Newer modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and posterior, posteromedial soft tissue release in 6 month to 5 year age group children

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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Comparison of the Soft-Tissue Release Methods in Idiopathic Clubfoot

Journal of Pediatric Orthopaedics ◽

10.1097/01241398-200009000-00019 ◽

2000 ◽

Vol 20 (5) ◽

pp. 648-651 ◽

Cited By ~ 15

Author(s):

Tuncay Centel ◽

A. Erdem Bagatur ◽

Tahir Öğüt ◽

Taner Aksu

Keyword(s):

Soft Tissue ◽

Soft Tissue Release ◽

Idiopathic Clubfoot

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What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

EFORT Open Reviews ◽

10.1302/2058-5241.6.200110 ◽

2021 ◽

Vol 6 (5) ◽

pp. 354-363

Author(s):

Daniel Murphy ◽

Mohsen Raza ◽

Hiba Khan ◽

Deborah M. Eastwood ◽

Yael Gelfer

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Functional Limitation ◽

Soft Tissue Release ◽

Idiopathic Clubfoot ◽

Tibial Osteotomy ◽

Patient Reported ◽

Walking Age ◽

Study Population ◽

Equinus Deformity

Equinus contracture is the most common deformity at clubfoot relapse and causes pain and functional limitation. It presents a challenge to the orthopaedic surgeon throughout childhood. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were: (i) original articles, (ii) investigating management of relapsed idiopathic clubfoot, (iii) with at least a partial study population of primarily equinus deformity, and (iv) a paediatric study population of independent walking age. Nine studies were included with a total of 163 patients (207 feet). Studies presented five management paradigms: gastrocnemius-soleus complex release, extensive posterior soft tissue and joint release, anterior distal tibial hemi-epiphysiodesis, distal tibial osteotomy, and circular frame distraction. All approaches reported success in at least one of our selected outcome domains: plantigrade status, range of motion, clinical outcome scores, functional status, radiographic outcomes, patient-reported outcomes, and complications. Younger children tend to be managed with soft tissue release while older children tend to require more extensive bone/joint procedures. Relapse in surgically treated feet is harder to treat. Comparison across treatment approaches is limited by the small size and low evidence level of the literature, as well as a lack of consistent outcome reporting. It is therefore not possible to recommend any one treatment option in any age group. This review highlights the need for a validated core outcome set to enable high-quality research into the management of equinus deformity. Cite this article: EFORT Open Rev 2021;6:354-363. DOI: 10.1302/2058-5241.6.200110

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Radiographic Prognostic Factors for Selective Soft Tissue Release After Ponseti Failure in Young Pediatric Clubfoot Patients

Foot & Ankle International ◽

10.1177/1071100718755475 ◽

2018 ◽

Vol 39 (6) ◽

pp. 712-719

Author(s):

Michael Seungcheol Kang ◽

Il-Yeong Hwang ◽

Soo-Sung Park

Keyword(s):

Prognostic Factors ◽

Soft Tissue ◽

Lateral View ◽

Soft Tissue Release ◽

Tibialis Posterior ◽

Idiopathic Clubfoot ◽

Abductor Hallucis ◽

Retrospective Case ◽

Level Of Evidence ◽

Metatarsal Angle

Background: Selective soft tissue release (SSTR), which includes a combination of abductor hallucis, tibialis posterior, and Achilles lengthening, has been used in patients with recurrent clubfoot deformity after Ponseti treatment. The aim of this study was to investigate the prognostic factors for recurrence of clubfoot deformity after SSTR. Methods: Consecutive patients with idiopathic clubfoot and residual or recurrent deformity after Ponseti treatment underwent SSTR between 2005 and 2013. The clinical and radiologic characteristics before and after SSTR were analyzed. The ability of radiologic factors to predict recurrence of clubfoot deformity was assessed using multivariate analysis. Rigid deformities of forefoot adduction, and hindfoot varus, and equinus were examined separately. Forty-three patients with 64 clubfeet were included. Results: Postoperative improvement in the talo–first metatarsal angle on the anteroposterior view, the talocalcaneal angle on the lateral view, and the tibiocalcaneal angle on the lateral view independently predicted recurrence after SSTR. Additionally, the preoperative talocalcaneal angles on the anteroposterior and lateral views were also significant predictors, but these angles did not significantly improve after SSTR. Conclusions: SSTR seems to be an effective surgical modality only in milder deformities. Among patients with poor talocalcaneal angles, a high percentage required further surgery. The present results may be useful for the choice of SSTR or more extensive surgery. Level of Evidence: Level III, retrospective case-control study.

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Results of ala carte Posteromedial Soft Tissue Release in Idiopathic Clubfoot

Malaysian Orthopaedic Journal ◽

10.5704/moj.2107.013 ◽

2021 ◽

Vol 15 (2) ◽

pp. 89-95

Author(s):

Barik S ◽

Das L ◽

Yadav AK ◽

Arora SS ◽

Singh V

Keyword(s):

Soft Tissue ◽

Soft Tissue Release ◽

Idiopathic Clubfoot

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Ponseti Casting vs. Soft Tissue Release for the Initial Treatment of Non-idiopathic Clubfoot

Frontiers in Surgery ◽

10.3389/fsurg.2021.668334 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jonathan Abraham ◽

Jon Cooper Wall ◽

Michel Diab ◽

Cody Beaver

Keyword(s):

Soft Tissue ◽

Initial Treatment ◽

Operating Time ◽

Ponseti Method ◽

Soft Tissue Release ◽

Idiopathic Clubfoot ◽

Continuous Variables ◽

Time Data ◽

Retrospective Case ◽

Level Of Evidence

Purpose: Ponseti casting has universally been accepted as the gold standard for treatment of idiopathic clubfoot. Conversely, primary treatment for non-idiopathic clubfoot has not been established. The purpose of this study is to compare treatment outcomes following primary soft tissue release (STR) and Ponseti casting of non-idiopathic clubfoot.Methods: An IRB-approved retrospective study of patients treated for non-idiopathic clubfoot between 2005 and 2020 was conducted. Patients were included if they began treatment before the age of 2 and had at least 1 year of follow up. Patients were placed into either the STR group or Ponseti group and variables of interest were documented including reoccurrence of deformity, number of surgeries performed, type of surgeries performed, anesthesia time, and surgery time. Data was analyzed using Mann-Whitney U test for continuous variables.Results: A total of 33 children with 57 neuromuscular/syndromic clubfoot were identified of which 9 (15 feet) were treated with STR and 24 (42 feet) were treated with Ponseti casting. Average anesthesia and surgery time were found to be 291 and 179 min, respectively, for the STR group, and 113 and 67 min for the Ponseti group. The difference in operating time was determined to be significant (p = 0.02, p = 0.01). Patients treated with STR were found to have significantly more surgeries performed over the course of treatment than those treated with Ponseti casting (p = 0.001) with an average of 4.2 surgeries in the STR group and 1.5 surgeries in the Ponseti group. Extracapsular procedures were performed in 100% of the STR group and 97.6% of the Ponseti group (p = 0.55). Intracapsular procedures were performed in 100% of the STR group and 50% of the Ponseti group (p = 0.001).Conclusion: The Ponseti method should serve as the primary approach in the initial treatment of non-idiopathic clubfoot as it can reduce the risk of future invasive intracapsular surgery and shorten anesthesia and surgery times when surgical treatment is necessary.Level of Evidence: Level III retrospective case control study.

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