Clubfoot: current concept of treatment

Introduction Idiopathic clubfoot (IC), also referred to as congenital talipes equinovarus, is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment when left untreated. Early minimally invasive treatment has been praised as one of the most successful practice of modern pediatric orthopedics. This review aims to report current knowledge and controversies about clubfoot treatment. Material and methods We describe the main trends in clubfoot managing, identifying peculiarities, difficulties and prognostic factors related to the treatment. Results Many treatment techniques either conservative, surgical or hybrid have been used over the past decades. Based on good and excellent results during long-term follow-up, Ponseti method has been globally accepted by paediatric orthopaedic surgeons as standard method of treatment. However, some other conservative methods are still widely applied in the clinical setting, such as the French Physical Therapy method. Adherence to the bracing protocol is critical for the long-term success of the treatment, being a better predictor for relapse than severity of the deformity at birth. Conclusions Taking care of the manipulation and casting details by trained professionals, together with enhancing the child and patents’ adherence to the brace, are essential for the success of conservative treatment. Surgery should be performed only when strictly needed, preferably on a “a la carte” approach.

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MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

10.36106/ijar/5904771 ◽

2021 ◽

pp. 38-39

Author(s):

Chunchesh MD Chunchesh MD ◽

Vani Ahuja ◽

Kiran S Mahapure

Keyword(s):

Cost Effective ◽

Ponseti Method ◽

Foot Deformities ◽

Idiopathic Clubfoot ◽

Congenital Talipes Equinovarus ◽

Cost Effective Treatment ◽

Pediatric Orthopaedics ◽

Talipes Equinovarus ◽

Main Factor

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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Management of idiopathic clubfoot with Ponseti technique

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173156 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3355 ◽

Cited By ~ 1

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.

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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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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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Does idiopathic congenital talipes equinovarus have an impact on attainment of developmental milestones? A multicentre international study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190060 ◽

2019 ◽

Vol 13 (4) ◽

pp. 353-360 ◽

Cited By ~ 2

Author(s):

K. Hughes ◽

Y. Gelfer ◽

M. Cokljat ◽

S. Wientroub ◽

A. Yavor ◽

...

Keyword(s):

Treatment Compliance ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Inclusion Criteria ◽

Developmental Milestones ◽

Congenital Talipes Equinovarus ◽

Group I ◽

Significant Difference ◽

Talipes Equinovarus ◽

Congenital Talipes

Purpose The Ponseti method is a well-established approach to treating clubfoot. Potentially, both the underlying pathology and adherence to post-correction bracing can affect lower limb function and age of independent standing and walking. This cohort study investigates the age at which infants with idiopathic clubfoot treated using the Ponseti method achieved three selected developmental milestones and whether or not this correlated with treatment compliance. Methods A prospectively collected database from four centres was visited. Inclusion criteria were patients with idiopathic clubfoot with no comorbidities or prior treatment. Age at attainment of independent standing, walking, nocturnal continence was compared across three groups: I) congenital talipes equinovarus (CTEV) children compliant with treatment; II) CTEV children non-compliant with treatment; and III) typically-developed siblings. Minimum follow-up was five years. Results In all, 130 patients (198 feet) fitted the inclusion criteria: 43:87 (F:M). Standing was achieved by a mean 12.0 months in group I (sd 2.50); 12.0 months (sd 2.0) in II and ten months (sd 3.0) in III. Walking was achieved by a mean 15 months (sd 4.0) in group I, 14 months (sd 1.75) in II and 12 months (sd 3) in III, respectively. Both the compliant and non-compliant CTEV children were significantly slower at achieving standing and walking compared to sibling controls (p < 0.0001). There was no significant difference between age of nocturnal continence between the three groups. Conclusion Infants with idiopathic clubfoot treated according to the Ponseti method achieve independent standing and walking approximately two months later than their typically-developed siblings. The delay is not related to the use of the foot abduction brace. Level of evidence: III

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Evaluation of Ponseti method in correction of congenital talipes equinovarus

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180460 ◽

2018 ◽

Vol 4 (2) ◽

pp. 238

Author(s):

Gopal M. Shinde ◽

Yogesh A. Dhole ◽

Manoj R. Kashid ◽

Vijay R. Kakatkar ◽

S. K. Rai

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot ◽

Age Group ◽

Foot Deformity ◽

Congenital Talipes Equinovarus ◽

Excellent Outcome ◽

Talipes Equinovarus ◽

Reproducible Method ◽

Congenital Talipes ◽

Extensive Surgery

Background: Congenital idiopathic clubfoot is a complex foot deformity often requires many months of treatment and frequently resulted in incomplete or defective correction by older methods. Deformity can be corrected with serial manipulation and casting with minimal or no surgery as reported by Ponseti. This study is an attempt to evaluate the effectiveness of Ponseti technique in treatment of idiopathic congenital talipes equino varus.Methods: 30 patients between age group of 01 to 24 weeks with 48 feet having congenital idiopathic clubfoot were treated using Ponseti technique. The guidelines for treatment were followed as per the Ponseti method of serial manipulation and casting at weekly intervals.Results: 43 (89.58%) cases were treated successfully by using Ponseti technique without need of extensive surgery. 42 feet required tenotomy. 38 (79.16%) feet had an excellent outcome, 5 (10.42%) feet had a fair outcome and 05 feet (10.42%) had poor outcome as measured by the Pirani scoring system. 7 (14.58%) patients had cast related complications.Conclusions: The Ponseti method is a safe, effective and reproducible method for correction of idiopathic congenital talipes equinovarus which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot.

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Results of Ponseti Casting for Clubfoot in a Tertiary Public Hospital

Acta Medica Philippina ◽

10.47895/amp.v55i3.1774 ◽

2021 ◽

Vol 55 (3) ◽

Author(s):

Ilian Dominiq D. Eusebio ◽

Carlo Emmanuel J. Sumpaico

Keyword(s):

Third World ◽

Public Hospital ◽

The Philippines ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Early Age ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Congenital Talipes ◽

Poor Outcomes

Introduction. Congenital talipes equinovarus (CTEV), also called clubfoot, is one of the most common orthopedic congenital anomalies. However, there is no formal study of the condition here in the Philippines, and data is sparse regarding the epidemiology, treatment, and outcomes in similar third-world countries. Methods. Retrospective review of data of clubfoot patients seen at the Philippine General Hospital (PGH) Clubfoot Clinic from 2006 up to the present. Results. Records from 75 patients treated at the PGH Clubfoot Clinic from 2010-2016 were reviewed. Idiopathic clubfoot comprised 76% of the patients, while syndromic clubfoot comprised 24%. A good outcome of the Ponseti method was seen in 82% and 88% of the idiopathic and syndromic clubfoot patients, respectively. Idiopathic clubfoot cases that had good outcomes required an average of 11.84 casts to tenotomy or bracing, which was not statistically significant compared to 9.55 average sessions for syndromic clubfoot (p=0.21). The initial Pirani scores for both cases were not significantly different (p=0.95). Idiopathic cases with poor outcomes needed less casting sessions (4.45) because the decision to operate was made early. Age was not found to significantly affect the outcome of treatment for idiopathic clubfoot (p=0.20) and syndromic clubfoot (p=0.64). Conclusion. Ponseti casting was found to be effective in treating both idiopathic and syndromic clubfoot patients. The number of sessions did not differ significantly between the two.

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Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot

Children ◽

10.3390/children8080618 ◽

2021 ◽

Vol 8 (8) ◽

pp. 618

Author(s):

Vito Pavone ◽

Andrea Vescio ◽

Annalisa Culmone ◽

Alessia Caldaci ◽

Piermario La Rosa ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Evaluation ◽

Interobserver Reliability ◽

Strongly Correlated ◽

Congenital Talipes Equinovarus ◽

Orthopaedic Surgeons ◽

Careful Preparation ◽

Talipes Equinovarus ◽

Pediatric Orthopaedic ◽

Paediatric Orthopaedic

Background: Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. Methods: Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). Results: The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked “good” in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an “excellent” interobserver reliability was found but was only “good” in the NPeO cohort. Conclusions: In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.

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THE EVALUATION OF THE RESULTS OF NEGLECTED CLUBFOOT MANAGED BY PONSETI METHOD

10.36106/ijsr/7203606 ◽

2021 ◽

pp. 23-25

Author(s):

Nandram Saryam ◽

Raja Yadav ◽

Manish Rajpoot

Keyword(s):

Ponseti Method ◽

Effective Technique ◽

Congenital Talipes Equinovarus ◽

Medical College ◽

Relapse Pattern ◽

Study Results ◽

Talipes Equinovarus ◽

Gandhi Medical College ◽

A Prospective Study ◽

Foot Disorder

Background: Congenital talipes equinovarus is the most common congenital foot disorder. neglected of clubfoot deformity occurs after the treatment by Ponseti method .we evaluate the relapse pattern of clubfoot basis of bhasker et al then treat the patient by Ponseti technique. Methods: This is a Prospective study .We are conducting a clubfoot clinic since 2013 in Department of Orthopaedics Gandhi medical college Bhopal . We register all clubfoot patient at our clubfoot clinic on his/her rst visit. All the clubfeet assessed with Pirani scoring system on the initial presentation to our institution and treat by Ponseti method. During this study there were a total of 558 children with 713 idiopathic clubfeet registered at our clinic. A total of 80 neglected clubfeet in 56 children presenting with neglected clubfeet were included in our study. Results: We found that The neglected feet in our study is (80 feet out of 713 feet. The male patient is 38 (67.86%) and female patient is 18 (32.14%). Male were predominantly involved as compared to female.The post treatment Pirani score after relapse treatment is 0.40 Conclusion: Ponseti technique is a simple, effective, inexpensive method for treatment of clubfeet there is, no requirement of special setup with limited resources and less rate of recurrence/complication than the surgical treatment It has been concluded that Ponseti method is a effective technique to treat congenital idiopathic clubfeet with success rate is 94.65% in our study

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