Evaluation of effectiveness of Ponseti's method in the clubfoot management under 1-year children: 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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Ponseti Casting for Severe Club Foot Deformity: Are Clinical Outcomes Promising?

Advances in Orthopedics ◽

10.1155/2015/821690 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Mohammad Hallaj-Moghaddam ◽

Ali Moradi ◽

Mohammad Hosein Ebrahimzadeh ◽

Seyed Reza Habibzadeh Shojaie

Keyword(s):

Club Foot ◽

Ponseti Method ◽

Foot Deformity ◽

Achilles Tenotomy ◽

Serial Casting ◽

Before And After ◽

The Mean ◽

A Prospective Study ◽

Demographic Features

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13±7.2versus9.2±18), it was not significant (P=0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was16±3.4and at the end of follow-up it was1.6±6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents’ were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

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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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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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Clinico-Sonographical Evaluation of Idiopathic Clubfoot and its Correction by Ponseti Method-A Prospective Study

Clinical Research on Foot & Ankle ◽

10.4172/2329-910x.1000255 ◽

2018 ◽

Vol 06 (01) ◽

Author(s):

Sumit Chawla ◽

Mallika Gupta ◽

Varun Pandey ◽

Abhishek Jain ◽

Manoj Kumar

Keyword(s):

Prospective Study ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

A Prospective Study

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Outcome of Dorsal Onlay Urethroplasty for Long Segment Anterior Urethral Stricture: Experience of 31 Cases

Bangladesh Journal of Urology ◽

10.3329/bju.v19i1.49339 ◽

2020 ◽

Vol 19 (1) ◽

pp. 28-31

Author(s):

Hafiz Al Asad ◽

Prodyut Kumar Saha ◽

AKM Shahadat Hossain ◽

Md Waliul Islam ◽

Akm Musa Bhuiyan

Keyword(s):

Urethral Stricture ◽

Kidney Diseases ◽

Successful Outcome ◽

Anastomotic Site ◽

Short Term ◽

Term Outcome ◽

Buccal Mucosa Graft ◽

Retrograde Urethrogram ◽

A Prospective Study

Objective: To determine the short-term outcome of dorsolateral onlay urethroplasty in the treatment of long segment anterior urethral stricture. Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal. Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%. Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.28-31

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Dorsolateral Onlay Urethroplasty for the Long Segment Anterior Urethral Stricture: Outcome of 31 Cases

Bangladesh Journal of Urology ◽

10.3329/bju.v18i1.49203 ◽

2020 ◽

Vol 18 (1) ◽

pp. 12-15

Author(s):

Hafiz Al Asad ◽

Md Sharif Shahjamal ◽

Sarforaj Ali Khan ◽

Md Waliul Islam ◽

AKM Zamanul Islam Bhuiyan

Keyword(s):

Urethral Stricture ◽

Kidney Diseases ◽

Successful Outcome ◽

Anastomotic Site ◽

Short Term ◽

Buccal Mucosa Graft ◽

Retrograde Urethrogram ◽

A Prospective Study ◽

Optical Internal Urethrotomy

Objective: This study is designed to observe the short-term outcomes of dorsolateral onlay urethroplasty to treat long segment anterior urethral stricture. Materials and Methods: A prospective study from May 2011 to September 2012 is carried out in department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBanglanagar, Dhaka. Thirty one patients with long anterior urethral stricture were treated by a dorsolateral onlay buccal mucosa graft. After voiding trial, they were followed up at 3 weeks and 3 months with history, physical examination, uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Patients were further followedup at 3 months interval with uroflowmetry and retrograde urethrogram (RGU) if required (uroflowmetry <15 ml/sec). Successful outcome was defined as normal voiding with no surgical intervention after catheter removal. Results: Mean stricture length was 42.49±12.77 mm (range 24-70 mm) and mean follow up was 8 months (range 6 to 12 months). Three patients were found to develop stricture at anastomotic site, during follow-up and required optical internal urethrotomy and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90.32%. Conclusion: Dorsolateral onlay BMG urethroplasty is feasible for long anterior urethral stricture with good short term surgical outcome. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.12-15

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STEENBEEK FOOT ABDUCTION BRACE FOR CLUBFOOT: COST EFFECTIVE BUT IS IT EFFECTIVE? A PROSPECTIVE STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i5.16296 ◽

2017 ◽

Vol 10 (5) ◽

pp. 99 ◽

Cited By ~ 1

Author(s):

Thatikonda Sai Dinesh ◽

Prem Kotian

Keyword(s):

Cost Effective ◽

Ponseti Method ◽

Exact Test ◽

Pirani Score ◽

Proven Efficacy ◽

The Status ◽

Cost Effective Alternative ◽

A Prospective Study ◽

Fischer Exact Test

Introduction: Foot Abduction Brace is recommended to prevent recurrence after casting phase in Ponseti method. Various types of braces are described, most current braces with proven efficacy are costly(100-300$) and difficult to acquire especially for the common man in India. Steenbeek brace can be made with locally available materials and is very simple to make and is cost effective(10$). Its efficacy is largely untested.Aim: To evaluate effectiveness of Steenbeek foot abduction brace to maintain correction achieved and to study the reasons for failure and complications associated with the brace.Materials and Methods: In KMC Mangalore and allied hospitals between Jun’2014-Aug’2016 25patients (38feet) who were treated by Ponseti method of cast application were given the Steenbeek foot abduction brace and followed up for a minimum duration of 1 year. The Status of foot was assessed using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and Compliance defined as brace application for 23 hours/day for the first three months, and nap time brace application for rest of the duration of study.Results: In 36 of 38 feet on the brace the correction was maintained(94.7% effective). In two patients(feet) there was worsening of the Pirani score after brace application and recurrence was seen. The reason for failure was found to be non compliance. The correlation between noncompliance and recurrence was significant(p <0.001) using Fischer Exact Test. Pirani score improved significantly in compliant group with significant worsening noted in noncompliant group. There were no other brace related complications.Conclusions: The significant correlation between noncompliance and recurrence shows that Steenbeek FAB is effective in maintaining correction and can be a cost-effective alternative to the more costly braces, for use in developing countries.

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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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