Treatment of infantile idiopathic scoliosis using a novel thoracolumbosacral orthosis: a case report

Background The recommended treatment for mild to moderate infantile idiopathic scoliosis curves involves serial casting. There are concerns, however, regarding the safety of repeated casting in very young children owing to the requirement for anesthetization during the casting process. Very little research has been conducted on the influence of bracing as an initial treatment for scoliosis in this age group. This report details the successful treatment of a large thoracic curve using a thoracolumbosacral orthosis in an infant diagnosed with infantile idiopathic scoliosis. Case presentation The Dutch-Australian patient presented at 11 weeks of age with a 44° thoracic scoliosis and a rib vertebral angle difference of 14°. The history and physical examination failed to reveal a cause of the curvature, and a diagnosis of infantile idiopathic scoliosis was made. The patient was prescribed a thoracolumbosacral orthosis (ScoliBrace) to be worn on a part-time basis for a period of 8 months. At the end of the bracing program, the patient’s curve had been reduced to 7° and a rib–vertebral angle difference of 0°. A final follow-up of the patient at 2 years after the cessation of treatment revealed no evidence of scoliosis. The parents were compliant with the bracing protocol and reported that the treatment was tolerated by the infant. Conclusion The use of an orthosis as a standalone treatment in this patient resulted in significant reduction in a large thoracic scoliosis. Based on the results witnessed in this patient, further investigation into bracing as an alternative to casting is warranted.

The Level of Public Awareness About Clubfoot in The Al-Qassim Region and Importance of Early Childhood Intervention: A Cross-Sectional Study

Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which can last a lifetime if untreated. There are several types of interventions to treat this condition. However, these interventions depend on the age of presentation and result in good outcomes if started early. This study aimed to investigate the level of public awareness about clubfoot in the Al-Qassim region in Saudi Arabia. Method: This observational cross-sectional study was conducted on a population living in the Al-Qassim region in 2020. The study was conducted using a structured, validated questionnaire that was available online. The chi-square test and t-test were used to analyze the data. All the analyses were conducted using SPSS (version 21). Results: This study included 7085 individuals from the Al-Qassim region. The level of public awareness was as follows 15.6% had poor knowledge, 43.8% had fair knowledge, and 40.6% had high knowledge. The most common sources of knowledge were relatives and friends (42.55%) and websites (29.83%). A multivariate analysis showed that several factors affected the levels of knowledge, including gender (P˂0.0001), having an affected child (P˂0.0003), certain sources of information, affected persons (P˂0.005), relatives and friends (P˂0.0001), websites (P˂0.0001), and printed media (P˂0.0001). Conclusion: A moderate level of knowledge was found among the population in the Al-Qassim region. Their knowledge level was affected by several factors, such as the source of information. Therefore, educational interventions, such as campaigns, are needed to improve the awareness level, leading to better outcomes. Keywords: Clubfoot, Awareness, General population, Al-Qassim, Serial casting, misconception, Early Interventions

Bilateral idiopathic club foot in baby of a rheumatoid mother: A rare case report and its management

Congenital clubfoot has a multifaceted etiology, with several hypotheses offered in its etiopathogenesis. The clubfoot has rarely been reported in babies born to women who have rheumatoid arthritis (RA). We present a rare case of a 31-year-old lady with RA on disease-modifying anti-rheumatoid drugs who delivered a child with bilateral congenital clubfoot. She had previously been using Methotrexate, Hydroxychloroquine, and Sulfasalazine regularly, but Methotrexate was stopped seven months before pregnancy. A full-term female baby was born through the cesarean section with bilateral clubfoot deformity and a modified Pirani score of eight out of 10. The deformity correction was done with the Ponseti serial casting method. The final modified Pirani score was two out of ten. In newborns born to rheumatoid arthritis mothers, the club foot deformity was effectively treated with serial Ponseti corrective casts, as was idiopathic clubfoot in babies born to non-rheumatoid mothers. Our findings validate the Ponseti serial casting method for these kinds of patients.

Ponseti method for treatment of idiopathic congenital talipes equinovarus at tertiary care center in India

<p class="abstract"><strong>Background:</strong> Different treatment methods were tried with variable success rates but Ponseti method of serial casting and manipulation stood apart due to better understanding of foot biomechanics and became accepted choice of treatment worldwide.</p><p class="abstract"><strong>Methods:</strong> 50 patients were enrolled in the study out of which 40 were available for final follow-up. We studied 40 cases during October 2018 to December 2020 at Government Medical College, Aurangabad. Out of 40 cases 31 were male and 9 were female. 25 were unilateral and 15 were bilateral. All cases were idiopathic. 4 inches Plaster of Paris (POP) bandages were cut into half and such 2 inches POP bandages were used for casting. Tenotomies were performed under controlled environment of Operation Theater with general anaesthesia. Number 12 surgical blade was used. Dennis-Browne splint was used for maintenance of correction.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of total 55 feet studied, 10 feet (18.18%) required tendo Achilles tenotomy and 45 feet (81.82%) were treated with casting alone. There were 8 cases of relapses (20%). All relapsed cases were treated with repeat casting as per Ponseti protocol and none of them required repeat tenotomy. Complications related to plaster were minimal and there were no incidence of rocker bottom deformity.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that in a low income developing country like India where case load is very high; Ponseti method is effective, inexpensive form of treatment with minimal complications. Need for extensive soft tissue procedures vastly reduced with this method.</p>

Is botulinum toxin type A more effective and safer than other treatments for the management of lower limb spasticity in children with cerebral palsy? A Cochrane Review summary with commentary

BACKGROUND: Botulinum toxin A (BoNT-A) is a well-accepted treatment for the medical management of spasticity in children with cerebral palsy (CP). OBJECTIVE: To assess the efficacy and safety of BoNT-A compared with other treatment options in managing lower limb spasticity in children with CP. METHODS: A summary of the Cochrane Review update by Blumetti et al. (2019), with comments. RESULTS: This review included 31 randomized controlled trials (1508 participants). Compared with usual care/physiotherapy, the evidence is very uncertain about the effect of BoNT-A on gait, function, ankle joint range of motion (ROM), satisfaction, and ankle spasticity in children with CP. Compared with placebo/sham, BoNT-A probably benefits these same outcomes, although the results for function are contradictory. BoNT-A may not be more effective than serial casting at improving gait, function, ankle ROM and spasticity at any time point. However, it may be more effective than an orthosis at medium-term follow-up for hip ROM and adductor spasticity, but not function. The rate of adverse events with BoNT-A is similar to placebo/sham and serial casting. CONCLUSIONS: Evidence for the effectiveness and safety of BoNT-A for the management of lower limb spasticity in children with CP is uncertain, with better quality evidence available from studies of placebo/sham than non-placebo controls. To produce high-quality evidence, future studies need to improve their methodological quality and increase sample sizes.

Conservative treatment of the longitudinal flatfeet in children

Introduction. A significant percentage of the musculoskeletal system pathology in children is currently fall on the foot pathology – longitudinal flatfeet, which is not only a medical, but also a social problem. The incidence of this pathology is up to 58% of the total orthopedic foot pathology. Traditional methods of treatment and prevention of mild (I– II severity) longitudinal flatfeet (LF), which are known today (massage, physiotherapy exercises, the use of orthopedic devices, electromyostimulation) do not give a significant effect and a stable, long-term result. This makes us look for more effective methods of conservative treatment of LF of the I– II severity degree, which have a pathogenic orientation and physiological effect. Purpose of the work: to develop the most effective algorithm for the complex conservative treatment of LF, depending on the severity, hemodynamic disorders, deformity options, foot rigidity. Materials and methods. Conservative treatment was carried out in 62 patients aged 10– 18 years with LF of the I– II severity degree. Depending on the clinical manifestations and examination results, the treatment was carried out in two stages. At the first stage, serial casting was used (in the presence of concomitant deformations – silicone pelottes were used). Results. The results of the two-stage conservative treatment of LF demonstrate the effectiveness of serial casting in combination with the use of silicone pelottes and biostimulators in comparison with traditional methods of foot correction. Conclusions. Algorithms for conservative treatment of LF were developed, depending on the severity, nature of the deformity, hemodynamic disorders and muscle tone of the lower leg and foot.

Accelerated method of casting for correction of clubfoot applicable?

Objective: To see the results of accelerated method against standard Ponseti method for correction of clubfoot by using Pirani scoring system. Study Design: Randomized controlled trial. Setting: Children’s hospital and the institute of child’s health, Lahore. Period: June 2019 Dec 2019. Material & Method: 100 patients included in this study and divided into two groups. In group A (50 patients) correction was done by standard Ponseti method while accelerated method was applied in group B(50 patients). Weekly serial casting was done in group A while twice weekly in group B. Assessment was done by Pirani scoring system in both groups at beginning of correction, at each cast and at end of correction. Results: Average casting time for group A was 38 days while it was 20 days in group B. Correction rate was 94% in group A and 89% in group B. This difference was not found to be statistically significant (p=0.396). Conclusion: Accelerated method is applicable for correction of clubfoot because treatment time is shorter and results are similar to standard Ponseti method. Hence, this method should be adopted in Pakistan so that poor and rural parents can easily manage travel and financial issues because only 2 to 3 weeks are required for whole casting treatment.