Clubfoot treatment with Ponseti method – Parental distress during plaster casting

Abstract Background Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. The Spearman correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected.Conclusion The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

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Clubfoot treatment with Ponseti method – Parental distress during plaster casting

10.21203/rs.3.rs-21711/v1 ◽

2020 ◽

Author(s):

Christian Walter ◽

Saskia Sachsenmaier ◽

Markus Wünschel ◽

Martin Teufel ◽

Marco Götze

Keyword(s):

Ponseti Method ◽

Long Term Results ◽

Congenital Defects ◽

Idiopathic Clubfoot ◽

Parental Distress ◽

Achilles Tenotomy ◽

Pirani Score ◽

Plaster Casting ◽

Initial Hypothesis ◽

Mental Resilience

Abstract Background: Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot.Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani-Score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani-Score). Therefore, we wanted to investigate weather the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.Results: High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63) and mental resilience (M = 2.25) and. During treatment, mental resilience improved (p = 0.015) significantly. The Spearmann correlation coefficient between Pirani-Score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected. Conclusion: The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

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Treatment of idiopathic clubfoot by Ponseti method: a prospective evaluation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172876 ◽

2017 ◽

Vol 3 (4) ◽

pp. 800

Author(s):

Vijaykumar Kulambi ◽

Subodh Shetty ◽

Venkatesh Ghantasala ◽

Vishwanath Bhagavati

Keyword(s):

Ponseti Method ◽

Congenital Deformity ◽

Idiopathic Clubfoot ◽

Pirani Score ◽

Significant Difference ◽

Before And After ◽

Plaster Casting ◽

Long Time ◽

Full Correction ◽

Pre Treatment

Background: From long time clubfoot has been a clinical challenge to orthopaedic surgeons. It is one of the commonest congenital deformity of the musculoskeletal system in children. Each year more than 1,00,000 babies are born with congenital clubfoot. 80% of which occur in developing countries.Methods: 60 feet in 40 children were treated by the Ponseti method from September 2014 to august 2016. Prospective follow up for a mean duration of 18 months was undertaken. The deformity was evaluated by Pirani score before and after the treatment. At the end of treatment all feet were functionally classified into good, fair and poor.Results: The average number of casts applied before full correction was 8. 21.66% of the feets needed tenotomy before full correction. 90% of the patients showed good results, 3.3% had fair results and 6.6% of patients had poor results. There was a significant difference in the pre-treatment and post-treatment pirani score values.Conclusions: Ponseti method of manipulation and plaster casting is very effective to correct club foot deformity.

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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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Frequency of percutaneous achilles tenotomy in the treatment of idiopathic clubfoot using the ponseti method

Nigerian Journal of Medicine ◽

10.4103/1115-2613.278775 ◽

2018 ◽

Vol 27 (2) ◽

pp. 163

Author(s):

ChukwuemekaOkechukwu Anisi ◽

JosephEffiong Asuquo ◽

InnocentEgbeji Abang

Keyword(s):

Ponseti Method ◽

Idiopathic Clubfoot ◽

Achilles Tenotomy

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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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Clubfoot treatment with Ponseti method—parental distress during plaster casting

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01782-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Christian Walter ◽

Saskia Sachsenmaier ◽

Markus Wünschel ◽

Martin Teufel ◽

Marco Götze

Keyword(s):

Ponseti Method ◽

Parental Distress ◽

Plaster Casting

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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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TL 18192 - Perspective on the Ponseti method for the treatment of clubfoot associated with amniotic band constriction syndrome

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1085 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 106S

Author(s):

Jordanna Maria Pereira Bergamasco ◽

Marcelo Chakkour ◽

Raoni Madeiro ◽

Marco Tulio Costa ◽

Ricardo Cardenuto Ferreira ◽

...

Keyword(s):

Daily Living ◽

Lymphatic System ◽

Ponseti Method ◽

Lower Limbs ◽

Deep Fascia ◽

Amniotic Band ◽

Achilles Tenotomy ◽

The Past ◽

Plaster Casting

Introduction: Amniotic band constriction syndrome is a rare anomaly with an incidence of approximately 1:15,000 live births. It manifests as fibrous amniotic bands involving the deep fascia and, depending on its depth, can compromise the venous and lymphatic system. The presence of fibrous amniotic bands in the lower limbs is strongly associated with foot malformations, and the prevalence of clubfoot under such conditions ranges from 12 to 56%. Clubfoot associated with amniotic band constriction syndrome is characterized by rigidity and edema and tends to respond poorly to conservative treatment. We present a series of cases of clubfoot associated with amniotic band constriction syndrome that were treated with manipulation and plaster casting using the Ponseti method. Methods: Over the past 10 years, we followed 19 patients with amniotic band constriction syndrome affecting the lower limbs. Of these patients, 6 had clubfoot, including 2 who were bilaterally affected. The 6 children in this series had constriction bands in Hennigan and Kuo zone 2. The 8 affected feet were rigid, with a mean Pirani score of 5.5 and Dimeglio III classification. Four extremities with complete constriction bands initially underwent z-plasty for band release, followed by manipulation and plaster casting. The other four extremities had incomplete bands, which were initially subjected to manipulation using the Ponseti method, followed by band release at the time of the Achilles tenotomy. Results: Over a mean follow-up time of 5 years, 7 of the study feet were plantigrade and painless, with no limitations of activities of daily living; only one foot showed limited dorsiflexion, and that patient is awaiting corrective surgery. This limb showed a double band in zone 2 that was both complete and deep. Conclusion: Despite the rigidity, clubfoot secondary to amniotic band constriction syndrome showed good outcomes when treated using the Ponseti method.

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Mini-Open Technique for the Achilles Tenotomy in Correction of Idiopathic Clubfoot

Journal of the American Podiatric Medical Association ◽

10.7547/0980414 ◽

2008 ◽

Vol 98 (5) ◽

pp. 414-417 ◽

Cited By ~ 13

Author(s):

Ali Dogan ◽

Ali Murat Kalender ◽

Ebubekir Seramet ◽

Mustafa Uslu ◽

Ahmet Sebik

Keyword(s):

Present Article ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Open Technique ◽

Achilles Tenotomy ◽

Neurovascular Injury ◽

Equinus Deformity ◽

Mini Open

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30°) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced. (J Am Podiatr Med Assoc 98(5): 414–417, 2008)

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190503 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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