Percutaneous heel cord release for clubfoot: a retrospective, multicentre cost analysis

Purpose The Ponseti method of treatment is the standard of care for idiopathic clubfoot. Following serial casting, percutaneous tendo-Achilles tenotomy (TAT) is performed to correct residual equinus. This procedure can be performed in either the outpatient clinic or the operating room. The purpose of this study was to evaluate the expense of this procedure by examining hospital charges in both settings. Methods We retrospectively reviewed charts of 382 idiopathic clubfoot patients with a mean age of 2.4 months (0.6 to 26.6) treated with the Ponseti method at three institutions. Patients were divided into three groups depending on the setting for the TAT procedure: 140 patients in the outpatient clinic (CL), 219 in the operating room with discharge following the procedure (OR) and 23 in the operating room with admission to hospital for observation (OR+). Medical records were reviewed to analyze age, deformity, perioperative complications and specific time spent in each setting. Hospital charges for all three groups were standardized to one institution’s charge structure. Results Charges among the three groups undergoing TAT (CL, OR, OR+) were found to be significantly different ($3840.60 versus $7962.30 versus $9110.00, respectively; p ≤ 0.001), and remained significant when separating unilateral and bilateral deformities (p < 0.001). There were nine total perioperative complications (six returns to the ER and three unexpected admissions to the hospital): five (2.3%) in the OR group, four (17.4%) in the OR+ group and none in the CL group. The OR+ group statistically had a higher rate of complications compared with the other two groups (p = 0.006). The total event time of the CL group was significantly shorter compared with the OR and OR+ groups (129.1, 171.7 and 1571.6 minutes respectively; p < 0.001). Conclusion Hospital charges and total event time were significantly less when percutaneous TAT was performed in the outpatient clinic compared with the operating room. In addition, performing the procedure in clinic was associated with the lowest rate of complications. Level of Evidence Therapeutic, Level III

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Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

The American Surgeon ◽

10.1177/00031348211038590 ◽

2021 ◽

pp. 000313482110385

Author(s):

Claudio F. Feo ◽

Chiara Ninniri ◽

Cinzia Tanda ◽

Giulia Deiana ◽

Alberto Porcu

Keyword(s):

Spinal Anesthesia ◽

Operating Room ◽

Local Anesthesia ◽

Outpatient Clinic ◽

Perioperative Complications ◽

Study Groups ◽

Reoperation Rate ◽

Hyperbaric Bupivacaine ◽

Open Hemorrhoidectomy ◽

American Society

Background There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. Methods Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. Results There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher’s grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients’ satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. Discussion Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.

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

Wiadomości Lekarskie ◽

10.36740/wlek202012115 ◽

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.

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

Nigerian Journal of Medicine ◽

10.4103/1115-2613.278775 ◽

2018 ◽

Vol 27 (2) ◽

pp. 163

Author(s):

ChukwuemekaOkechukwu Anisi ◽

JosephEffiong Asuquo ◽

InnocentEgbeji Abang

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot ◽

Achilles Tenotomy

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Bracing in clubfoot: do we know enough?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190069 ◽

2019 ◽

Vol 13 (3) ◽

pp. 258-264 ◽

Cited By ~ 5

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

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Effectiveness of achillotomy in children with arthrogryposis

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7251-60 ◽

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.

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

Journal of the American Podiatric Medical Association ◽

10.7547/0980414 ◽

2008 ◽

Vol 98 (5) ◽

pp. 414-417 ◽

Cited By ~ 13

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)

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Ponseti method for treatment of idiopathic congenital talipes equinovarus at tertiary care center in India

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213176 ◽

2021 ◽

Author(s):

Maruti B. Lingayat ◽

Sourabh S. Dhamale ◽

Gaurav B. Mate

Keyword(s):

Low Income ◽

Care Center ◽

Tertiary Care ◽

Ponseti Method ◽

Success Rates ◽

Congenital Talipes Equinovarus ◽

Achilles Tenotomy ◽

Serial Casting ◽

Foot Biomechanics ◽

Talipes Equinovarus

Background: Different treatment methods were tried with variable success rates but Ponseti method of serial casting and manipulation stood apart due to better understanding of foot biomechanics and became accepted choice of treatment worldwide.Methods: 50 patients were enrolled in the study out of which 40 were available for final follow-up. We studied 40 cases during October 2018 to December 2020 at Government Medical College, Aurangabad. Out of 40 cases 31 were male and 9 were female. 25 were unilateral and 15 were bilateral. All cases were idiopathic. 4 inches Plaster of Paris (POP) bandages were cut into half and such 2 inches POP bandages were used for casting. Tenotomies were performed under controlled environment of Operation Theater with general anaesthesia. Number 12 surgical blade was used. Dennis-Browne splint was used for maintenance of correction.Results: Out of total 55 feet studied, 10 feet (18.18%) required tendo Achilles tenotomy and 45 feet (81.82%) were treated with casting alone. There were 8 cases of relapses (20%). All relapsed cases were treated with repeat casting as per Ponseti protocol and none of them required repeat tenotomy. Complications related to plaster were minimal and there were no incidence of rocker bottom deformity.Conclusions: We conclude that in a low income developing country like India where case load is very high; Ponseti method is effective, inexpensive form of treatment with minimal complications. Need for extensive soft tissue procedures vastly reduced with this method.

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Assessment of Ponseti technique of manipulation and serial casting in idiopathic clubfoot

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190503 ◽

2019 ◽

Vol 5 (2) ◽

pp. 248

Author(s):

Asif Hussain Khazi Syed ◽

Kiran Kumar Koppolu Kanthi ◽

Yakub Baroothu ◽

Lalith Mohan Chodavarapu

Keyword(s):

Treatment Protocol ◽

Ponseti Method ◽

Foot Deformities ◽

Idiopathic Clubfoot ◽

Congenital Talipes Equinovarus ◽

Pirani Score ◽

Serial Casting ◽

Talipes Equinovarus ◽

Full Correction ◽

Time Of Presentation

Background: Congenital talipes equinovarus is one of the commonest congenital foot deformities. Ponseti technique of treatment of clubfoot has gained popularity in the last few decades. Feet treated by Ponseti technique are supple, flexible and pain free. We have treated congenital idiopathic clubfoot with Ponseti technique at our institute and present our results.Methods: Forty eight feet in thirty children with clubfoot were treated by Ponseti technique in our institute. The study was conducted from December 2013 to December 2015. Parents were counselled regarding treatment protocol and maintenance with bracing was closely monitored. Each child was followed up for a minimum of six months. Pirani score was used to objectively document progress of treatment.Results: The average number of casts required for complete correction was 6.6. 38% feet required tendoachilles tenotomy. Higher the initial Pirani score, more number of casts were required to achieve full correction. Number of casts needed for complete correction did not correlate to time of presentation.Conclusions: Ponseti method is very effective in correcting congenital idiopathic clubfoot deformity. It’s easy to learn, is inexpensive and can completely correct the deformity. In developing nations, well trained Orthopaedic surgeons can treat these children effectively and decrease disabled population.

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OUTCOME OF PONSETI METHOD IN TREATING CONGENITAL IDIOPATHIC CLUBFOOT: FIVE YEARS’ EXPERIENCE AT A TERTIARY HOSPITAL

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i4.23322 ◽

2018 ◽

Vol 11 (4) ◽

pp. 118

Author(s):

Edewet Daun ◽

Mohd Yazid Bajuri ◽

Abdul Halim Abd Rashid ◽

Sharaf Ibrahim ◽

Srijit Das

Keyword(s):

Scoring System ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Cross Sectional ◽

Serial Casting ◽

Talipes Equinovarus ◽

Clinical Scoring ◽

Paediatric Orthopaedic

Objective: The earliest non-surgical treatment for the correction of congenital idiopathic talipes equinovarus (CTEV) deformity was described by Ignacio Ponseti. He suggested gentle manipulation and serial applications of casts followed by a period of bracing to maintain the correction. The main objective of this study was to evaluate the result of the Ponseti method with a subjective clinical scoring system using Pirani score, to compare the results with the published literature and to evaluate the effectiveness of foot abduction orthosis (FAO) or ankle-foot orthoses (AFO) in preventing relapse following correction.Methods: A cross-sectional study which was conducted at the Paediatric Orthopaedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A minimum of 12 months follow-up casting was observed before the patient was subjected to the subjective clinical scoring system. A total of 25 patients which included 5 right feet, 9 left feet, and 10 bilateral feet with idiopathic clubfeet were treated with Ponseti serial casting. Percutaneous Achilles tendon tenotomy was done for 28 feet (82.35%) to correct the equinus to achieve full correction.Results: Our results showed that the Ponseti method for treating CTEV was comparable to other published studies. Satisfactory and good results were observed in 97% of cases. A total of 41.18% underwent re-tenotomy of tendon Achilles due to recurrent and persistent equinus.Conclusion: The treatment of CTEV using Ponseti method will increase the successful correction. Meanwhile, the FAO gave better results for maintenance and prevention of recurrent deformity, compared to the AFO.

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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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