Relapse Pattern in Club Foot Treated with Ponseti Technique - A Prospective Observational Study from Kerala, India

BACKGROUND Though the Ponseti method has become the popular and standard of care for clubfoot correction, relapse of clubfoot deformity following correction is not uncommon. The relapsed feet can progress from flexible to rigid if left untreated and can become as severe as the initial deformity. The purpose of this study was to analyse the relapse pattern in clubfeet that have undergone treatment with the Ponseti method. METHODS Between 2015 and 2017, 78 children (134 feet), 58 boys and 20 girls were included in this study. It was a prospective observational study of relapse patterns in idiopathic clubfoot after one year of completion of the Ponseti method of treatment. Pirani scoring system was used to identify the relapse. RESULTS Dynamic, fixed, and complete relapse patterns were observed in this study. Patients were categorised into two groups - bilateral and unilateral. In the bilateral group, 18 children (36 feet i.e. 23 %) had decreased ankle dorsiflexion, 5 had (10 feet i.e. 6 %) rigid equinus, 22 had (44 feet i.e., 29 %) dynamic forefoot adduction or supination and 5 had (10 feet i.e. 6 %) fixed adduction in forefoot and midfoot. Six children from the bilateral group showed complete relapse. Among the unilateral group, 8 children (8 feet i.e. 36 %) presented with decreased ankle dorsiflexion, 4 had (4 feet i.e. 18 %) rigid equinus relapse, 6 had (6 feet i.e. 27 %) dynamic forefoot adduction or supination and 4 had (4 feet i.e. 18 %) showed fixed forefoot adduction. CONCLUSIONS Dynamic forefoot adduction or supination pattern is common to relapse pattern in the bilateral group and dynamic hind-foot relapse was common in the unilateral group. Age at initial presentation, initial Pirani score, and the number of casts required were not significantly related to the incidence of relapse. KEYWORDS Club Foot, CTEV, Ponseti Method, Relapse Pattern

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499018772364 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877236 ◽

Cited By ~ 4

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.

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Conservative Management of Idiopathic Clubfoot: Kite versus Ponseti Method

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700115 ◽

2009 ◽

Vol 17 (1) ◽

pp. 67-71 ◽

Cited By ~ 26

Author(s):

AV Sanghvi ◽

VK Mittal

Keyword(s):

Conservative Management ◽

Ponseti Method ◽

Ankle Dorsiflexion ◽

Long Term Results ◽

Idiopathic Clubfoot ◽

Success Rates ◽

Residual Deformity ◽

Full Correction ◽

Rapid Correction

Purpose. To compare the long-term results of the Kite and Ponseti methods of manipulation and casting for clubfoot. Methods. 42 patients (with 64 idiopathic clubfeet) were equally randomised to Kite or Ponseti treatments in the early weeks of life. 14 males and 7 females (34 clubfeet) were treated by the Kite method, whereas 13 males and 8 females (30 clubfeet) were treated by the Ponseti method. All the clubfeet were manipulated, casted, and followed up (for a mean of 3 years) by one experienced orthopaedic surgeon. The final results were compared. Results. The success rates for the Kite and Ponseti treatments were similar (79% vs 87%). With the Ponseti method, the number of casts was significantly fewer (7 vs 10); the duration of casting required to achieve full correction was significantly shorter (10 vs 13 weeks); the maximum ankle dorsiflexion achieved was significantly greater (12 vs 6 degrees); and the incidence of residual deformity and recurrence was slightly lower. Conclusion. The Ponseti method can achieve more rapid correction and ankle dorsiflexion with fewer casts, without weakening the Achilles tendon.

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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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