Clubfoot treatment with Ponseti method – Parental distress during plaster casting

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.

Clubfoot treatment with Ponseti method – Parental distress during plaster casting

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.

Selecting Appropriate 3D Scanning Technologies for Prosthetic Socket Design and Transtibial Residual Limb Shape Characterisation

Introduction: Plaster casting and manual rectification represent the benchmark prosthetic socket design method. 3D technologies have increasing potential for prosthetic limb design and fabrication, especially for enhancing access to these services in lower and middle income countries (LMICs). However, the community has a responsibility to verify the efficacy of these new digital technologies. This study’s objective was to assess the repeatability of plaster casting in vivo, specifically for clinically-relevant residuum shape and landmark capture, and to compare this with three clinically-used 3D scanners. Materials and Methods: A comparative reliability assessment of casting and 3D scanning was conducted in eleven participants with established transtibial amputation. For each participant, two positive moulds were cast by a prosthetist and digitised using a white light 3D surface scanner. Between casts, each participant’s residuum was scanned. The deviation between scan volumes, cross-sections and shapes was calculated.Results: 95% of the clinically-relevant socket shape surface area had a deviation between manual casts <2.87mm (S.D. 0.44mm). The average deviation by surface area was 0.18mm (S.D. 1.72mm). The repeatability coefficient of casting was 46.1ml (3.47%) for volume, and 9.6mm (3.53%) for perimeters. For all clinically-meaningful measures, greater reliability was observed for the Omega scanner, and worse for the Sense and iSense scanners, although it was observed that the Sense scanner performance was comparable to casting (95th percentile shape consistency). Conclusions: This study provides a platform to appraise new clinical shape capture technologies in the context of best practice in manual plaster casting, and starts the conversation of which 3D scanning devices are most appropriate for different types of clinical use. The methods and benchmark results may support prosthetists in acquiring and applying their clinical experience, as part of their continuing professional development.

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

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.