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

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.

scholarly journals Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

2017 ◽  
Vol 3 (4) ◽  
pp. 775
Author(s):  
Rahul Bansal ◽  
Angad Jolly ◽  
P. B. Mohammed Farook ◽  
Idris Kamran ◽  
Syed Wahaj ◽  
...  
Keyword(s):  
Club Foot ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Non Invasive ◽  
Bilateral Involvement ◽  
The Past ◽  
Pirani Score ◽  
Congenital Talipes

<p class="abstract"><strong>Background:</strong> Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.</p><p class="abstract"><strong>Methods:</strong> We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.</p><p><strong>Conclusions:</strong> Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications.</p>

scholarly journals Upper limb dysfunction and activities in daily living in idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Jani Sirkka ◽  
Marita Parviainen ◽  
Henna-Kaisa Jyrkkänen ◽  
Anne M. Koivisto ◽  
Laura Säisänen ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Normal Pressure Hydrocephalus ◽  
Daily Living ◽  
Motor Performance ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Lower Limbs ◽  
Shunt Surgery

Abstract Background Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease with a characteristic symptom triad of gait disturbance, cognitive decline, and incontinence. Recently, also dysfunctions in upper limbs have been described in iNPH and reported to improve after shunt surgery. We aim to describe the role of upper limb motor function in the clinical assessment of iNPH patients and its influence on activities of daily living (ADL). Methods Seventy-five consecutive patients with probable iNPH were studied pre-operatively and at 3 and 12 months after shunt surgery. The pre-operative evaluation included lumbar drainage of cerebrospinal fluid (tap test). Motor functions were assessed in upper and lower limbs with Grooved Pegboard Test (GPT), Box & Block Test (BBT), Total Score of Gait (TSG), and balance test. ADL was assessed with Barthel’s index and cognition in accordance with the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Results Patients showed improvement in all motor tests and ADL at 3 months after shunt surgery. The improvement remained stable during the 12-month post-operative follow-up. The motor function tests correlated with each other and with ADL. Conclusions A 3-month follow-up period after shunt surgery is adequate to show improvement in motor tasks, and a positive outcome will last for at least 12 months. A shunt-responsive dysfunction of upper limb motor performance plays a major role in ADL of iNPH patients. Therefore, we suggest an evaluation of upper limb motor performance to be included in routine evaluation of iNPH patients.

Surgical strategies in management of ankylosed bilateral hips and knees in crouched posture

2020 ◽  
Vol 13 (10) ◽  
pp. e236043
Author(s):  
Sathish Muthu ◽  
Girinivasan Chellamuthu ◽  
Thiruvengita Prasad Gopalswamy ◽  
Velmurugan Kandasamy
Keyword(s):  
Treatment Plan ◽  
Lower Limbs ◽  
Good Recovery ◽  
Surgical Strategies ◽  
Holistic Treatment ◽  
The Past ◽  
Thoracolumbar Region ◽  
Neurovascular Structures ◽  
Locomotor Ability

A 26-year-old wheelchair-bound man was brought to our institute with progressive painful deformity of both lower limbs involving bilateral hip and knee for the past 5 years. The patient was wheelchair-bound for the past 18 months. He was only able to crawl to meet his locomotor demands. On examination, the patient was in a crouched posture with mild kyphosis at the thoracolumbar region and ankylosis of bilateral hip and knee in an unfavourable position. Radiological and serological evaluation diagnosed him to be a case of neglected ankylosing spondylosis. We planned for arthroplasty of the bilateral hip and knee for correcting his posture and to regain his locomotor ability. The severity of the deformity mandated extensive releases and the handling of neurovascular structures. Hence, a holistic treatment plan with various surgical strategies was devised to manage his deformities. The patient made a good recovery and regained his locomotor ability without any major complications at a 2-year follow-up.

scholarly journals Correlation of Pirani Scoring with the Outcome of Treatment in Idiopathic Congenital Talipes Equinovarus Treated with Ponseti Method: A Prospective Cohort Study

2021 ◽  
Author(s):  
Karnakar Kolla ◽  
BD Athani ◽  
Shweta Jain ◽  
Vikas Gupta
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ponseti Method ◽  
Achilles Tenotomy ◽  
Pirani Score ◽  
Satisfactory Outcome ◽  
Talipes Equinovarus ◽  
Congenital Talipes

Introduction: Congenital Talipes Equino Varus (CTEV) is the most common congenital musculoskeletal malformation and Ponseti method of correction is most commonly used technique. Pirani score is the simplest, reliable and quick to use tool designed to assess the severity of deformity. Aim: To evaluate the results of Ponseti method in children with idiopathic CTEV using modified Pirani score. Materials and Methods: A prospective cohort study was conducted over a period of 18 months from September 2015 to February 2017 in the Departments of Physical Medicine and Rehabilitation (PMR) and Orthopaedics of Safdarjung hospital, New Delhi. Thirty cases representing 47 feet were recruited for the study. They were divided (15 in each) into 0-6 months (younger) and 6-12 months (older) group and were evaluated pre and post Ponseti correction using modified Pirani score in terms of number of casts required, necessity of Percutaneous Tendo-Achilles Tenotomy (PTAT) and the outcome after 12 months of follow-up. Spearman rank correlation coefficient was used for correlation. Results: There was preponderance of bilateral CTEV, 17 (56.6%) and 38 severe cases (80.85%) had mean Pirani score higher (5.52) in older group than in younger group (5.38). Number of casts required to correct the deformity with Pirani score 0 at the end of the treatment was related to severity (p=0.001) and not age (p=0.591). Present study showed 43 feet (91.48%) required PTAT to correct the equinus deformity (p=0.041). Satisfactory outcome was noted in 41 feet (87.23%) of cases at 12 months of follow-up out of which more were in younger age group. Conclusion: Requirement of number of casts and tenotomy was related with severity of CTEV.

scholarly journals Using the modified Ponseti method to treat complex clubfoot: early results

2020 ◽  
Author(s):  
Celal Bozkurt ◽  
Serkan Sipahioğlu ◽  
Baran Sarıkaya ◽  
Mehmet Akif Altay ◽  
Baki Volkan Çetin
Keyword(s):  
Clinical Characteristics ◽  
Ponseti Method ◽  
Final Visit ◽  
Achilles Tenotomy ◽  
Plantar Surface ◽  
Early Results ◽  
Appropriate Treatment ◽  
The Mean ◽  
Demographic Features

Abstract Objectives In complex clubfoot, equinus, varus of the heel, forefoot adduction, and supination are more severe than in typical clubfoot. The feet are short and stubby, with deep creases above the heel and on the plantar surface. To successfully treat this subgroup of patients, orthopaedic clinicians must be able to recognise the clinical characteristics of complex clubfoot and implement the appropriate treatment effectively.Methods A total of 11 patients with 16 clubfeet were included in this study. Demographic features, clubfoot severity, number of casts, position of each foot before cast removal, ankle dorsiflexion (DF), complications, and additional procedures were noted at all clinical visits.Results The mean follow-up period was 13.3 months. All patients were initially corrected using a mean of 7 (5–8) casts and Achilles tenotomy. Relapses occurred in three patients (18.75%), but all recovered after recasting. The creases above the heels disappeared in all of the patients, whereas plantar creases persisted on two (12.5%) feet. The mean Pirani scores calculated at the first visit, after tenotomy, and at the final visit were 5.22± 0.52,, 0.72 ± 0.41and 0.41 ± 0.42, respectively. The mean DF measurements recorded before tenotomy, after tenotomy, and at the final visit were 8.31° ± 3.03°, 15.19° ± 3.75 °, and 20.19° ± 4.46°, respectively. Pirani scores and DF improved statistically significantly after treatment, and DF improved significantly between tenotomy and the final visit.Conclusions The modified Ponseti method is an effective treatment for complex clubfoot. It is crucial that orthopaedic clinicians can recognise this deformity at any stage and implement the modified Ponseti method effectively.

scholarly journals Non-pharmacological interventions for aggression in persons with dementia: A 10-year follow-up review of the literature

2018 ◽  
Vol 6 (3) ◽  
pp. 8 ◽  
Author(s):  
Caroline Kinskey ◽  
Jeffrey A. Buchanan
Keyword(s):  
Side Effects ◽  
Staff Training ◽  
Daily Living ◽  
Psychotropic Medications ◽  
Empirical Literature ◽  
Review Of The Literature ◽  
Pharmacological Interventions ◽  
Training Interventions ◽  
The Past

Aggression is a common behavior in persons with dementia (PWDs). Nursing staff report that aggression is the most distressing behavior they face on the job. In addition, aggression may result in the prescription of psychotropic medications, which are largely ineffective and have dangerous side effects. Therefore, non-pharmacological interventions are necessary to safely manage aggressive behaviors and target the underlying cause of aggression. The current paper is a 10-year follow-up to Buchanan and colleagues’ 2007 literature review of non-pharmacological interventions for aggression in PWDs. This paper has three primary purposes: (1) To update the review of the empirical literature in this area; (2) To examine how limitations in the literature have been addressed over the past 10 years; and (3) To suggest areas of future inquiry. Findings suggest that comprehensive staff training interventions and distraction-based interventions during activities of daily living (ADLs) show the most promise for managing aggression in PWDs.

scholarly journals PO 18191 - Congenital distal tibiofibular diastasis

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 39S
Author(s):  
Jordanna Maria Pereira ◽  
Ricardo Cardenuto Ferreira ◽  
Marco Tulio Costa ◽  
Noé De Marchi Neto ◽  
Daiana Kerry Gobbo ◽  
...  
Keyword(s):  
Daily Living ◽  
Skeletal Maturity ◽  
Good Alternative ◽  
The Other ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Unknown Etiology ◽  
Rare Entity ◽  
The Right

Introduction: Congenital distal tibiofibular diastasis is an extremely rare entity of unknown etiology that compromises the feet and ankles with different degrees of deformity, although in general, the feet show equinovarus deformity, and the talus is proximally dislocated due to the separation of the distal tibial and fibular epiphyses. There are few reports of this disorder in the literature, and most describe cases that ultimately lead to limb amputation. We present the cases of 2 patients treated from birth to skeletal maturity. Methods: Two female patients with clubfoot at birth were diagnosed with congenital distal tibiofibular diastasis. One of them had the deformity of the right foot, and the other had deformity of both limbs. Both patients underwent early distal tibiofibular arthrodesis and serial stretching of the compromised feet and legs. Results: After 20 years of clinical follow-up and after reaching skeletal maturity, both patients had plantigrade feet without significant shortening of the lower limbs or pain, and both performed activities of daily living without restrictions, wearing conventional shoes. Conclusion: Early distal tibiofibular arthrodesis followed by limb stretching was effective for treating congenital distal tibiofibular diastasis and is a good alternative to amputation, which is indicated in the literature.

scholarly journals Clubfoot treatment with Ponseti method – Parental distress during plaster casting

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.

scholarly journals Clubfoot treatment with Ponseti method – Parental distress during plaster casting

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). 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.

scholarly journals Ponseti Casting for Severe Club Foot Deformity: Are Clinical Outcomes Promising?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mohammad Hallaj-Moghaddam ◽  
Ali Moradi ◽  
Mohammad Hosein Ebrahimzadeh ◽  
Seyed Reza Habibzadeh Shojaie
Keyword(s):  
Club Foot ◽  
Ponseti Method ◽  
Foot Deformity ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Before And After ◽  
The Mean ◽  
A Prospective Study ◽  
Demographic Features

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13±7.2versus9.2±18), it was not significant (P=0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was16±3.4and at the end of follow-up it was1.6±6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents’ were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

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