Outcome of treatment with modified Ponseti technique in atypical congenital talipes equinovarus

Background: The atypical congenital talipes equinovarus (CTEV) patients tend to have a different clinical foot presentation with small great toe, deep transverse crease of sole, tender swollen dorsum of foot and rigid equinus.Methods: This study was conducted in GMC Jammu to evaluate efficacy of modified Ponseti technique in atypical CTEV patients. It was a prospective study and the patient data was collected during OPD visits of patients from August, 2018 to June, 2020. Twenty-one patients were diagnosed as atypical CTEV and were managed with modification of conventional Ponseti technique and percutaneous release of achilles tendon was done in all patients. Three patients were lost to follow-up. Hence, the final number of study participants was 18 (n=18).Results: With modified Ponseti technique, functional correction was achieved in all the patients in our study. The average number of casts required was 8 (range; 5-10). At final follow-up visit, all feet are functionally corrected. Only one case of relapse was seen.Conclusions: Early diagnosis and treatment with modified Ponseti technique is an effective and easy method of treatment in atypical CTEV.

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Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2021.009 ◽

2021 ◽

Vol 25 (1) ◽

pp. 473-479

Author(s):

Jagar Doski ◽

Berivan Jamal

Keyword(s):

Ponseti Method ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

The Mean ◽

Congenital Talipes ◽

The Difference ◽

Group 2 ◽

Accelerated Protocol ◽

Group 1

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.

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Congenital Talipes Equinovarus (CTEV)

e-CliniC ◽

10.35790/ecl.v8i2.30180 ◽

2020 ◽

Vol 8 (2) ◽

Author(s):

Richardo J. Laloan ◽

Andreissanto C. Lengkong

Keyword(s):

Surgical Treatment ◽

Quantitative Measurement ◽

Foot Deformities ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Long Term Follow Up ◽

Congenital Talipes ◽

Non Surgical Treatment

Abstract: Congenital talipes equinovarus (CTEV) is a type of foot deformities characterized with hindfoot varus, adducted metatarsus, wide arched of the foot (cavus), and equinus. Its incidence is 1.2% per 1000 births annually. Around 80% of cases occur as idiopathic type and the remaining 20% is associated with other anomaly conditions. Genetic component is considered to play a role in the occurrence of CTEV. However, up to this day, there is no exact underlying etiology that defines the exact pathogenesis of CTEV. The evolving etiology nowadays is still multifactorial. Management of CTEV varies from non-surgical treatment to surgical treatment. A number of scoring and grading using qualitative and quantitative measurement are being used nowadays to assess the severity of CTEV because this deformity needs long-term follow-up due to its tendency to relapse.Keywords: congenital talipes equinovarus, clubfoot Abstrak: Congenital talipes equinovarus (CTEV), dikenal juga dengan true clubfoot, merupakan deformitas pada kaki yang ditandai oleh adanya bentuk varus kaki belakang, adduksi metatarsus, dan adanya bentuk lengkungan kaki yang lebar (cavus) serta equinus. CTEV merupakan salah satu dari deformitas kaki pada saat lahir dengan insidensi 1,2% per 1000 kelahiran hidup per tahunnya. Pada 80% kasus terjadi secara idiopatik dan 20% dikaitkan dengan kondisi-kondisi lain. Komponen genetik diduga berperan pada CTEV, namun, sampai saat ini, belum ada etiologi pasti yang menjelaskan patogenesis CTEV. Etiologi yang berkembang sampai saat ini bersifat multifaktorial. Tatalaksana pasien CTEV bervariasi mulai dari non-operatif maupun operatif. Sejumlah pengukuran kualitatif maupun kuantitatif telah dikembangkan untuk menilai keparahan CTEV berhubung kondisi deformitas ini membutuhkan follow-up jangka panjang karena mempunyai kecenderungan untuk relaps.Kata kunci: congenital talipes equinovarus, clubfoot

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Comparative analysis of correction of idiopathic congenital talipes equinovarus by conventional and accelerated Ponseti method with minimum 12 months follow up in a tertiary care hospital in North India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211413 ◽

2021 ◽

Author(s):

Pankaj Vir Singh ◽

Abdul Ghani ◽

Tejpal Singh ◽

Anzar Tariq Malik ◽

Simranpreet Singh

Keyword(s):

Tertiary Care ◽

North India ◽

Standard Group ◽

Care Hospital ◽

Congenital Talipes Equinovarus ◽

Pirani Score ◽

Talipes Equinovarus ◽

Congenital Talipes ◽

Accelerated Ponseti

Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle affecting 1/1000 live birth approximately. With a male dominance pattern, this deformity is bilateral in 50% cases. It has four basic components: cavus, adduction, varus and equinus. Severity of clubfoot is accessed using Pirani score (0 to 6). Insights into the basic pathoanatomy of this complex 3 dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopaedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in Steenbeek splint initially for 23 hours day for 3 months and then 12 hours a day for 3 years. The most important component of this treatment is parental counselling regarding the need for compliance with treatment which is often loophole responsible for relapse in initially corrected feet.Methods: This was a prospective study including 40 patients (61 feets) of idiopathic clubfoot with age <3 month at presentation who were randomly distributed in two groups, group 1 (accelerated Ponseti casting group) in which twice weekly casts were applied and group 2 (standard Ponseti casting group) in which weekly casts were applied. Initial Pirani score was calculated in all the patients and was rechecked and documented in every successive visit. All the patients were followed upto 12 months and there was no lost to follow up in this study.Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p value <0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0).Conclusions: Accelerated biweekly Ponseti casting reduces the overall days of treatment with similar results compared to standard weekly casting regime.

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Follow-Up Study of a Method of Management of Congenital Talipes Equinovarus Deformities with Easily Available Surgical Facilities in Developing Countries

The Clubfoot ◽

10.1007/978-1-4613-9269-9_89 ◽

1994 ◽

pp. 549-553

Author(s):

A. Sengupta ◽

P. Gupta

Keyword(s):

Developing Countries ◽

Congenital Talipes Equinovarus ◽

Follow Up Study ◽

Talipes Equinovarus ◽

Congenital Talipes

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Functional outcome of idiopathic congenital talipes equinovarus treated by Ponseti method: a midterm study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20180683 ◽

2018 ◽

Vol 4 (2) ◽

pp. 296

Author(s):

Madhuchandra P. ◽

Raju K. P. ◽

Pawankumar K. M. ◽

Shrinidhi I. S.

Keyword(s):

Functional Outcome ◽

Skeletal Maturity ◽

Ponseti Method ◽

Final Outcome ◽

Indian Children ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Long Term Follow Up ◽

Congenital Talipes

Background: Idiopathic congenital talipes equinovarus is a characterized by deformities with lot of ambiguity regarding the forces maintaining the deformity and preventing its correction. The aim of our midterm study is to analyze the functional outcome of idiopathic congenital talipes equinovarus using Ponseti’s technique in Indian children presenting to us within the first three months of life without any prior treatment.Methods: 87 patients with 132 feet were treated for correction of idiopathic congenital talipes equino varus using the Ponseti technique from September 2009 to January 2013 at our Institute. These patients were followed up in a prospective manner for a period ranging from twelve months to fifty seven months (mean period of follow up was thirty two months). Children were evaluated before casting and at the end of casting, then at monthly intervals for another two months. Further follow up was done every six weeks till three years of age and then at six monthly intervals.Results: Our overall good to fair result was seen in 87.6% of cases. Rest of them had poor functional outcome. Long term follow up of all patients till skeletal maturity is required to know the final outcome of our treatment. Conclusions: Severity of the deformity and the compliance of the parents and infants with orthotic devices for maintenance of the correction were the factors which ultimately determine the final outcome.

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An evaluation of congenital talipes equinovarus patients treated by various methods

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201729 ◽

2020 ◽

Vol 6 (3) ◽

pp. 480

Author(s):

Navneet Goel ◽

Ashish Goyal ◽

Mohit Sharma

Keyword(s):

Soft Tissue Release ◽

Late Childhood ◽

Congenital Talipes Equinovarus ◽

Initial Management ◽

Radiological Criteria ◽

R Programming Language ◽

Talipes Equinovarus ◽

Congenital Talipes ◽

R Programming

Background: Idiopathic congenital talipes equinovarus is one of the commonest congenital anomaly. Although treatment provides many options, near universal agreement exists that initial management should consist of gentle manipulation of the affected foot. In developing country like India presentation is extremely variable from soon after birth to very late childhood and irregular follow up makes treatment more difficult.Methods: 100 cases of congenital talipes equinovarus who attended the Orthopedics OPD of our hospital (March 2013 to 2016) were taken up. In neonates with delicate skin, the passive manipulation was demonstrated to the mother which they did 5-6 times daily. The application of plaster of Paris cast and passive manipulation was done every 15th day upto 3 months of age. After the 3-month age, passive manipulation was done every 3 weeks. If no normalization, surgery was advised and done to correct the resistant component accordingly. All the analyses were performed in R-programming language (R- 3.0.0).Results: 6 cases,10 feet were lost during follow-up. Results were assessed in 134 feet, 128 cases managed conservatively, 13 surgically. Results were assessed according to clinical, radiological criteria of Beatson and Pearson. 13 feet were operated of 144 feet,11 cases posteromedial soft tissue release (PMSTR) was done. In two Joshi’s external stabilizing system (JESS) fixator was applied.Conclusions: Majority of cases can be treated successfully by conservative means and only in 11 cases PMSTR was done, 2 cases of relapsed feet JESS was applied.

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