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

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

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

scholarly journals Ponseti Treatment in the Management of Clubfoot Deformity – A Continuing Role for Paediatric Orthopaedic Services in Secondary Care Centres

2007 ◽  
Vol 89 (5) ◽  
pp. 510-512 ◽  
Author(s):  
Charles EJ Docker ◽  
Simon Lewthwaite ◽  
Nigel T Kiely
Keyword(s):  
Tertiary Care ◽  
Resource Utilisation ◽  
Tertiary Referral Centre ◽  
Congenital Talipes Equinovarus ◽  
Hub And Spoke ◽  
Surgical Interventions ◽  
Achilles Tenotomy ◽  
Talipes Equinovarus ◽  
Paediatric Orthopaedic ◽  
Set Up

INTRODUCTION The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. PATIENTS AND METHODS In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). RESULTS Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. CONCLUSIONS This ‘hub-and-spoke’ approach would appear to be efficient in terms of resource utilisation. Additional benefits atients and their carers include ease of access to services and reduced financial and transport burdens.

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

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

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

scholarly journals Achilles tenotomy performed percutaneously under local anesthesia in operation theater room in clubfoot.

2019 ◽  
Vol 26 (09) ◽  
pp. 1477-1481
Author(s):  
Abdul Latif Shahid ◽  
Abdul Latif Sami ◽  
Farhad Alam
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Posterior Tibial Artery ◽  
Ponseti Method ◽  
Peroneal Artery ◽  
Congenital Talipes Equinovarus ◽  
Achilles Tenotomy ◽  
Talipes Equinovarus ◽  
Pediatric Orthopedic ◽  
Mini Open

Objectives: Achilles tenotomy is required in 80 % of cases after the Ponseti method in clubfoot. There are many complications reported if it is perfomed percutaneously under local anesthesia in the clinic. Complications are bleeding from either posterior tibial artery or peroneal artery and sometimes from small saphenous vein. Nerve injuries like tibial nerve and sural nerve are also documented. Incomplete Achilles tenotomy is another complication responsible for recurrence of deformity and redo tenotomy. On the other hand, mini-open Achilles tenotomies performed under general anesthesia in Operation Theater have no such complications as mentioned above. The rationale of this present study is to document the safety and any complications when Achilles tenotomy is performed percutaneously under local anesthesia instead of mini-open technique under general anesthesia in the operation theater room. Study Design: Retrospective review study. Setting: Pediatric Orthopedic Department of the Children Hospital and the Institute of Child Health, Lahore.  Period: 2014 to 2018. Material and Methods: In infants with congenital talipes equinovarus who underwent percutaneous Achilles tenotomy in operation theater room under local anesthesia. Results: Fifty patients with seventy five feet included in this retrospective study who underwent Achilles tenotomy percutaneously under local anesthesia in operation theater room. Before starting Ponseti casts, average Pirani score was 5.6.Before Achilles tenotomy, the average number of casts applied was 4.9.11.9 weeks was the average age at the time of Achilles tenotomy. No vascular, neural and tendon related complications occured in any infants and they discharged from hospital on same day. Conclusions: Achilles tenotomy performed percutaneously under local anesthesia in the operation theater room is more safe and comfortable for both family and pediatric orthopedic surgeon in clubfoot. No vascular, neural and tendon related complications occurred. Operation theater environment and local anesthesia are very beneficial for eliminating any chance of vascular, neural and tendon related complications.

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

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

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

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.

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

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.

scholarly journals Bracing in clubfoot: do we know enough?

2019 ◽  
Vol 13 (3) ◽  
pp. 258-264 ◽  
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

scholarly journals Knowledge and Acceptance of Labour Analgesia in Pregnant Women

2018 ◽  
Vol 16 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Mona Sharma ◽  
Saurya Dhungel ◽  
Sujata Niroula ◽  
Manan Karki
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Care Center ◽  
Tertiary Care ◽  
College Teaching ◽  
Cross Sectional Study ◽  
Acceptance Rate ◽  
Labour Analgesia ◽  
Low Income Countries ◽  
Cross Sectional

Background: Labour analgesia, though practiced worldwide, is not very popular in low-income countries. The aim of the study was to assess the awareness, attitude, acceptance, and reasons for hindrance of labour analgesia among patients visiting a tertiary care center in the capital cityMethods: It was a cross sectional study conducted in Obstetrics and Gynecology outpatient department of Kathmandu Medical College Teaching Hospital in the month of August 2017. All pregnant patients presenting for antenatal checkup was included. Data was collected based on a questionnaire after informed consent. Statistical analysis was done in SPSS version 20 and results were expressed in frequencies and percentage.Results: Total of 270 pregnant women participated in the study. Out of these forty-four (16.3%) patients were aware about labour analgesia. The acceptance rate was high (72.2%). Majority (84.6%) had no problem with expenditure associated with labour analgesia.Conclusions: Despite low awareness about painless delivery among the antenatal women, the acceptance rate is high.

scholarly journals Effectiveness of achillotomy in children with arthrogryposis

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.

Sign in / Sign up

Export Citation Format

Share Document