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 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 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 RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY

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.

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 Congenital club foot

2010 ◽  
Vol 57 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Z.S. Vukasinovic ◽  
N.S. Slavkovic ◽  
Z.M. Zivkovic ◽  
V.D. Bascarevic
Keyword(s):  
Surgical Treatment ◽  
Club Foot ◽  
Soft Tissues ◽  
Plantar Flexion ◽  
Lateral Side ◽  
Foot Deformity ◽  
Congenital Clubfoot ◽  
Medial Side ◽  
Success Of Treatment ◽  
Bone Deformities

Congenital club foot is the most frequent foot deformity. It occurs in 1% of newborns, two times more frequently in boys, with family inheritance. Patoanatomicaly, entity consists of bone deformities, articular malpositions and soft tissues retraction. All these produce adduction of the forefoot and varus and equinovarus of the hindfoot. Lateral side of the foot is convex and medial side is concave. Forefoot is in adduction and plantar flexion in relation to the hindfoot. The heel is rotated medially which induces varus and eqinus of the foot. The aim of the treatment is to establish anatomically normal foot, painless, with moderate movements, which is suitable for normal shoes. At the beginning treatment is nonsurgical. If nonsurgical treatment fails further step should be surgical treatment. The success of treatment of congenital clubfoot depends on the time of diagnosis and treatment beginning.

scholarly journals Comparison of ponseti method versus surgical treatment in congenital idiopathic clubfoot: A 5-year follow up study

2019 ◽  
Vol 5 (3) ◽  
pp. 666-669
Author(s):  
Chatupon Chotigavanichaya ◽  
Jidapa Wongchareonwatana ◽  
Charikdhamma Saelim ◽  
Thanase Ariyawatkul ◽  
Kamolporn Kaewpornsawan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Follow Up Study

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 An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Murtaza Kadhum ◽  
Mu-Huan Lee ◽  
Jan Czernuszka ◽  
Chris Lavy
Keyword(s):  
Soft Tissues ◽  
Ponseti Method ◽  
Tissue Growth ◽  
Matrix Remodeling ◽  
Foot And Ankle ◽  
Congenital Clubfoot ◽  
Posterior Aspect ◽  
Pediatric Foot ◽  
Significant Disability ◽  
Rate Limiting

Congenital clubfoot is a complex pediatric foot deformity, occurring in approximately 1 in 1000 live births and resulting in significant disability, deformity, and pain if left untreated. The Ponseti method of manipulation is widely recognized as the gold standard treatment for congenital clubfoot; however, its mechanical aspects have not yet been fully explored. During the multiple manipulation-casting cycles, the tendons and ligaments on the medial and posterior aspect of the foot and ankle, which are identified as the rate-limiting tissues, usually undergo weekly sequential stretches, with a plaster of Paris cast applied after the stretch to maintain the length gained. This triggers extracellular matrix remodeling and tissue growth, but due to the viscoelastic properties of tendons and ligaments, the initial strain size, rate, and loading history will affect the relaxation behavior and mechanical strength of the tissue. To increase the efficiency of the Ponseti treatment, we discuss the theoretical possibilities of decreasing the size of the strain step and interval of casting and/or increasing the overall number of casts. This modification may provide more tensile stimuli, allow more time for remodeling, and preserve the mechanical integrity of the soft tissues.

scholarly journals Results of treatment of congenital clubfoot after soft tissue release in children

2020 ◽  
pp. 81-85
Author(s):  
O. Holubenko ◽  
◽  
A. Levytskyi ◽  
O. Karabenyuk ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Cuboid Bone ◽  
Long Term Treatment ◽  
Plaster Casts

Topicality. Widespread use of the method of I. Ponseti allows to significantly reduce the number of reconstructive surgeries and/or reduce their volume. However, if presence the rigid, severe deformities that cannot be corrected with staged plaster casts, or recurrences, surgical treatment is advisable. The literature describes many surgical techniques, the main purpose of which is to reduce the frequency of postoperative complications. And at the same time find the most convenient access to eliminate contractures, further wound healing by primary tension with minimal formation of connective tissue elements. Objective: to reduce the incidences of complications in the surgical treatment of congenital clubfoot by using a modified surgical approach. Materials and methods. In the Department of Orthopedics and Traumatology of NCSH «OKHMATDYT» 57 children (72 feet) with a diagnosis of congenital clubfoot underwent surgical treatment using a modified Carroll approach for the period from January 2014 to September 2018. The mean age of patients was 3±0.4 years. 41 of them boys and 16 girls. Bilateral deformity was observed in 12 patients. 48 patients (58 feet) were underwent surgical treatment after initial treatment with staged plaster casts according to the method of I. Ponseti. Recurrences of deformity after surgery was observed in 9 patients (14 feet). Results. When assessing the immediate results during surgery in all patients, complete correction of foot deformity was achieved. No postoperative complications were noted. Long-term treatment results 2 years after surgery showed that good results were in 12 patients (21±9.53%), satisfactory in 39 (68.4±27.14%) and unsatisfactory in 6 (7±2.18%). Four patients with unsatisfactory results and residual manifestations of deformity in the form of passively corrected isolated adduction of the anterior foot, subsequently underwent surgery to transplant the anterior tibialis tendon to the lateral cuneiform bone. And 2 patients – wedge-shaped resection of the cuboid bone. Indication of which was not the possibility of passive correction of deformity. Conclusions. The comparative analysis of the obtained results and literature data testifies to the effectiveness of the proposed method of treatment of idiopathic clubfoot in children (using three approaches), as well as in the presence of residual deformity after conservative and surgical treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: clubfoot, children, posteromedial release, surgical treatment.

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.

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