scholarly journals Outcomes of the Ponseti method for the treatment of children diagnosed with congenital clubfoot in population under five years at Fundación Ruth Paz in San Pedro Sula, Honduras

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sandy Lizeth Guerrero Sorto ◽  
Gustavo A. Vásquez García ◽  
Nolvia Sarahí Díaz Cruz ◽  
Paola Estela Figueroa Avilez ◽  
Gabriela Alejandra Contreras
Keyword(s):  
Achilles Tendon ◽  
Plaster Cast ◽  
Ponseti Method ◽  
Abnormal Development ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Children Under Five ◽  
Under Five ◽  
San Pedro ◽  
San Pedro Sula

Background: Congenital clubfoot is a common deformity characterized by an abnormal development of the foot. The etiology is multifactorial and genetic causes have been related. The Ponseti method is a conservative treatment for the clubfoot, mostly used in idiopathic cases. This method involves serial plaster cast changes, tenotomy of the Achilles tendon and use of braces to prevent relapses. This study was designed to identify the characteristics of the patients diagnosed with congenital clubfoot who were treated with the Ponseti method and the main outcomes of this treatment in children under five years.Method: A retrospective study was conducted in Fundación Ruth Paz in San Pedro Sula, Honduras, since June 1st 2015 to May 31th 2017. This study included patients under five years who were diagnosed with congenital clubfoot and treated with Ponseti method. The data were collected from the clinical files of the identified cases.Results: Congenital clubfoot was more common among males (66.3%) and the localization of the deformity was more commonly bilateral (51.8%). The cases of idiopathic clubfoot represent 91.6% of all the cases. The tenotomy of the Achilles tendon was performed in 51.8% of the patients.  Complete treatment was identified in 90.4% of the cases and relapses were reported in 12% of the children who completed treatment.Conclusions: Ponseti method was effective for treat children under five years diagnosed with clubfoot (idiopathic and non-idiopathic) and a significant decrease of the Pirani scoring after treatment was identified in all the cases. A correct use of braces is necessary to avoid relapses.

scholarly journals The impact of the early tenotomy of Achilles tendon on the length and results of congenital clubfoot severe forms treatment

2019 ◽  
Vol 76 (8) ◽  
pp. 795-801
Author(s):  
Zoran Rakonjac
Keyword(s):  
Achilles Tendon ◽  
Negative Impact ◽  
Ponseti Method ◽  
Congenital Clubfoot ◽  
Results Of Treatment ◽  
Analysis Of Results ◽  
Group 2 ◽  
The Impact ◽  
Group 1 ◽  
Female Subjects

Background/Aim. In this paper we present our modification of the Ponseti method which we have been using for the treatment of severe forms of congenital clubfoot since 2007. The aim of this paper was to determine, on the basis of the analysis of results, the impact of the early tenotomy of the Achilles tendon on the length and results of treatment of severe forms of congenital clubfoot. Methods. The study was prospective and lasted from 2007 to 2016 year. It was implemented in the Clinic for Children's Surgery Banjaluka. The Group 1 consisted of the subjects treated by the modified Ponseti method in the period of 9 years (2007?2016). There were a total of 30 subjects (52 feet). There were 20 (67%) of male and 10 (33%) of female subjects. There were 22 (77%) subjects with bilateral and 8 (27%) with unilateral deformity. The Group 2 consisted of the subjects treated by the classic Ponseti method in the period of 9 years (2007?2016). There were a total of 32 subjects (52 feet). There were 26 (81%) of male and 6 (19%) of female subjects. There were 20 (63%) of subjects with bilateral and 12 (37%) with unilateral deformity. We used the Pirani score for: classification of deformity according to the severity, monitoring of results of the correction, determination of indication for tenotomy of the Achilles tendon and for the analysis of results of the treatment. Results. The total length of treatment in the Group 1 was from 6 to 9 weeks (mean = 6.71 ? 0.871), and in the Group 2 from 9 to 12 weeks (mean = 9.92 ? 0.882) (r = 0.86; p = 0.001). There was no difference in the results of the treatment (?2 = 2.372 df = 2 n = 52 p = 0.936. Conclusion. Applying early tenotomy of Achilles tendon in the treatment of severe forms of congenital club foot significantly shortens the duration of treatment and has no negative impact on the results of treatment.

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 TL 18142 - The Ponseti method in children with clubfoot after walking age

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 91S
Author(s):  
Kelly Cristina Stéfani ◽  
Gabriel Ferraz Ferreira ◽  
Davi Podestá Haje ◽  
Mônica Paschoal Nogueira
Keyword(s):  
Random Effects ◽  
Low Cost ◽  
Ponseti Method ◽  
Cochrane Library ◽  
Idiopathic Clubfoot ◽  
Complication Rates ◽  
Random Effects Model ◽  
Congenital Clubfoot ◽  
Walking Age ◽  
The Cochrane Library

Introduction: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an interventional option for older, untreated children.  Methods: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.  Results: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82-0.94, p < 0.01) relative to the total analyzed. The recurrence rate was 18% (95% CI = 0.14-0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03-0.15, p = 0.19).  Conclusion: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures that are likely to cause complications. The obtained results exhibited considerable heterogeneity

scholarly journals APPLICATION OF I.PONSETI TECHNIQUE IN SURGICAL TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

2019 ◽  
Vol 111 (3) ◽  
pp. 6-10
Author(s):  
Oleksii Holubenko ◽  
Anatolii Levytskyi ◽  
Oleksandr Karabeniuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Preoperative Preparation ◽  
Congenital Clubfoot ◽  
High Relapse Rate ◽  
Group I ◽  
Initial Correction ◽  
Prevention Of Recurrence

Summary. One of the most common malformation of the musculoskeletal system in children is congenital clubfoot, which occurs from 2 to 5 cases per 1000 newborns. Treatment of idiopathic clubfoot by the Ponseti method is now standard, and most feet can achieve satisfactory initial correction using this technique. But the high relapse rate (from 20 to 40%) and the existing postoperative complications necessitate the search for approaches to reduce them. One of such approaches is the application of the I.Ponseti technique at the stages of preoperative preparation. The aim of our work is to reduce the incidence of complications in the surgical treatment of congenital clubfoot by applying the I.Ponseti technique. Materials and methods. An analysis was made of the treatment of 62 children (74 feet) with idiopathic congenital clubfoot, who were inpatient and outpatient treatment at the NSH «Ohmatdet» from september 2015 to august 2018. Of these, 39 were patients with recurrence of congenital clubfoot after the initial treatment according to method I.Ponseti and 23 patients with relapsed deformity after initial surgical treatment. Of these, 35 boys and 27 girls. All patients were separated into two groups. Group I – 27 patients (32 feet) who did not use casting according to the I.Ponseti technique before surgical treatment. Group II – 35 patients (42 feet) who underwent staging casting according to I.Ponseti technique at the stages of preoperative planning. The average age of the patients is 4 ± 0.85 years. Result. Use of the I.Ponseti technique at the stages of preoperative preparation in the treatment of congenital clubfoot can significantly reduce the incidence of postoperative complications. The result of which is the possibility of early rehabilitation of patients and prevention of recurrence of deformity.

scholarly journals Rapid decrease of cast-induced forces during the treatment of clubfoot using the Ponseti method

2018 ◽  
Vol 100-B (12) ◽  
pp. 1655-1660 ◽  
Author(s):  
R. B. Giesberts ◽  
E. E. G. Hekman ◽  
G. J. Verkerke ◽  
P. G. M. Maathuis
Keyword(s):  
Life Time ◽  
Plaster Cast ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Force Measurements ◽  
Rapid Reduction ◽  
First Metatarsal ◽  
Short Period ◽  
Force Data ◽  
Over Time

Aims The Ponseti method is an effective evidence-based treatment for clubfoot. It uses gentle manipulation to adjust the position of the foot in serial treatments towards a more physiological position. Casting is used to hold the newly achieved position. At first, the foot resists the new position imposed by the plaster cast, pressing against the cast, but over time the tissues are expected to adapt to the new position and the force decreases. The aim of this study was to test this hypothesis by measuring the forces between a clubfoot and the cast during treatment with the Ponseti method. Patients and Methods Force measurements were made during the treatment of ten idiopathic clubfeet. The mean age of the patients was seven days (2 to 30); there were nine boys and one girl. Force data were collected for several weeks at the location of the first metatarsal and the talar neck to determine the adaptation rate of the clubfoot. Results In all measurements, the force decreased over time. The median (interquartile range) half-life time was determined to be at 26 minutes (20 to 53) for the first metatarsal and 22 minutes (9 to 56) for the talar neck, suggesting that the tissues of the clubfoot adapt to the new position within several hours. Conclusion This is the first study to provide objective force data that support the hypothesis of adaptation of the idiopathic clubfoot to the new position imposed by the cast. We showed that the expected decrease in corrective force over time does indeed exist and adaptation occurs after a relatively short period of time. The rapid reduction in the forces acting on the foot during treatment with the Ponseti method may allow significant reductions in the interval between treatments compared with the generally accepted period of one week.

scholarly journals The Ponseti Method in Children with Clubfoot after Walking Age: Systematic Review and Metanalysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0040
Author(s):  
Kelly Cristina Stéfani ◽  
Davi de Podestá Haje ◽  
Monica Paschoal Nogueira
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Low Cost ◽  
Ponseti Method ◽  
Cochrane Library ◽  
Idiopathic Clubfoot ◽  
Complication Rates ◽  
Random Effects Model ◽  
Congenital Clubfoot ◽  
Walking Age

Category: Clubfoot Introduction/Purpose: The prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children. Methods: A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model. Results: Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82–0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14–0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03–0.15, p = 0.19). Conclusion: Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.

scholarly journals Results of the treatment of congenital clubfoot and its relapses in children: outcomes of 8-year surgical practical work

2020 ◽  
pp. 35-42
Author(s):  
G. V. Divovich ◽  
A. A. Bronova ◽  
T. I. Romanyuk
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Soft Tissues ◽  
Primary Treatment ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Minimally Invasive Surgical ◽  
Minimally Invasive Surgical Treatment ◽  
Foot Deformation

Objective: to evaluate the results of minimally invasive surgical treatment of congenital idiopathic clubfoot and its relapses in children. Material and methods. The results of the treatment of 78 children with congenital idiopathic clubfoot (main group) over the period of 2010-2018 were analyzed in comparison with the results of the treatment of 41 children with relapsed congenital clubfoot, the primary treatment of which had been performed before 2010 (comparison group). Results. It has been found that in the treatment of congenital clubfoot using the Ponseti method relapses occur in no more than 21.79 % cases, and in traditional treatment - in 57.74% cases. The surgical treatment of the relapses using the Ponseti method is to perform release operations on the tendon-ligament apparatus from minimally invasive accesses, whereas cases of rigid chronic deformities require extensive releases on soft tissues, as well as resection-arthrodesis interventions on the joints of the foot. Conclusion. In the treatment of children with congenital clubfoot using the Ponseti method, the rate of relapses is twice as low as that in the application of traditional methods. Relapses in the treatment of congenital clubfoot in children occur mainly at the age of 5. Repeated relapses of foot deformation after the performance of minimally invasive operations did not occur during the study.

scholarly journals Clubfeet and Constriction Band Syndrome - Case Report

2021 ◽  
Author(s):  
Bujar Shabani ◽  
Dafina Bytyqi ◽  
Cen Bytyqi
Keyword(s):  
Ponseti Method ◽  
Interesting Case ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Case Presentation ◽  
Constriction Band ◽  
The Right ◽  
Two Stages ◽  
Constriction Band Syndrome ◽  
Systematic Manipulation

Abstract Background: Clubfeet and constriction band syndrome is a very rare non-idiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in the treatment of congenital constriction band syndrome accompanied by clubfoot deformity and lymphedema. Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in the lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stages completely excising the fibrous band and multiple two-stage Z-plasties on the right calf. Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is an effective treatment of non idiopathic clubfoot distal to congenital amniotic constriction band.

scholarly journals Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: should it affect bracing protocol when using the Ponseti method?

2019 ◽  
Vol 13 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Y. Hemo ◽  
R. Gigi ◽  
S. Wientroub
Keyword(s):  
Biological Response ◽  
Ponseti Method ◽  
Abnormal Development ◽  
Successful Outcome ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Developmental Abnormalities ◽  
Published Evidence ◽  
Tarsal Bones ◽  
Delayed Ossification

Purpose To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF). Methods Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF. Results The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot. Conclusion Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management. Level of Evidence V

scholarly journals Clubfeet and congenital constriction band syndrome - Case report 

2021 ◽  
Author(s):  
Bujar Shabani ◽  
Dafina Bytyqi ◽  
Cen Bytyqi
Keyword(s):  
Ponseti Method ◽  
Interesting Case ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Case Presentation ◽  
Constriction Band ◽  
The Right ◽  
Two Stages ◽  
Constriction Band Syndrome ◽  
Systematic Manipulation

Abstract Background: Clubfeet and constriction band syndrome is a very rare non-idiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in the treatment of congenital constriction band syndrome accompanied by clubfoot deformity and lymphedema. Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in the lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stages completely excising the fibrous band and multiple two-stage Z-plasties on the right calf. Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is an effective treatment of non idiopathic clubfoot distal to congenital amniotic constriction band.

Sign in / Sign up

Export Citation Format

Share Document