scholarly journals Bilateral idiopathic club foot in baby of a rheumatoid mother: A rare case report and its management

2021 ◽  
Vol 7 (1) ◽  
pp. 46-49
Author(s):  
Ranjeet Choudhary ◽  
Alok Chandra Agrawal ◽  
Anupam Pradip Inamdar ◽  
Pandya Raj ◽  
Shilp Verma
Keyword(s):  
Rheumatoid Arthritis ◽  
Club Foot ◽  
Rare Case ◽  
Deformity Correction ◽  
Idiopathic Clubfoot ◽  
Casting Method ◽  
Congenital Clubfoot ◽  
Pirani Score ◽  
Serial Casting ◽  
Female Baby

Congenital clubfoot has a multifaceted etiology, with several hypotheses offered in its etiopathogenesis. The clubfoot has rarely been reported in babies born to women who have rheumatoid arthritis (RA). We present a rare case of a 31-year-old lady with RA on disease-modifying anti-rheumatoid drugs who delivered a child with bilateral congenital clubfoot. She had previously been using Methotrexate, Hydroxychloroquine, and Sulfasalazine regularly, but Methotrexate was stopped seven months before pregnancy. A full-term female baby was born through the cesarean section with bilateral clubfoot deformity and a modified Pirani score of eight out of 10. The deformity correction was done with the Ponseti serial casting method. The final modified Pirani score was two out of ten. In newborns born to rheumatoid arthritis mothers, the club foot deformity was effectively treated with serial Ponseti corrective casts, as was idiopathic clubfoot in babies born to non-rheumatoid mothers. Our findings validate the Ponseti serial casting method for these kinds of patients.

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

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.

scholarly journals Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877236 ◽  
Author(s):  
Anil Agarwal ◽  
Nargesh Agrawal ◽  
Sitanshu Barik ◽  
Neeraj Gupta
Keyword(s):  
Treatment Outcomes ◽  
Deformity Correction ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy ◽  
Female Patients ◽  
Bilateral Group ◽  
Pirani Score ◽  
The Mean ◽  
Treatment Analysis ◽  
Unilateral Group

Introduction: Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot. Material and methods: We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe. Results: There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet. Conclusions: Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.

scholarly journals Change in the severity of congenital clubfoot in the first week of life

2020 ◽  
Vol 7 (4) ◽  
pp. 49-56
Author(s):  
Igor Yu. Kruglov ◽  
Nicolai Yu. Rumyantsev ◽  
Gamzat G. Omarov ◽  
Natalia N. Rumiantceva
Keyword(s):  
Deformity Correction ◽  
Varus Deformity ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Study Group ◽  
Congenital Clubfoot ◽  
Initial Examination ◽  
Global Literature ◽  
Equinus Deformity ◽  
Receive Treatment

Backgrоund. Congenital clubfoot or congenital equino-cava-varus deformity of the feet is one of the most common pathologies of the musculoskeletal system in children. Numerous articles in global literature have been published about changes in clubfoot severity during treatment; however, there are very few reports on how the severity of foot deformities with congenital clubfoot changes during the first week of life in the absence of deformity correction. Aim. To analyze changes in the severity of congenital clubfoot in the first week of life without any treatment. Materials and methods. The study group included 28 newborns with idiopathic congenital clubfoot (a total of 40 feet). The severity of clubfoot was evaluated on days one and seven after birth using the Dimeglio and Pirani scores. Results. During the initial examination of the newborns on the first day of life, the clubfoot severity recorded on the Pirani score was between 2 to 3 points and between 9 to 15 points on the Dimeglio score. Thus, in the first seven days of life in all patients who did not receive treatment, there was a significant increase in the severity of the equino-cava-varus deformity of the feet (p 0.05). The results of this study confirm that the severity of congenital clubfoot increases in the first week of life. This necessitates the beginning of the correction of severe idiopathic clubfoot in the first days after birth. Conclusions. The severity of congenital clubfoot during the first week of life significantly increased in all feet studied (p 0.05: 2 higher than in the table). If left untreated in the first week after birth, the equinus deformity progresses followed by varus deformity, anterior forefoot reduction, and, to a lesser extent, rotation.

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>

Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

2019 ◽  
Vol 30 (6) ◽  
pp. 822-832
Author(s):  
Cecilia L. Dalle Ore ◽  
Christopher P. Ames ◽  
Vedat Deviren ◽  
Darryl Lau
Keyword(s):  
Rheumatoid Arthritis ◽  
Spinal Deformity ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Vena Cava ◽  
Deformity Correction ◽  
Perioperative Outcomes ◽  
Medical Complications ◽  
Filter Placement ◽  
Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

scholarly journals Rational selection of treatment methods in recurrent clubfoot

2021 ◽  
pp. 64-71
Author(s):  
G. V. Divovich
Keyword(s):  
Surgical Treatment ◽  
Bone Growth ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Growth Potential ◽  
Idiopathic Clubfoot ◽  
Rational Selection ◽  
Congenital Clubfoot ◽  
Selection Of

Objective. Based on an analytical assessment of the results of surgical treatment of children with equinovarus foot deformity of various origins (idiopathic clubfoot, syndromic clubfoot), to determine a way of rational selection of surgical techniquesin each specifc case.Materials and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot over the period 2010–2018 were assessed in comparison with the results of the treatment of 41 children with recurrent congenital clubfoot, whose primary treatment had been carried out before 2010. We have gained the experience in treating 30 children with severe clubfoot syndrome (meningomyelocele, CNS lesions, chromosomal diseases and others).Results. In the treatment of congenital clubfoot with the Ponseti method, recurrences occur in 21.79 % of the cases, and in the traditional treatment — in 57.74 %. The Ponseti surgical treatment of recurrences consists in performing release operations on the tendon-ligament apparatus from mini-accesses. Cases of rigid, long-standing deformities require extensive releases on soft tissues, as well as resection and arthrodesis interventions on the joints of the foot. The treatment of clubfoot syndrome requires “surgically aggressive” methods of correction in early childhood.Conclusion. In the idiopathic variants of clubfoot and its relapses, it is possible to correct the vicious position of the feet by minimally invasive operations with minimal damage to the tissues of the circumflex joints and without damage to the flexor tendons and their sheaths in the medial ankle area. Long-standing recurrent rigid variants, as well as syndromic clubfoot, presuppose the performance of extensive releases, osteotomies and arthrodetic resections of the joints of the foot at an early age. A promising direction for clubfoot correction in the process of child development is a surgery with the use of the bone growth potential of the lower leg and foot.

scholarly journals A Case of BeckwithWiedemann Syndrome with Polyhydramnios

2017 ◽  
pp. 185
Author(s):  
Yusrawati Yusrawati ◽  
Reno Muhatiah
Keyword(s):  
Birth Weight ◽  
Prenatal Diagnosis ◽  
Caesarean Section ◽  
Apgar Score ◽  
Rare Case ◽  
Obstet Gynecol ◽  
Fetal Distress ◽  
Polycystic Kidney ◽  
Prenatal Diagnostic ◽  
Female Baby

Objective: To report a rare case of Beckwith-Wiedemann Syndrome with polyhydramnios. Methods: Reporting a case of Beckwith-Wiedemann syndrome with polyhydramnios. Results: Case of Mrs. Y, 27 years old woman, G2P1A0L1 preterm pregnancy (30-31 weeks) with polyhidramnios. From ultrasound found renomegaly, bilateral hyperechogenic polycystic kidney, and the karyotype result was 46,XX. Caesarean section was performed due to fetal distress. A female baby was born by caesarean section with birth weight of 1300 grams, 37 centimeters of body length, and APGAR score of 6/8. The congenital anomalies found were hepatomegaly, renomegaly, bilateral hyperechogenic renal polycystic, low set ears. The baby was died in NICU on day care 5th, with suspected of sepsis. Conclusion: Prenatal diagnosis of Beckwith-Wiedemann syndrome on fetus with polyhydramnios. [Indones J Obstet Gynecol 2017; 5-3: 185-188] Keywords: amniocentesis, beckwith-wiedemann syndrome, polyhydramnios, prenatal diagnostic, USG

To Evaluate the Role of Pirani Score in Deformity Assessment and Management of Club Foot by Ponseti Method – A Hospital Based Prospective Study from Tirupati

2021 ◽  
Vol 8 (29) ◽  
pp. 2633-2638
Author(s):  
Venkat R ◽  
Suguru Rav Kumar ◽  
Penugonda Ravi Shankar ◽  
Deety Lakshmi Venkatesh
Keyword(s):  
Prospective Study ◽  
Scoring System ◽  
Club Foot ◽  
Study Groups ◽  
Ponseti Method ◽  
Classification Systems ◽  
Statistical Inferences ◽  
Pirani Score ◽  
Ethical Approval

BACKGROUND Pirani scoring system is one of the classification systems in management of club foot which is simple and easy to use. However, there is paucity of studies using Pirani system to determine the severity and monitor progress in the treatment of club foot. We therefore set out with the aim of assessing severity and monitoring the progress of treatment using the Pirani scoring system. The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. METHODS It was a hospital-based prospective study of 57 club foot in 41 patients designed to evaluate the role of Pirani score in deformity assessment and management of club foot by Ponseti method. Consecutive patients presenting at the outpatient department at SVRRGGH, Tirupati with idiopathic club foot, and in-patients department with idiopathic club foot were recruited into the study. Informed consent was obtained from parents/guardians of the patients that were recruited in the study. This was a prerequisite for obtaining the ethical approval. Data collected from the study groups was entered into a worksheet, and analysis was performed using the statistical package for social sciences (SPSS) software for windows version 21. Significant statistical inferences were drawn at p & lt ; 0.05. RESULTS The correlation between the midfoot score, hindfoot score, Pirani score and the number of casts to achieve correction was significant (P = 0.001). Also, there was correlation between the Pirani score and the need for tenotomy (P = 0.001); between the number of casts to achieve correction and the need for tenotomy (P = 0.001). Moreover, the progress of treatment can be monitored with the Pirani score (P = 0.001). CONCLUSIONS Pirani scoring system is a simple, easy, quick and reliable system to determine severity and monitor progress in the treatment of club foot with excellent interobserver variability. KEYWORDS Pirani Score, Club Foot, Ponseti Method

Congenital Clubfoot

PEDIATRICS ◽  
1966 ◽  
Vol 38 (3) ◽  
pp. 531-531
Author(s):  
PAUL P. GRIFFIN
Keyword(s):  
Club Foot ◽  
Review Of The Literature ◽  
Congenital Clubfoot ◽  
Excellent Review ◽  
Congenital Form ◽  
Principles Of Treatment ◽  
Physical Findings ◽  
Degrees Of Severity ◽  
Illustrated Book

In this short, well written and illustrated book the author gives an excellent review of the literature related to the etiology and pathology of the congenital form of clubfoot. In the first part of the book he clearly describes the physical findings one would see in clubfeet of varying degrees of severity. The remainder of the book is devoted to techniques and principles of treatment, several of which are only of historical interest. Doctor Hauser describes a method for the treatment of congenital club-foot which in his hands has given uniformly excellent results over a period of 23 years

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