scholarly journals Rapid decrease of cast-induced forces during the treatment of clubfoot using the Ponseti method

2018 ◽  
Vol 100-B (12) ◽  
pp. 1655-1660 ◽  
Author(s):  
R. B. Giesberts ◽  
E. E. G. Hekman ◽  
G. J. Verkerke ◽  
P. G. M. Maathuis
Keyword(s):  
Life Time ◽  
Plaster Cast ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Force Measurements ◽  
Rapid Reduction ◽  
First Metatarsal ◽  
Short Period ◽  
Force Data ◽  
Over Time

Aims The Ponseti method is an effective evidence-based treatment for clubfoot. It uses gentle manipulation to adjust the position of the foot in serial treatments towards a more physiological position. Casting is used to hold the newly achieved position. At first, the foot resists the new position imposed by the plaster cast, pressing against the cast, but over time the tissues are expected to adapt to the new position and the force decreases. The aim of this study was to test this hypothesis by measuring the forces between a clubfoot and the cast during treatment with the Ponseti method. Patients and Methods Force measurements were made during the treatment of ten idiopathic clubfeet. The mean age of the patients was seven days (2 to 30); there were nine boys and one girl. Force data were collected for several weeks at the location of the first metatarsal and the talar neck to determine the adaptation rate of the clubfoot. Results In all measurements, the force decreased over time. The median (interquartile range) half-life time was determined to be at 26 minutes (20 to 53) for the first metatarsal and 22 minutes (9 to 56) for the talar neck, suggesting that the tissues of the clubfoot adapt to the new position within several hours. Conclusion This is the first study to provide objective force data that support the hypothesis of adaptation of the idiopathic clubfoot to the new position imposed by the cast. We showed that the expected decrease in corrective force over time does indeed exist and adaptation occurs after a relatively short period of time. The rapid reduction in the forces acting on the foot during treatment with the Ponseti method may allow significant reductions in the interval between treatments compared with the generally accepted period of one week.

scholarly journals Ponseti technique: efficacy in idiopathic clubfoot in Indian population

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals Outcomes of the Ponseti method for the treatment of children diagnosed with congenital clubfoot in population under five years at Fundación Ruth Paz in San Pedro Sula, Honduras

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sandy Lizeth Guerrero Sorto ◽  
Gustavo A. Vásquez García ◽  
Nolvia Sarahí Díaz Cruz ◽  
Paola Estela Figueroa Avilez ◽  
Gabriela Alejandra Contreras
Keyword(s):  
Achilles Tendon ◽  
Plaster Cast ◽  
Ponseti Method ◽  
Abnormal Development ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Children Under Five ◽  
Under Five ◽  
San Pedro ◽  
San Pedro Sula

Background: Congenital clubfoot is a common deformity characterized by an abnormal development of the foot. The etiology is multifactorial and genetic causes have been related. The Ponseti method is a conservative treatment for the clubfoot, mostly used in idiopathic cases. This method involves serial plaster cast changes, tenotomy of the Achilles tendon and use of braces to prevent relapses. This study was designed to identify the characteristics of the patients diagnosed with congenital clubfoot who were treated with the Ponseti method and the main outcomes of this treatment in children under five years.Method: A retrospective study was conducted in Fundación Ruth Paz in San Pedro Sula, Honduras, since June 1st 2015 to May 31th 2017. This study included patients under five years who were diagnosed with congenital clubfoot and treated with Ponseti method. The data were collected from the clinical files of the identified cases.Results: Congenital clubfoot was more common among males (66.3%) and the localization of the deformity was more commonly bilateral (51.8%). The cases of idiopathic clubfoot represent 91.6% of all the cases. The tenotomy of the Achilles tendon was performed in 51.8% of the patients.  Complete treatment was identified in 90.4% of the cases and relapses were reported in 12% of the children who completed treatment.Conclusions: Ponseti method was effective for treat children under five years diagnosed with clubfoot (idiopathic and non-idiopathic) and a significant decrease of the Pirani scoring after treatment was identified in all the cases. A correct use of braces is necessary to avoid relapses.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

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.

scholarly journals La couverture médiatique des accommodements raisonnables dans la presse écrite québécoise : Vérification de l’hypothèse du tsunami médiatique

2010 ◽  
Vol 35 (3) ◽  
Author(s):  
Thierry Giasson ◽  
Colette Brin ◽  
Marie-Michèle Sauvageau
Keyword(s):  
Social Issue ◽  
Public Debate ◽  
Reasonable Accommodation ◽  
Press Coverage ◽  
The Public ◽  
Public Agenda ◽  
Short Period ◽  
The Media ◽  
Media Hype ◽  
Over Time

ABSTRACT  From March 2006 to May 2008, the province of Québec engaged in a contentious public debate on diversity and reasonable accommodation practices. This study examines the evolution of press coverage in eleven Québec dailies dedicated to the issue of reasonable accommodation over the intensive twelve-month period during which the concept entered the public agenda. We examine the “media tsunami” hypothesis, an expanded version of the media hype theory developed by Vasterman (2005). The hypothesis posits that the media, in dealing with an emergent social issue in a relatively short period of time, amplify the importance of the issue through successive waves of press coverage that gain in intensity and magnitude over time. In doing so, they can manufacture social “crises.”RÉSUMÉ  De mars 2006 à mai 2008, le Québec a été secoué par un débat sociétal sur la question de la gestion de la diversité culturelle et du principe d’accommodement raisonnable. Cette étude s’intéresse à l’évolution de la couverture du concept d’accommodement raisonnable dans la presse écrite québécoise au cours de la période intensive du traitement médiatique où le terme est entré dans le discours public. L’article examine l’hypothèse du « tsunami médiatique », une version plus étoffée de la théorie du media hype mise de l’avant par Vasterman (2005). L’hypothèse de la déferlante médiatique pose que l’enjeu en question est une création médiatique dont la couverture en amplifie l’importance sociétale et peut générer une inquiétude au sein de la société. Les données tirées d’une analyse exhaustive du contenu de onze journaux québécois révèlent que la couverture produite par la presse écrite de la question des accommodements raisonnables représente un cas typique de « tsunami médiatique. »

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