽  
Ponseti Method ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Results Of Treatment ◽  
Pirani Score ◽  
Serial Casting

The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children’s Specialized Hospital “Okhmatdet”. Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-tests). Statistical data processing was performed in SPSS 17.0 program. Results: The results of Pirani score reveal satisfactory outcomes for both groups. But Ponseti method has the more conservative approach and lower complication rate (11,29±5,27% and 24,24±11,74%, p=0,52). Conclusions: Ponseti method is a safe, effective method for treatment of congenital idiopathic clubfoot in children from first days after birth. Open surgery should be reserved for deformity that cannot be completely corrected or for treatment of recurrences.

To Evaluate the Role of Pirani Score in Deformity Assessment and Management of Club Foot by Ponseti Method – A Hospital Based Prospective Study from Tirupati

2021 ◽  
Vol 8 (29) ◽  
pp. 2633-2638
Author(s):  
Venkat R ◽  
Suguru Rav Kumar ◽  
Penugonda Ravi Shankar ◽  
Deety Lakshmi Venkatesh
Keyword(s):  
Prospective Study ◽  
Scoring System ◽  
Club Foot ◽  
Study Groups ◽  
Ponseti Method ◽  
Classification Systems ◽  
Statistical Inferences ◽  
Pirani Score ◽  
Ethical Approval

BACKGROUND Pirani scoring system is one of the classification systems in management of club foot which is simple and easy to use. However, there is paucity of studies using Pirani system to determine the severity and monitor progress in the treatment of club foot. We therefore set out with the aim of assessing severity and monitoring the progress of treatment using the Pirani scoring system. The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. METHODS It was a hospital-based prospective study of 57 club foot in 41 patients designed to evaluate the role of Pirani score in deformity assessment and management of club foot by Ponseti method. Consecutive patients presenting at the outpatient department at SVRRGGH, Tirupati with idiopathic club foot, and in-patients department with idiopathic club foot were recruited into the study. Informed consent was obtained from parents/guardians of the patients that were recruited in the study. This was a prerequisite for obtaining the ethical approval. Data collected from the study groups was entered into a worksheet, and analysis was performed using the statistical package for social sciences (SPSS) software for windows version 21. Significant statistical inferences were drawn at p & lt ; 0.05. RESULTS The correlation between the midfoot score, hindfoot score, Pirani score and the number of casts to achieve correction was significant (P = 0.001). Also, there was correlation between the Pirani score and the need for tenotomy (P = 0.001); between the number of casts to achieve correction and the need for tenotomy (P = 0.001). Moreover, the progress of treatment can be monitored with the Pirani score (P = 0.001). CONCLUSIONS Pirani scoring system is a simple, easy, quick and reliable system to determine severity and monitor progress in the treatment of club foot with excellent interobserver variability. KEYWORDS Pirani Score, Club Foot, Ponseti Method

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

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877236 ◽  
Author(s):  
Anil Agarwal ◽  
Nargesh Agrawal ◽  
Sitanshu Barik ◽  
Neeraj Gupta
Keyword(s):  
Treatment Outcomes ◽  
Deformity Correction ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy ◽  
Female Patients ◽  
Bilateral Group ◽  
Pirani Score ◽  
The Mean ◽  
Treatment Analysis ◽  
Unilateral Group

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.

scholarly journals Management of idiopathic clubfoot with Ponseti technique

2017 ◽  
Vol 5 (8) ◽  
pp. 3355 ◽  
Author(s):  
Sumeet Singh Charak ◽  
Khalid Muzafar ◽  
Omeshwar Singh
Keyword(s):  
Effective Treatment ◽  
Club Foot ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Corrective Surgery ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus ◽  
The Mean ◽  
Congenital Talipes ◽  
Main Factor

Background: Idiopathic congenital talipes equinovarus (club foot) is a complex deformity that is difficult to correct. The goal of treatment is to reduce or eliminate its four components so that the patient has a functional foot and leads a normal life.Methods: Study have treated 20 patients with 32 idiopathic clubfoot deformities using Ponseti method. The severity was assessed by modified pirani scoring.Results: The mean number of casts that were applied to obtain correction was 7.02 (range four to nine casts). Tenotomy was done in 30 feet. Thirty feet had good results. One patient developed recurrence of the deformity due to non-compliance of the use of orthrotics.Conclusions: The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for corrective surgery. Non-compliance with orthotics main factor causing failure of the technique.

Factors Associated With The Relapse In Ponseti Treated Congenital Club Foot

2021 ◽  
Author(s):  
Wei Hu ◽  
Baoyi Ke ◽  
Niansu Xiao ◽  
Sen Li ◽  
Cheng Li ◽  
...  
Keyword(s):  
Club Foot ◽  
Ethics Committee ◽  
Ponseti Method ◽  
Ethical Standards ◽  
Factors Associated ◽  
Pirani Score ◽  
Walking Age ◽  
The Mean ◽  
Hospital Ethics

Abstract Objectives. We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method.Methods. We retrospectively reviewed all children with congenital club foot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee.Results. In this study, there were 148 cases with 164 feet in total that underwent the Ponseti method. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50±2.15 months. The average initial Pirani score was 4.98±1.33, 2 and the average number of casts was 5.71±2.28 times. The mean age of mothers at birth was 25.81±2.38 years old. The walking age of children was at a mean of 14.83±1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 feet (76.4%). The average follow–up period was 7.27±1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group.Conclusion. The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

scholarly journals Simple , safe and fast Ponseti cast removal procedure in pes equina varus patients

2021 ◽  
Vol 8 (2) ◽  
pp. 64-67
Author(s):  
Ferdi Dırvar ◽  
Ömer Cengiz
Keyword(s):  
Cutting Tool ◽  
Classical Group ◽  
Cutting Tools ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Chi Square ◽  
Removal Time ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Objective: In our study, it is aimed to remove the cast more easily and safely without using the cutting tools by leaving the cast ends marked by folding in the idiopathic clubfoot patients treated with Ponseti method. Material and Methods: Forty feet of 29 patients treated for Pes Equinovarus were included in the study. Patients were followed up in two groups. The group treated with Ponseti method by cast marking were named as “modified group” and cast wrapped group without marking were named as “classical group”. Neurological, teratologic and syndromic clubfoot patients were not included in the study. During the six series of casting, cast removal times for each extremity are recorded in minutes and it is noted that whether any additional cutting tool is used during cast removal or not. A summary of the data was presented as mean, standard deviation and percentage. Comparisons of the categorical characteristics were analysed by using the Chi-square test and the Mann-Whitney test. IBM-SPSS 20 program was used for analysis. In all tests, the level of significance was adjusted to 0.05. Results: Thirteen (44.8%) of the 29 patients were male and 16 (55.2%) were female. While the mean time to start treatment for the 15 patients in the modified group was 3.46 (2-7) days, mean time for the 14 patients in the classical group was 3.78 (2-10) days. While the mean cast removal time of the 20 extremities of 15 patients in the modifying group was 10.9 minutes (8-14.3 min);it was 22.2 minutes (17.1-29.5 min) for the 20 extremities of 14 patients in the classical group. While no additional cutting tool was used during cast removal in the modified group, additional cutting tools were used during removal of cast in 75% (15/20) of the patients in the classical group and statistically significant difference was found between two groups in terms of the use of cutting tools (p<0.001). Conclusion: We found that the cast ends’ being marked by folding during plastering in idiopathic clubfoot patients treated with Ponseti technique is costless, easy to apply, significantly shortens cast removal time, does not require the use of cutting tools, and thus is a notably safe method for these patients.

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

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