scholarly journals Zdravljenje idiopatskega in kompleksnega prirojenega talipes ekvinovarusa z metodo po Ponsetiju

2015 ◽  
Vol 84 (10) ◽  
Author(s):  
Lovro Suhodolčan ◽  
Karin Schara ◽  
Janez Brecelj ◽  
Vane Antolič
Keyword(s):  
Healthy Child ◽  
Plantar Flexion ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Live Births ◽  
Rigid Deformation ◽  
Tendo Achillis ◽  
Sole Of The Foot

Abstract:Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application.Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized  as short, stubby foot,  having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.

scholarly journals Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot

2020 ◽  
Author(s):  
Mehmet Demirel ◽  
Fuat BİLGİLİ ◽  
Çiğdem ÖZKARA BİLGİLİ ◽  
Serkan Bayram ◽  
Ömer Naci Ergin ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Plantar Flexion ◽  
Retrospective Chart Review ◽  
Significant Negative Correlation ◽  
Underlying Mechanism ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Tendon Elongation ◽  
Metatarsus Adductus

Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. Nevertheless, this possible underlying mechanism behind recurrences has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by Ponseti method. Methods: A retrospective chart review was performed on 20 children (14 boys, 6 girls; mean age: 7 years; age range: 5-9) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was ultrasonographically measured. Results: The plantar flexion/dorsiflexion ratio was lower on the involved side (p = 0.001). No significant differences in the strength ratio of inversion/eversion were found (p = 0.4). No difference was observed in lengths of tibialis anterior and posterior tendon (p = 0,1), but Achilles tendon was longer on the involved side (p = 0.001; p < 0.01). A significant negative correlation was discovered between involved/uninvolved Achilles tendon length ratios and involved/uninvolved plantar flexion strength ratios (r = −0.524; p = 0.02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with the relapsed forefoot adduction treated by the Ponseti technique.

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 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.

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

2021 ◽  
pp. 38-39
Author(s):  
Chunchesh MD Chunchesh MD ◽  
Vani Ahuja ◽  
Kiran S Mahapure
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Cost Effective Treatment ◽  
Pediatric Orthopaedics ◽  
Talipes Equinovarus ◽  
Main Factor

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

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