Ponseti Method for clubfoot

NewsBot · Jan 24, 2023

The Ponseti Method for the Treatment of Clubfeet Associated With Down Syndrome: A Single-institution 18-year Experience
Portalatin Perez, Edwin MD et al
Journal of Pediatric Orthopaedics 43(2) e106-e110, February 2023. | DOI: 10.1097/BPO.0000000000002293

Background:
Although the Ponseti method has been used with great success in a variety of nonidiopathic clubfoot deformities, the efficacy of this treatment in clubfeet associated with Down syndrome remains unreported. The purpose of this study is, therefore, to compare treatment characteristics and outcomes of clubfoot patients with Down syndrome to those with idiopathic clubfoot treated with the Ponseti method.

Methods:
An Institutional Review Board–approved, retrospective review of prospectively gathered data were performed at a single pediatric hospital over an 18-year period. Patients with either idiopathic clubfeet or clubfeet associated with Down syndrome who were less than 1 year of age at the outset of treatment were treated by the Ponseti method, and had a minimum of 2 year’s follow-up were included. Initial Dimeglio score, number of casts, need for heel cord tenotomy, recurrence, and need for further surgery were recorded. Outcomes were classified using the Richards classification system: “good” (plantigrade foot +/− heel cord tenotomy), “fair” (need for a limited procedure), or “poor” (need for a full posteromedial release).

Results:
Twenty clubfeet in 13 patients with Down syndrome and 320 idiopathic clubfeet in 215 patients were identified. Average follow-up was 73 months for the Down syndrome cohort and 62 months for the idiopathic cohort. Down syndrome patients presented for treatment at a significantly older age (61 vs. 16 d, P=0.00) and with significantly lower average initial Dimeglio scores than the idiopathic cohort (11.3 vs. 13.4, P=0.02). Heel cord tenotomy was performed in 80% of the Down syndrome cohort and 79% of the idiopathic cohort (P=1.00). Recurrence rates were higher in the Down syndrome cohort (60%) compared with the idiopathic group (37%), but this difference was not statistically significant (P=0.06). Need for later surgical procedures was similar between the 2 cohorts, though recurrences in the Down syndrome group were significantly less likely to require intra-articular surgery (8.3% vs. 65.5%, P=0.00). Clinical outcomes were 95% “good,” 0% “fair,” and 5% “poor” in the Down syndrome cohort and 69% “good,” 27% “fair,” and 4% “poor” in the idiopathic cohort (P=0.01).

Conclusions:
Despite the milder deformity and an older age at presentation, clubfeet associated with Down syndrome have similar rates of recurrence and may have better clinical outcomes when compared with their idiopathic counterparts. When deformities do relapse in Down syndrome patients, significantly less intra-articular surgery is required than for idiopathic clubfeet.
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NewsBot · Jan 24, 2023

Efficacy of 2 Nonpharmaceutical (Non-nutritive Sucking and Human Care Contact) Pain Relief Measures for Idiopathic Clubfoot Casted Using Ponseti Technique
Upadhyay, Ankur et al
Journal of Pediatric Orthopaedics 43(2) e100-e105, February 2023. | DOI: 10.1097/BPO.0000000000002299

Purpose:
This study aimed at exploring the pain and physiological responses exhibited during Ponseti manipulation and casting in clubfoot infants. In addition, we compared the efficacy of 2 nonpharmaceutical techniques (non-nutritive sucking and human care contact) for tackling these responses.

Methods:
The study included children with unilateral and bilateral idiopathic clubfeet between 15 days to 6 months of age. For comparisons, children were divided into control group without any intervention (group A), non-nutritive sucking group (group B), and human care contact group (group C). Pain score (Neonatal Infant Pain Score), heart rate (HR), and oxygen saturation (SpO2) was assessed before, during and 1 minute after casting. These measurements were compared using statistical methods.

Results:
There were 16 children (11 bilateral) in group A, 17 (10 bilateral) in group B, and 18 (8 bilateral) in group C. Before casting, the baseline parameters (Neonatal Infant Pain Score, HR, and SpO2) of the 3 groups were comparable. Groups B and C had a significant reduction in pain score at casting and in postcasting period when compared with group A (P<0.05). Group B (at casting—mean: 174.1/min, postcasting—mean: 168.2/min) had the lowest HR both during and after cast application. Group B had the highest SpO2 among all the 3 groups, both during casting (mean: 95.7%) and after casting (mean: 97.4%) (P<0.05).

Conclusions:
Infants exhibit moderate pain response and altered physiological responses during and after Ponseti casting. Non-nutritive sucking emerged as a better method to lessen these parameters when compared with the conventional technique and human care contact.
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NewsBot · Feb 23, 2023

Effectiveness of the Ponseti Method in the Treatment of Clubfoot: A Systematic Review
Elena López-Carrero et al
Int. J. Environ. Res. Public Health 2023, 20(4), 3714; https://doi.org/10.3390/ijerph20043714

Clubfoot is a common congenital deformity of the lower limbs. It should be treated as soon as possible so that its correction is more easily achieved. The objective of this systematic review was to assess the effectiveness of the Ponseti method in the treatment of clubfoot. A bibliographic search was carried out in different databases, including PubMed and SciELO. Filters such as full text and randomized controlled trial were selected to find those articles that best matched our search. Among the results, we selected the ones that interested us, and the rest were discarded, either because they did not meet the requirements for our work or because they were repeated. In total, we collected 19 articles, but after using the critical evaluation instrument CASPe, 7 of them were eliminated, leaving us with a total of 12 articles for our systematic review. After analyzing the results obtained in the selected articles, we concluded that the Ponseti method is effective in the treatment of clubfoot, presenting a high success rate.
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NewsBot · Mar 30, 2023

Experience with accelerated ponseti technique for treatment of idiopathic clubfoot in a regional orthopaedic hospital in Nigeria
Omolade Ayoola Lasebikan et al
Afr J Paediatr Surg. 2023 Apr-Jun;20(2):106-108.

Introduction: Idiopathic talipes equinovarus (ITEV) 'aka clubfoot' is the most common foot deformity in children. Ponseti technique had been accepted as a standard method for correction. The traditional Ponseti technique for correction is well known. Accelerated Ponseti technique is said to offer some advantages over the standard technique. The aim of this study was to determine and document the efficiency and success rate of accelerated Ponseti technique.

Methods: This was a prospective interventional study which lasted 26 months from February 2017 to April 2019. Twenty-eight patients with 42 feets who met the inclusion criteria were recruited. They had serial manipulation and casting twice every week till percutaneous tenotomy was done as indicated. Final cast usually applied after tenotomy and left for 3weeks. Each patient was followed up for a year corresponding to 9 months after the commencement of night bracing. Data were analysed using SPSS version 20.

Results: The mean age was 8.1 months with a range of 1-36 months. The mean Pirani score recorded was 4.4, while the mean number of casting sessions was 3.6 and the mean duration of treatment was 12.4 days. The tenotomy rate recorded was 42.9%. Pre-bracing assessment of Pirani score, passive ankle dorsiflexion and foot abduction done and repeated after a year revealed optimal correction. The relapsed rate at 1 year was 4.8%. The only complication observed was pressure sore in a patient.

Conclusion: The accelerated Ponseti technique is an efficient method of treatment of ITEV in a much shorter time with a higher success rate. It facilitates compliance with treatment.
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NewsBot · Apr 9, 2023

Anterior Distal Tibial Guided Growth for recurrent equinus deformity in idiopathic Congenital Talipes Equinovarus treated with the Ponseti method
Arya Suman Mishra et al
Foot Ankle Surg. 2023 Mar 29

Introduction: Distal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment.

Methods: Patients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles' tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity.

Results: We identified 22 feet in 16 patients, with an average follow-up was 25 (8.8-47.3) months. The mean aDTA changed from 88.9 (82.3-94.5) to 77.0 (65.0-83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot.

Conclusion: This procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment.
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NewsBot · Apr 14, 2023

Pain behavior of children with bilateral idiopathic clubfoot undergoing Ponseti casting and the effect of non-pharmaceutical pain-relieving agents
Anil Agarwal et al
Arch Orthop Trauma Surg. 2023 Apr 13

Introduction: This study prospectively investigated the pain response and physiological parameters [heart rate (HR) and oxygen saturation (SpO2)] during sequential casting in bilateral clubfoot. Additionally, it explored the role of non-nutritive sucking and human care contact on the observed responses during casting.

Methods: Subjects were allotted to control group (Group A with no intervention) and two intervention groups (Group B: non-nutritive sucking intervention, Group C: human care contact intervention). Neonatal Infant Pain Score (NIPS), heart rate (HR), and oxygen saturation (SpO2) were used to assess the response.

Results: The three groups matched in age and gender characteristics of the participants. Pain response was noted across all groups. The left foot demonstrated a statistically significant preexisting tachycardia which rose further during casting (p < 0.01). Intergroup comparisons revealed that the alteration for NIPS during casting was in following sequence (Group A > C > B, p < 0.00001). The effect of interventions offered in Group B and C lasted in the post-cast period as well (B > C).

Conclusion: The clubfoot child exhibited moderate pain response during casting of both feet. A tachycardia was noted prior to initiation of second cast which further exaggerated with subsequent cast. Pacifier (non-nutritive sucking) intervention produced better control of pain response than human care contact during casting for both feet.
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NewsBot · May 9, 2023

EVALUATION OF EARLY TREATMENT OF IDIOPATHIC CLUBFOOT USING THE PONSETI METHOD
Caio Luiz DE Toledo Oliveira, Geraldo Mota Gonçalves, José Batista Volpon
Acta Ortop Bras. 2023 May 1;31(2)

Congenital clubfoot is one of the most common congenital deformities of the lower limbs, with an estimated incidence of 1 for every 1,000 live births. Its treatment is controversial, and currently the Ponseti method has been widespread, showing promising results and decreasing the need for extensive surgical releases, as was usually done until the introduction of the technique. Currently used in approximately 55 countries, the method has changes and scopes that vary according to the society in which it is applied, with the results and peculiarities of the method molded according to the sample studied.

Objective: To evaluate the clinical outcome of clubfoot treatment using the Ponseti method under local conditions.

Methods: The clinical evaluation will include a descriptive analysis of the sample, as well as radiographic evaluation and family satisfaction with the treatment.

Results: In total, 46% of the patients had good results and no family was dissatisfied with the treatment results. No statistically relevant relationships were found between the studied variables.

Conclusion: The results are good and generally similar to those in the literature. Our epidemiological data generally agree with those reported by other authors
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NewsBot · May 23, 2023

Effectiveness of Ponseti technique in management of arthrogrypotic clubfeet - a prospective study
Noor Alam et al
Int J Burns Trauma. 2023 Apr 15;13(2):33-43. eCollection 2023.

Background: Clubfoot constitutes roughly 70 percent of all foot deformities in arthrogryposis syndrome and 98% of those in classic arthrogryposis. Treatment of arthrogrypotic clubfoot is difficult and challenging due to a combination of factors like stiffness of ankle-foot complex, severe deformities and resistance to conventional treatment, frequent relapses and the challenge is further compounded by presence of associated hip and knee contractures.

Method: A prospective clinical study was conducted using a sample of nineteen clubfeet in twelve arthrogrypotic children. During weekly visits Pirani and Dimeglio scores were assigned to each foot followed by manipulation and serial cast application according to the classical Ponseti technique. Mean initial Pirani score and Dimeglio score were 5.23 ± 0.5 and 15.79 ± 2.4 respectively. Mean Pirani and Dimeglio score at last follow up were 2.37 ± 1.9 and 8.26 ± 4.93 respectively. An average of 11.3 casts was required to achieve correction. Tendoachilles tenotomy was required in all 19 AMC clubfeet.

Result: The primary outcome measure was to evaluate the role of Ponseti technique in management of arthrogrypotic clubfeet. The secondary outcome measure was to study the possible causes of relapses and complications with additional procedures required to manage clubfeet in AMC an initial correction was achieved in 13 out of 19 arthrogrypotic clubfeet (68.4%). Relapse occurred in 8 out of 19 clubfeet. Five of those relapsed feet were corrected by re-casting ± tenotomy. 52.6% of arthrogrypotic clubfeet were successfully treated by the Ponseti technique in our study. Three patients failed to respond to Ponseti technique required some form of soft tissue surgery.

Conclusion: Based on our results, we recommend the Ponseti technique as the first line initial treatment for arthrogrypotic clubfeet. Although such feet require a higher number of plaster casts with a higher rate of tendo-achilles tenotomy but the eventual outcome is satisfactory. Although, relapses are higher than classical idiopathic clubfeet, most of them respond to re-manipulation and serial casting ± re-tenotomy.
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NewsBot · May 29, 2023

Exploring the distribution of risk factors for drop-out from Ponseti treatment for clubfoot across Bangladesh using geospatial cluster analysis
Manon Pigeolet et al
Geospat Health. 2023 May 25;18(1)

Clubfoot is a congenital anomaly affecting 1/1,000 live births. Ponseti casting is an effective and affordable treatment. About 75% of affected children have access to Ponseti treatment in Bangladesh, but 20% are at risk of drop-out. We aimed to identify the areas in Bangladesh where patients are at high or low risk for drop-out. This study used a cross-sectional design based on publicly available data. The nationwide clubfoot program: 'Walk for Life' identified five risk factors for drop-out from the Ponseti treatment, specific to the Bangladeshi setting: household poverty, household size, population working in agriculture, educational attainment and travel time to the clinic. We explored the spatial distribution and clustering of these five risk factors. The spatial distribution of children <5 years with clubfoot and the population density differ widely across the different sub-districts of Bangladesh. Analysis of risk factor distribution and cluster analysis showed areas at high risk for dropout in the Northeast and the Southwest, with poverty, educational attainment and working in agriculture as the most prevalent driving risk factor. Across the entire country, twenty-one multivariate high-risk clusters were identified. As the risk factors for drop-out from clubfoot care are not equally distributed across Bangladesh, there is a need in regional prioritization and diversification of treatment and enrolment policies. Local stakeholders and policy makers can identify high-risk areas and allocate resources effectively.
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NewsBot · Jun 6, 2023

The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot
Sourabh Kumar Sinha, Varun Garg & Vivek Singh
Indian Journal of Orthopaedics (2023)

Background
The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized. The purpose of this study was to evaluate the clinical outcomes at the end of the casting period while addressing these issues.

Methods
A retrospective study of 17 patients with 25 complex clubfeet over a period of 2 years was conducted. Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads.

Results
The mean age of patients at diagnosis was 4.41 months (2–7 months). The mean pre-casting Pirani score was 4.8 (4–6) and post casting Pirani score was 0.4 (0–1). A total of 128 casts were applied to correct 25 complex clubfeet. The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4–7). Overall, four incidences of cast slippage occurred.

Conclusion
The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast.
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NewsBot · Jul 19, 2023

Achilles tenotomy during Ponseti’s clubfoot treatment: better early than late
Ghanem, Ismata; Ghanem, Dianeb; Rassi, Joea; Saliba, Ibrahima
Journal of Pediatric Orthopaedics B ():10.1097/BPB.0000000000001106, July 03, 2023.

To evaluate the outcome of Achilles tenotomy at first cast in neonates with stiff clubfoot undergoing Ponseti’s method of treatment. One hundred forty stiff clubfeet (Dimeglio grades III and IV) scheduled for Ponseti’s method were prospectively randomized into two groups of 70 each: (1) early, tenotomy at first cast; (2) late, tenotomy at fourth to sixth casts (conventional). The procedure was performed under local lidocaine spray in an office setting using a needle. The results were assessed at an average follow-up of 12.4 years. Technical difficulties and short and long-term complications were recorded. At last follow-up, the results were rated excellent, good, fair, and poor in 70, 18, 9, and 3% of patients in the late group, respectively, and 82, 13, 4, and 1% in the early group (P = 0.048). Technical difficulties were encountered in 38% of the late group and 3% in the early group (P < 0.0001). Flattening of the talar dome of mild to moderate severity was found in 16% of the late group and 4% in the early group (P < 0.001). Early Achilles tenotomy seems to give better results than the conventional late tenotomy, with less short and long-term complications. This may be explained by the greater ease to palpate the Achilles tendon on a previously untreated foot, and the less amount of compressive forces across the tibiotalar and subtalar joints produced by early release of the posterior tether.
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NewsBot · Aug 11, 2023

A four-year clinical and sonographic longitudinal follow-up of clubfeet treated according to Ponseti with normal references
G Arne Johansson et al
J Child Orthop. 2023 May 17;17(3):212-223

Purpose: To follow children with a clubfoot by ultrasonography during the entire treatment period up to 4 years and compare with controls.

Method: Thirty clubfeet in 20 children treated using the Ponseti method and 29 controls were followed by repeated ultrasonography investigations from neonates to the age of 4 years. The previously established coronal medial and lateral, sagittal dorsal and posterior projections were used. Changes over time, correlations to the Diméglio score, and the course of treatment were studied.

Results: The medial malleolus-navicular distance was shorter, while the talar tangent-navicular distance and the talo-navicular angle were larger in clubfeet than in controls even after the initial correction. The healthy feet in unilateral cases did not differ significantly from the controls. The range of motion in the talo-navicular joint was approximately 20° less in clubfeet than in controls during the first four years of life. The medial malleolus-navicular distance (r = -0.58) and the talo-navicular angle (r = 0.66) at the first ultrasonography showed the highest correlation to the number of casts needed to correct the deformities.

Conclusion: Ultrasonography can be used to evaluate the initial degree of deformities in clubfeet and to follow the progress of the treatment and growth. Ultrasonography showed a clear difference between clubfeet and controls during the first four years of life. Although it was not possible to define specific limit values as benchmarks in the treatment, dynamic ultrasonography can provide valuable support in the decision-making process when complementary treatment may be needed.
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NewsBot · Sep 8, 2023

Outcomes of the Ponseti Technique in Different Types of Clubfoot-A Single Center Retrospective Analysis
Maryum Naseer Buttet al
Children (Basel). 2023 Aug 3;10(8):1340

Background: Clubfoot is a congenital deformity that can affect one or both of a newborn's lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.
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NewsBot · Sep 27, 2023

Factors Related to Relapse of Congenital Talipes Equinovarus (CTEV) After the Ponseti Method
Waleed A Mohsenh et al
Cureus. 2023 Aug 18;15(8):e43701

Background: Congenital talipes equinovarus (CTEV) is one of the common congenital disorders in pediatric orthopedic practice that affects a large group of children.It is a combination of four parts of deformity that affect either a single foot or both feet. Our aim in this study is to estimate the prevalence and incidence of CTEV and to evaluate the risk factors that lead to relapse in some children to avoid relapse in future and complex surgical interventions, as well as to improve the final outcome.

Materials and methods: A retrospective cohort study for the cases of CTEV was conducted to estimate the prevalence of relapse in children with CTEV after management by the Ponseti method and to evaluate the risk factors that lead to recurrence.

Result: The study includes 103 patients with CTEV, and only 22 patients had relapse. The prevalence rate of relapsed cases was 20.4%, and the incidence was 42 per thousand. The average number of casts applied was 4.05 ± 1.37. The average severity of the deformity that was measured by the Pirani score was 4.97 ± 1.21. The most common atypical presentation of CTEV was associated with developmental dysplasia of the hip (DDH), followed by myelomeningocele (MMC).

Conclusion: The only significant factors in the study were the Pirani score and non-compliance of the brace with p < 0.05. There was not any significance in the correction of the deformity by Ponseti between idiopathic and non-idiopathic CTEV based on the number of casts and the Pirani score. The dynamic foot brace can be the solution for the high recurrence rate, yet more studies are needed in the future.
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NewsBot · Oct 10, 2023

Long-term clinical and functional outcomes of idiopathic clubfoot patients who were managed with ponseti method at Mulago National Referral Hospital
Masters thesis

Background: Ponseti method is being used for the management of ICTEV as it has shown consistently good clinical and functional outcomes in both the short and longtime. Relapse is inherent to ICTEV due to the stiff and non-compliant tissue and this is seen to increase with prolonged follow-up period. In the MNRH club foot clinic, many children have been managed by the Ponseti method but due to the lack of a clear follow-up protocol, not much is known about the long-term outcomes of Ponseti on clinical and functional outcomes. Objectives: To describe long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic. To determine associated factors which influence the long-term outcome of ICTEV patients. Methods: This cross-sectional study took place at the MNRH club foot clinic. We gathered socio-demographic and treatment history data using a structured questionnaire. Clinical and functional assessments were performed using PBS and DSI tools. Data was coded, entered into Epidata 4.6, and later analyzed in STATA 14.0. We used means, standard deviations, medians, and interquartile ranges for numerical variables and proportions for categorical data. Bivariate and multivariate analyses were conducted to identify significant factors, with significance considered at p-values < 0.2 and < 0.05, respectively. Results: 158 patients were enrolled for the study. Of these, 98(62.0%) were male, 00(63.3%) had bilateral involvement, 124 (78.5%) required tenotomy, 23(14.6%) had surgery, 18(11.4%) completed S-FAB phase up to 4 years. Of the 258 feet analyzed, 205 feet (83.3%) had no/slight deformity and 82.9% had good functional outcome. Noncompliance with S-FAB increased the likelihood of developing a recurrence by 4.6 times. Patients who did not undergo surgery were 0.46 times less likely to develop deformity. Conclusion: The long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic were excellent/good and similar to those in literature. Failure to adhere to bracing and surgery were found to predict outcome. Clubfoot awareness and sensitization should be done to enable Ponseti treatment to start early. Patients should be encouraged to complete the 4 years S- FAB casting phase. Ponseti method is being used for the management of ICTEV as it has shown consistently good clinical and functional outcomes in both the short and longtime. Relapse is inherent to ICTEV due to the stiff and non-compliant tissue and this is seen to increase with prolonged follow-up period. In the MNRH club foot clinic, many children have been managed by the Ponseti method but due to the lack of a clear follow-up protocol, not much is known about the long-term outcomes of Ponseti on clinical and functional outcomes. Objectives: To describe long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic. To determine associated factors which influence the long-term outcome of ICTEV patients. Methods: This cross-sectional study took place at the MNRH club foot clinic. We gathered socio-demographic and treatment history data using a structured questionnaire. Clinical and functional assessments were performed using PBS and DSI tools. Data was coded, entered into Epidata 4.6, and later analyzed in STATA 14.0. We used means, standard deviations, medians, and interquartile ranges for numerical variables and proportions for categorical data. Bivariate and multivariate analyses were conducted to identify significant factors, with significance considered at p-values < 0.2 and < 0.05, respectively. Results: 158 patients were enrolled for the study. Of these, 98(62.0%) were male, 00(63.3%) had bilateral involvement, 124 (78.5%) required tenotomy, 23(14.6%) had surgery, 18(11.4%) completed S-FAB phase up to 4 years. Of the 258 feet analyzed, 205 feet (83.3%) had no/slight deformity and 82.9% had good functional outcome. Noncompliance with S-FAB increased the likelihood of developing a recurrence by 4.6 times. Patients who did not undergo surgery were 0.46 times less likely to develop deformity. Conclusion: The long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic were excellent/good and similar to those in literature. Failure to adhere to bracing and surgery were found to predict outcome. Clubfoot awareness and sensitization should be done to enable Ponseti treatment to start early. Patients should be encouraged to complete the 4 years S- FAB casting phase.
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NewsBot · Jan 15, 2024

The Importance of Having a Single, Dedicated Medical Team to Treat Congenital Talipes Equinovarus Using the Ponseti Method: A Retrospective Analysis of Treatment Outcomes After 3 Years of Follow-up
Tabard-Fougère, Anne et al
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002613, January 8, 2024. | DOI: 10.1097/BPO.0000000000002613

Background:
Congenital talipes equinovarus (CTEV) is a relatively common pediatric orthopaedic disorder and a frequent cause of disability in adult populations. The Ponseti method has emerged as the generally preferred for treating children with CTEV. Strict adherence to this technique’s basic principles is critical to achieving favorable outcomes. In 2013, our institution decided that every case of pediatric CTEV would be treated by a single dedicated medical team. The present study aimed to compare the treatment outcomes of children with CTEV treated using the Ponseti method in period I (multiple surgeons) versus those in period II (single dedicated team).

Patients and Methods:
We included respectively the children with CTEV treated using the Ponseti method in Geneva University Hospitals’ pediatric units from 2007 to 2018. Data on patient demographics, clinical characteristics, and the treatment outcomes were collected. The primary outcome was the number of relapsed feet (treatment failure) after 3 years of follow-up. The 2 periods’ outcomes were compared using χ2 and independent Student t-tests. Run charts were used to report yearly rates of complications, minor and major recurrences, treatment failure, brace noncompliance, and feet that underwent tenotomy.

Results:
A total of 48 feet (32 patients) and 42 feet (29 patients) in periods I and II were included. The periods showed similar rates for participants’ characteristics. The run charts illustrated the overall improvements in treatment outcomes in period II. A total of 8 relapsed feet (5 patients) were reported, all during period I.

Conclusions:
Since all the pediatric CTEV patients at our institution began to be treated by a single dedicated medical team, we have observed a decrease in all recurrences and complications and an absence of treatment failure. These results highlight the importance of the continuity of care and strict adherence to the Ponseti method.
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NewsBot · Feb 21, 2024

Complex clubfoot: my 5 tips for appropriate evaluation and treatment with the Ponseti method
J Masquijo, E Arana
Acta Ortop Mex. 2023 Jul-Aug;37(4):233-236.

Complex clubfoot is a term used to describe a subset of patients that received previous treatment, and have distinctive anatomical features: severe equinus, with short first metatarsal, hyperextended big toe, severe plantar flexion of all metatarsals and deep folds through the sole of the foot and above the heel. Most complex clubfeet appear to be idiopathic and is usually associated with a poor casting technique. Complex clubfoot requires an early recognition and an adjustment of the casting protocol using the four finger Ponseti technique. This article gives the treating physician a general overview of the evaluation, treatment, and outcomes of complex clubfoot with the Ponseti method.
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NewsBot · Mar 6, 2024

The Efficacy of the Ponseti Method in the Management of Clubfoot: A Systematic Review
Hassan B Maghfuri, Ali A Alshareef
Cureus. 2024 Jan 18;16(1):e52482

Clubfoot is a congenital abnormality of the lower extremities, and it may be unilateral or bilateral. Left untreated, it may lead to issues with walking. Additionally, inappropriate treatment or the lack of treatment can result in functional damage. The goal of clubfoot treatment is to correct the deformities of the involved components. The Ponseti method has been regarded as the gold standard for the treatment of clubfoot as it is safe and effective. In this review, we aimed to assess the success of the Ponseti method in the treatment of clubfoot by reviewing the previous studies on this subject. We searched electronic databases, including PubMed, Scopus, Science Direct, and Google Scholar, for relevant articles spanning the period from 2018 to 2023. The keywords used in the search were "Ponseti method, Treatment, Outcomes, Success, Relapse, Failure, and Rates." The inclusion criteria were original articles in English on clubfoot patients treated with the Ponseti method. While our search yielded a total of 1,037 articles, only nine were deemed eligible for analysis based on the inclusion criteria. The articles involved a total of 537 feet of 358 patients and the age of the patients ranged from one day to five years. The success rate ranged between 55% and 100%, and the relapse rate ranged between 3.2% and 34.2%. Based on our findings, the Ponseti method has a high success rate in the treatment of idiopathic clubfoot, and hence it is an excellent conservative method of treatment. However, there are additional factors that may affect the treatment outcomes, which need to be taken into account.
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NewsBot · Apr 24, 2024

Assessment of Treatment Outcomes in the Management of Club foot using the Ponseti Technique: A cross-sectional study
Joseph E Asuquo et al
Afr J Paediatr Surg. 2024 Apr 1;21(2):85-89

Background: The Ponseti technique remains the preferred method for club foot treatment. Although measures of treatment outcomes have been well documented, there is no consensus on the determinants of those outcomes. This study aims to assess treatment outcomes and the factors which can influence treatment outcomes.

Materials and methods: This is a cross-sectional study. A total of 472 children representing 748 feet in total were recruited. Patient characteristics such as age at presentation, gender, tenotomy, walking with or without deformity, parental educational status and occupation were documented. Outcomes of care were assessed using indictors such as parents' satisfaction with the outcome of treatment and the patients' ambulation without deformity. The relationships between the determinant factors and these outcomes were explored using multivariable binary logistic regression.

Results: Most of the children (69.1%) were aged below 2 years. Brace compliance was very high (89.9%). The pre-treatment average Pirani scores were 3.9 ± 1.8 and 4.3 ± 1.8 for the right and left feet, respectively. Majority (88.3%) of the children achieved ambulation without deformity, whereas most (87%) of the parents were satisfied with the treatment outcomes. In total, parental satisfaction with child's treatment outcomes was lower in parents who were not formally educated odds ratio (OR) = 0.19 (95% confidence interval [CI] 0.08-0.43), but parental satisfaction was lower if the child had higher Pirani score OR = 0.77 (95% CI 0.62-0.96). Children who had more casts applied to the affected foot were more likely to walk without deformity OR = 1.24 (95% CI 1.01-1.52).

Conclusions: This study revealed that treatment outcomes in children with club foot can be determined by some sociodemographic and treatment-related factors.
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NewsBot · May 30, 2024

Management outcome of congenital talipes equinovarus (clubfoot) using Ponseti protocol at Lagos University Teaching Hospital
Enweluzo, George Okwudilichukwu et al
Journal of the West African college of surgeons 14(3) 270-274, July-September 2024. | DOI: 10.4103/jwas.jwas_106_23

Background:
Idiopathic clubfoot occurs commonly in children with a prevalence of 1 in 1000. The Pirani scoring system, which consists of a midfoot contracture score and hindfoot contracture score, is traditionally used in assessing the severity of clubfoot deformity. Ponseti protocol is used in the management of clubfoot deformity. The study aimed to evaluate the outcome of the management of clubfoot using the Ponseti protocol and to correlate the outcome with the initial Pirani score.

Materials and Methods:
Eighty-two children aged 1 week–2 years with 128 idiopathic clubfeet were recruited into the study. The severity of their clubfoot deformities was scored using the Pirani scoring system on recruitment. They were managed with weekly serial manipulation and cast application with or without tendon-Achilles tenotomy according to Ponseti protocol.

Results:
The average initial Pirani score was 3.6 ± 0.9. The average number of casts used was 5.9 ± 1.3 (range: 4–9 casts). Tenotomy was done in 51.56% of the feet. The group that required tenotomy required more casts and as such longer duration of treatment than the “no tenotomy” group. There was a relapse rate of 2% in the feet of the compliant group, whereas the relapse rate was 69% in the group that was not compliant with the use of foot-abduction brace. The success rate at 6 months follow-up was 84.4%.

Conclusions:
Ponseti protocol is an excellent method of management of idiopathic clubfoot, and the Pirani scoring system was useful in assessing the initial severity and the outcome. The initial Pirani score correlates with the duration of treatment.
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NewsBot · Jun 11, 2024

Early radiographic characteristics of the lateral talocalcaneal angle and its predictive significance for relapse in patients with idiopathic clubfoot treated with the Ponseti method
Jingchun Li, MD, et al
June 10, 2024

In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants’ feet were classified into three groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92±1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57°±12.05° and 39.37°±12.55°, respectively, while Group C was 49.61°±9.11°. A significant difference was found among the three groups of patients (F=31.48, P<0.001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse.
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NewsBot · Jul 8, 2024

Parent reported outcomes for idiopathic clubfoot children treated with the Ponseti technique: An analysis of 140 feet followed minimum 5 years
Lokesh Sharma et al
J Clin Orthop Trauma. 2024 Jun 6

Objective: The treated clubfoot children are often evaluated clinically during follow-up. However, patient reported outcomes (PROM) are seldom analysed for these children. We investigated 87 idiopathic clubfoot children (140 feet) treated by the Ponseti method and followed minimum 5 years to study their clinical outcomes and PROM.

Material and methods: This was a cross-sectional study, based on evaluating treated clubfoot children clinically (Pirani score) and PROM (Oxford Ankle and Foot Questionnaire - Parent Version) and comparing them with the age-matched healthy controls (n = 60). The questionnaire has four main domains related to the child's physical, school and play, emotional and footwear profile. The children having persistent deformity (residual/relapse) were specifically studied for their PROM scores.

Results: The mean child age at initial treatment was 2.3 months and the mean follow-up duration was 6.9 years. The PROM score of clubfoot children was statistically lower than the healthy controls (p < 0.001). Of the individual domains, the physical domain was the most affected. On calculating the Pirani scores, 10 out of 140 feet (7 %) had some form of persistent deformity. The children with persistent deformity had lower Oxford scores than healthy children or those with corrected feet. The physical domain followed by the emotional domain scored low when persistent deformity was present.

Conclusions: Most children (98 %) had a plantigrade foot following Ponseti treatment at follow-up. However, PROM score of the clubfoot children did not correspond to the clinical outcome. Persistent deformity, even minor, was a cause of parental concern and resulted in a low PROM score.
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NewsBot · Jul 15, 2024

Assessment of Gross Motor Skills in Ponseti-treated Children With Idiopathic Clubfoot at 3 Years Old: Insights from the Peabody Developmental Motor Scale 2
Rice, Samuel et al
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002771, July 15, 2024. | DOI: 10.1097/BPO.0000000000002771

Background:
Congenital talipes equinovarus, or clubfoot, can lead to lifelong functional impairments, including diminished gross motor skills (GMS), if left untreated. The Ponseti method corrects idiopathic clubfoot through casting and bracing. Given the importance of GMS in childhood development, this technique must be optimized to support childhood and long-term health outcomes. This study examined immediate posttreatment GMS in 3-year-old children treated with Ponseti, hypothesizing that they would perform on par with their nonclubfoot peers.

Methods:
Data from 45 children (33 to 46 mo of age) treated for idiopathic clubfoot were analyzed. The Peabody Developmental Motor Scales, 2nd edition, was used to assess GMS, and logistic regression identified factors influencing Gross Motor Quotient (GMQ) scores.

Results:
Approximately half (n=22) of the patients exhibited below-average GMS (11th to 25th percentile), with 11 scoring below the 10th percentile. Initial deformity severity, gender, and cast numbers did not impact GMQ. Repeat percutaneous tenotomy was associated with lower GMQs. Brace compliance significantly reduced odds of low GMQs by up to 80%. Age at testing and additional surgery were also linked to below-average and poor GMQs.

Conclusions:
GMS appeared to be impaired in almost half of the 3-year-old patients treated for idiopathic clubfoot, so our hypothesis was disproven. Repeat percutaneous tenotomy was associated with lower GMS, necessitating future recognition of patients who might be at risk of relapse. Brace noncompliance emerged as a significant risk factor, emphasizing early identification of these patients and education for their parents. This study offers a benchmark for clinicians and parents, but research on long-term outcomes is needed.
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NewsBot · Jul 16, 2024

Management outcome of congenital talipes equinovarus (clubfoot) using Ponseti protocol at Lagos University Teaching Hospital
George Okwudilichukwu Enweluzo et al
J West Afr Coll Surg. 2024 Jul-Sep;14(3):270-274

Background: Idiopathic clubfoot occurs commonly in children with a prevalence of 1 in 1000. The Pirani scoring system, which consists of a midfoot contracture score and hindfoot contracture score, is traditionally used in assessing the severity of clubfoot deformity. Ponseti protocol is used in the management of clubfoot deformity. The study aimed to evaluate the outcome of the management of clubfoot using the Ponseti protocol and to correlate the outcome with the initial Pirani score.

Materials and methods: Eighty-two children aged 1 week-2 years with 128 idiopathic clubfeet were recruited into the study. The severity of their clubfoot deformities was scored using the Pirani scoring system on recruitment. They were managed with weekly serial manipulation and cast application with or without tendon-Achilles tenotomy according to Ponseti protocol.

Results: The average initial Pirani score was 3.6 ± 0.9. The average number of casts used was 5.9 ± 1.3 (range: 4-9 casts). Tenotomy was done in 51.56% of the feet. The group that required tenotomy required more casts and as such longer duration of treatment than the "no tenotomy" group. There was a relapse rate of 2% in the feet of the compliant group, whereas the relapse rate was 69% in the group that was not compliant with the use of foot-abduction brace. The success rate at 6 months follow-up was 84.4%.

Conclusions: Ponseti protocol is an excellent method of management of idiopathic clubfoot, and the Pirani scoring system was useful in assessing the initial severity and the outcome. The initial Pirani score correlates with the duration of treatment.
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NewsBot · Aug 7, 2024

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Arthrogryposis
Schaibley, Claire BS; Torres-izquierdo, Beltran MD; Hosseinzadeh, Pooya MD
Journal of Pediatric Orthopaedics 44(8) 508-512, September 2024. | DOI: 10.1097/BPO.0000000000002715

Introduction:
The Ponseti serial casting method is the method of choice in treating children with congenital clubfeet. The arthrogrypotic clubfoot has traditionally been considered challenging to treat, with higher rates of recurrence and the need for more corrective surgeries. However, initial reports have found promising results in using the Ponseti method to treat arthrogrypotic feet. This study aims to compare the outcomes of idiopathic versus arthrogrypotic clubfeet following initial treatment with the Ponseti serial casting method.

Methods:
A retrospective review of medical records from a single institution was conducted. Data was collected from children ages 0 to 18 with idiopathic or arthrogrypotic clubfoot treated from 2002 to 2022 with Ponseti-style serial casting with a minimum 2-year follow-up. Recurrence was defined as the need for additional casting or subsequent surgeries following initial correction. Data was collected on relevant patient demographics, previous treatment, casting records, Achilles tenotomies, and surgical treatments.

Results:
A total of 352 patients (546 feet) met inclusion criteria. In all, 334 idiopathic and 18 arthrogrypotic patients were analyzed with an average follow-up duration of 3.4 and 4.2 years, respectively. Twelve patients had distal arthrogryposis, and 6 had amyoplasia. In all, 93.4% of idiopathic and 72.2% of arthrogrypotic patients successfully achieved correction with Ponseti casting and Achilles tenotomy. Recurrence rates were significantly higher in the arthrogrypotic group at 83.3% compared with 44.6% in the idiopathic group (P=0.001). A posterior or posterior medial release was performed in 35.0% of idiopathic and 66.7% arthrogrypotic feet.

Conclusions:
We report the largest series of arthrogrypotic clubfeet treated by Ponseti casting to the best of our knowledge. In contrast to earlier reports, our investigation underscores that while the Ponseti method may be able to secure initial correction in arthrogrypotic clubfeet, on average, at a 3-year follow-up, the prognosis is less favorable. These patients exhibit higher recurrence and often require operative treatment. Notably, a posterior medial release may eventually be needed in up to 6 of 10 patients.
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NewsBot · Aug 9, 2024

Original versus Accelerated Ponseti Techniques in
Treatment of Congenital Talipes Equinovarus
Ahmed A. Moneim Abdel Fatah et al
The Egyptian Journal of Hospital Medicine (January 2024) Vol. 94, Page 805-810

Background: Clubfoot, a prevalent congenital orthopedic anomaly, demands extensive treatment. Ignacio Ponseti
introduced a non-invasive approach for its management.
Objective: This study aimed to compare the accelerated and traditional Ponseti therapy methods for congenital talipes
equinovarus (clubfoot). Patients and Methods: Sixty infants diagnosed with idiopathic congenital talipes equinovarus
were enrolled in an RCT. Patients were divided into two groups, each comprising thirty individuals. One group
underwent modified accelerated Ponseti therapy with casts applied every three days, while the other followed the
traditional Ponseti method with casts applied weekly. The severity of clubfoot was assessed using the Pirani grading
system, and the Ponseti procedure was employed for casting. Tendo-Achilles tendonitis and tenotomy (TAT) were
monitored, with a six-month follow-up period.
Results: The duration of treatment was significantly shorter in the modified accelerated group (Group II) compared to
the traditional group (Group I) (P<0.001). Group II exhibited greater improvement at six months and one-year posttenotomy compared to Group I. Complication and recurrence rates were similar between the groups. The modified
accelerated Ponseti method not only reduced treatment duration but also facilitated in-hospital supervision, alleviating
parental burden. Early identification of issues is possible with this approach. Conclusions: Besides expediting treatment,
the modified method offers the advantage of hospital supervision, reducing parental stress associated with frequent
travel for plaster changes. Complication rates and recurrence were comparable between the two methods
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NewsBot · Sep 4, 2024

Treatment of Idiopathic Congenital Talipes Equino Varus by Ponseti Method: A Short Term Follow Up study

NewsBot · Oct 5, 2024

Midterm clinical and radiological outcomes of arthrogryposis-associated clubfoot treated with the Ponseti method: a retrospective observational study and comprehensive literature review
Nina Berger et al
J Orthop Surg Res. 2024 Sep 28;19(1):595

Background: The treatment results of the Ponseti method for arthrogrypotic clubfoot have been described in only a few case series. Further evaluations are necessary.

Methods: Children from two German paediatric orthopaedic hospitals with arthrogryposis-associated clubfoot treated with the Ponseti method between 2004 and 2011 and who were at least five years of age at their last follow-up were retrospectively evaluated. The endpoints were the clinical foot position, necessary surgeries during the follow-up period and radiological constellations. A comprehensive literature review was conducted after a systematic literature search.

Results: Seventeen patients (47% with amyoplasia [AP] and 53% with distal arthrogryposis [DA]) met the inclusion criteria. Thirty-one feet were evaluated. The period between the treatment start and the last follow-up examination covered 8.9 ± 2.5 years. After the last cast removal within the initial Ponseti cast series, 74% of the clinical results were good to excellent. However, the clinical outcomes in the patients with AP were significantly worse. Overall, in 23 feet (74%), at least one major surgery at the age of 2.9 ± 2.2 years was necessary during the clinical course. Major surgeries were much more frequent on the feet of the patients with AP than with DA. Lateral X-rays showed normal age-appropriate radiological angles in 4% of the feet, hindfoot equinus in 19%, under-corrected hindfoot in 44%, under-corrected clubfoot in 26% and rocker bottom deformity in 7%. The radiological residual deformities in AP were much more severe than in DA (p = 0.042). Most of the studies reviewed (11 case series, 144 patients) reported high initial clinical correction rates, followed by high recurrence rates and the need for further surgeries.

Conclusion: About a quarter of the arthrogrypotic patients benefited from the Ponseti therapy without further major surgery. However, the clinically observed high initial correction rate after Ponseti therapy of arthrogrypotic clubfoot was not accompanied by a correction of the bony foot position in the X-rays. The feet of the patients with DA had better outcomes than those of the patients with AP. Therefore, in outcome studies, a clear distinction between patients with AP and those with DA is necessary.
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NewsBot · Oct 12, 2024

Caregiver Impressions of Bracing and Its Association With Unsuccessful Outcomes Throughout the Ponseti Treatment
Andrew H Miller et al
J Pediatr Orthop. 2024 Oct 10

Background: Clubfoot is a common congenital foot deformity, occurring in about 1 in 1000 live births. The Ponseti method consists of weeks of manipulation and serial casting, followed by years of orthotic wear. Recurrent or relapse deformity following the Ponseti method remains a challenging problem for many patients. Many studies have attributed relapse to noncompliance with the treatment plan, particularly during the maintenance phase. Many patient risk factors have been studied and attributed to recurrent deformity, but less emphasis has been placed on aspects of the treatment method from the caregiver's perspective.

Methods: From 2010 to 2014, 127 patients between 1 and 354 days old who had been diagnosed with clubfoot were recruited for the parent study. At the initial visit, and each subsequent follow-up, the primary caregiver was given a questionnaire that included 21 binary belief questions exploring his or her experience with the Ponseti method. Univariate analyses were performed to find any relationship with caregiver responses and either clinical recurrence of the deformity or overall failure of treatment.

Results: Of the recruited patients, 126 were enrolled in the parent study and 100 were able to complete the full 3-year follow-up. Patient demographics and characteristics (sex, race, family history of clubfoot, laterality, and severity of deformity) were similar. Statistical analysis of the questionnaire responses found that choosing "yes" for either "I don't feel the braces are necessary" or "I am not comfortable with applying and removing the braces" was associated with significantly increased risk of overall failure.

Conclusions: Gathering insight from the caregiver's perspective can help identify barriers to treatment not recognized by the provider. Lack of comfortability with the orthosis and lack of understanding are associated with increased risk of overall failure. A better understanding of the caregiver's perspective on barriers to treatment could help guide the Ponseti method provider's educational efforts.
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NewsBot · Oct 14, 2024

Early Predictors of Recurrence and Long-Term Results of Clubfoot Treated by Ponseti Method
Pankaj Kumar Maurya, Alok Sahu, Mathew Varghese
Source

Background: Congenital Talipes Equino Varus (CTEV) or Clubfoot is one of the most common congenital deformities of foot. Ponseti cast treatment is considered as the standard method for management of idiopathic club foot with better short term as well as long term outcomes reported. It is important to evaluate the results of Ponseti method in treatment of clubfoot and cause for early recurrence along with long term result of this technique. Material and methods: Retro-prospective observational study regarding short term as well as long term follow up for result of Ponseti treatment method was done during period of September 2015 to June 2017. Short term results and early predictors of recurrence were assessed with data regarding initial Pirani scores, number of casts needed for correction, need of tenotomy, bracing follow up and treatment of recurrence. Long term outcomes were also noted in children older than 5 years after completion of treatment with performance outcomes like sports activity, squatting, shoe comfort, external rotation of foot, dynamic supination and parent satisfaction scores. Result: A total of 54 patients (80 club feet) were part of the study. Early recurrence (below 5 years) and late recurrence (after 5 years) was observed in 19% and 10% clubfeet respectively. Poor compliance with the foot abduction brace (Steenbeek brace) was thought to be the main cause of early recurrence. While brace bearing more than 5 hours is essential to prevent recurrence; early Achilles tendon tenotomy was noted to favor long term maintenance of correction and prevent recurrence. Long term result shows that clubfoot treated by Ponseti method had 97% supple feet with ability to squat in most of the patients with better clubfoot Disease Specific Instrument (DSI) score, external rotation and ankle dorsiflexion. Conclusion: Ponseti treatment method is a safe and satisfactory method for congenital idiopathic clubfoot with long term effectiveness. Recurrences mainly occurred due to non-compliance with foot abduction brace. Recurrences can also be treated by same method. Key words: Recurrence in clubfoot, Congenital tali-pes equinovarus (CTEV), Ponseti Treatment, Idiopathic CTEV, Steenbeek brace compliance
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NewsBot · Oct 15, 2024

LEARNING CURVE IN PONSETI METHOD – EVOLUTION IN 5 YEAR-INTERVALS
Source

Objective:
Evaluate whether the experience of the surgeon could reduce Ponseti treatment time, and a number of cast changes, and the evolution of the Pirani Score.

Methods:
2 reference centers were evaluated. At Institution 1, 254 patients with idiopathic clubfoot (403 feet) were included, and at Institution 2, 32 patients (51 feet). At institution 1 (mentor), 3 intervals of 5 years each were analyzed. At the Institution 2 (trainee), 1 interval of 5 years was analyzed.

Results:
Patients treated by the mentor had fewer casts compared with the trainee (p < 0.001). At Institution 1, the three mentor intervals showed differences in the number of casts (p < 0.05). A statistically significant difference was observed only in the first mentor interval (2000 to 2005, average of 3.47 casts) compared with the 2 other intervals (2005 to 2010; average of 2.6 casts and 2011 to 2015; average of 2.79 casts; p < 0.0001). Pirani score decreases the most until the third clinic visit.

Conclusion:
The mentor’s greater expertise was associated with fewer casts and shorter time to obtain correction in isolated clubfoot, especially right after the first 5 years of practice. Progression of the Pirani score in both institutions occurs between the first and the third casts.
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NewsBot · Oct 18, 2024

Effects of educational material among children with
clubfoot during bracing stage of treatment by Ponseti
method
Ershad Ali et al
Edorium J Disabil Rehabil 2024;10(2):1–15.

Aims: To identify effects of educational material among
children with clubfoot during bracing stage of treatment
by Ponseti method.
Methods: This study was a quantitative type quasiexperimental research design. Actually, it was an
experiment among specific groups and usual groups.
Exercises applied with educational material to the material
group or experiment group and only usual exercises applied
to the non-material group or the control group. A pretest (before exercises provided by educational material)
and post-test (after exercises provided by educational
material) was administered with each subject of both
groups to compare the effects on children with clubfoot
during bracing stage of treatment by Ponseti method.
Results: The mean Pirani score before providing
exercises with educational material for right feet among
the clubfoot babies were 0.56 ± 0.33 (material group)
and after providing exercises with educational material
for right feet among the clubfoot babies were 0.43 ±
0.41 (material group). Statistically it was found highly
significant (t = 2.99, p < 0.0003). So, it was concluded
that exercises with educational material had significant
influence on Pirani score reduction for right feet among
the clubfoot babies. The mean Pirani score before
providing usual exercises for left feet among the clubfoot
babies were 0.5 ± 0.15 (non-material group) and after
providing usual exercises for left feet among the clubfoot
babies were 0.53 ± 0.48 (non-material group). Statistically
it was found significant (t = −0.059, p < 0.056). So, it
was concluded that usual exercises without educational
material had influence on Pirani score increased for left
feet among the clubfoot babies.
Conclusion: The modern treatment of clubfoot is
Ponseti method which is very effective, outcome oriented,
and less invasive surgical procedure. This study was
concluded that exercises with educational material had
significant influence on Pirani score reduction among
the children with clubfoot. So, there was significant
importance of exercises with educational material rather
than usual exercises by verbal instructions.
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NewsBot · Oct 25, 2024

Clubfoot Correction with Ponseti Technique: Three-Dimensional Alignment Analysis and Residual Adult Deformity Effects on Patient-Reported Outcomes
Ryan Jasper, BS, Kepler A.M. Carvalho, MD, […], and Cesar de Cesar Netto, MD, PhD et al
Source

Introduction/Purpose:
Few studies have assessed the long-term outcomes of the Ponseti technique and none have utilized 3- dimensional weightbearing analysis. The goal of this study was to understand how potential residual 3D deformities and abnormalities influence patient reported outcomes (PROs). This was accomplished by assessing anatomical foot and ankle alignment in adult clubfoot patients treated with the Ponseti method using 3D weightbearing CT (WBCT) imaging and then correlating residual foot and ankle malalignment with PROs.
Methods:
There were 37 consecutive patients (57 feet) included and 14 volunteers healthy controls (28 feet) included in this study. Every participant was evaluated using a WBCT (HiRise©) in a bipedal standing position. From these scans Cavus, Adductus, and Varus components were evaluated using multiple 3D measurements calculated using the semi-automatic segmentation software Bonelogic®. Specific Cavus related measurements included sagittal talus-first metatarsal angle and the calcaneal inclination angle. Varus related measurements included talocalcaneal angle in both the sagittal and axial planes as well as the hindfoot moment arm and the hindfoot alignment angle. Adductus deformity was evaluated using talonavicular coverage angle. These measurements were then correlated with patient reported outcome surveys, which included Visual Acuity Scale for pain, PROMIS general health, PROMIS physical function, PROMIS pain interference, pain catastrophic scale, and European foot and ankle society score.
Results:
There was no significant overall residual 3D-deformity observed in clubfoot patients when compared to controls, with similar FAO measurements observed between the groups, clubfoot=2.63% (95%CI=1.41%-3.85%) and control=3.2% (CI=1.6%- 4.8%,P=0.58). The sagittal talus-first-metatarsal in the clubfoot-patients had a mean-value of -0.12° compared to the controls, −5.2°. Clubfoot patients also had a decreased calcaneal-inclination-angle relative to the controls, 13.01° and 21.5° respectively. Talocalcaneal-angle for clubfoot patients in both the sagittal-plane,44.28°, and axial-plane, 17.74°, were reduced compared to the controls, 57.51° and 25.78°. Talonavicular-coverage-angle in the clubfoot-group (18.63°) was less than the controls (29.19°). Talus- first-metatarsal-angle in the sagittal-plane was significantly correlated with VAS-scores (RSquare=0.19,P=0.0118) and the EFAS- Score (RSquare=0.27,P=0.0025). Talocalcaneal-angle in the sagittal plane was also significantly correlated with the PROMIS-Pain- Interference-score (P=0.038) and PROMIS-Physical-Function-score (RSquare=0.32,P=0.0007).
Conclusion:
The Ponseti technique is an effective nonsurgical treatment for the overall three-dimensional foot and ankle alignment of Clubfoot. While mild, but statistically significant residual Varus and Adductus deformities were observed in adult clubfoot patients, the overall 3D alignment (FAO) was found to be similar between clubfoot patients and controls. These findings highlight the efficacy of the Ponseti technique and potentially explain the overall good PROs. The results of this study could potentially provide insight into treatment targets that may be applied to help optimize patient outcomes when treating children with Clubfoot in the future.
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NewsBot · Oct 27, 2024

Outcomes of clubfoot conservative treatment using the Ponseti technique in an academic hospital in Saudi Arabia.
Bakarman K, Zamzam M, Addweesh AK, Basalem SM, Alsanad FA, AlHamdi KM, et al.
J Musculoskelet Surg Res. 2024;8:354-8. doi: 10.25259/JMSR_260_2024

Objectives:
Congenital talipes equinovarus (CTEV), commonly known as clubfoot, affects 1–4/1000 births, predominantly males. Without intervention, children face mobility limitations and deformities. Conservative treatment, particularly the Ponseti technique, which boasts a success rate exceeding 90%, is favored despite potential complications.

Methods:
This study aimed to assess the efficacy of the Ponseti technique through a retrospective analysis of idiopathic CTEV cases. Data on pre- and post-treatment Pirani scores were analyzed across variables including age, sex, number of casts, Achilles tenotomy, surgical intervention, and complications. Participants were categorized based on treatment outcomes to identify contributing factors.

Results:
Among 42 participants (69 feet), 62% were male, presenting at an average age of 9 weeks and receiving an average of 5.26 casts per patient. Pre-treatment Pirani scores averaged 4.52, significantly decreasing to 0.88 post-treatment. Feet managed without surgery demonstrated greater improvement in Pirani scores (mean change 3.888) compared to those requiring surgery (mean change 2.364), a statistically significant difference (P < 0.001). Acceptable outcomes were observed in 84.06% of feet. Percutaneous Achilles tenotomy was performed in 84% of cases. Surgical intervention was necessary in 15.94% of feet. Casting complications occurred in 14.49% of feet.

Conclusion:
This study confirms the Ponseti technique’s effectiveness in managing idiopathic CTEV, emphasizing early detection and initiation of conservative treatment. The early findings establish the Ponseti technique as the preferred initial approach for CTEV management.
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NewsBot · Oct 28, 2024

Assessing the Influence of Age, Weight, and Pirani Score on the Number of Casts During the Initial Phase of Clubfoot Treatment Using the Ponseti Method: A Prospective Study
Hussam Abdelrahim Dawi Ahmed, Ahmed Mohamed Yousif Mohamed, Monzir Salih, Mugahid Mohamed Gahalla Mohamed, Abobaker Younis, Sara Hussein Mohamed Hussein, Hadeel Sovla & Lina Motasim Khalil SeedAhmed
Indian Journal of Orthopaedics

Background
Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment.

Methods
A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction.

Results
The majority of participants were male infants aged 4–6 months, with a median age of 4.5 months. Half of them weighed between 3.00 and 4.99 kg at their first hospital visit, with a median weight of 3.20 kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0–3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3–9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts.

Conclusions
The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy.
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NewsBot · Nov 17, 2024

Parent reported outcomes for idiopathic clubfoot children treated with the Ponseti technique: An analysis of 140 feet followed minimum 5 years
Lokesh Sharma et al
Source

Objective
The treated clubfoot children are often evaluated clinically during follow-up. However, patient reported outcomes (PROM) are seldom analysed for these children. We investigated 87 idiopathic clubfoot children (140 feet) treated by the Ponseti method and followed minimum 5 years to study their clinical outcomes and PROM.
Material and methods
This was a cross-sectional study, based on evaluating treated clubfoot children clinically (Pirani score) and PROM (Oxford Ankle and Foot Questionnaire – Parent Version) and comparing them with the age-matched healthy controls (n = 60). The questionnaire has four main domains related to the child's physical, school and play, emotional and footwear profile. The children having persistent deformity (residual/relapse) were specifically studied for their PROM scores.
Results
The mean child age at initial treatment was 2.3 months and the mean follow-up duration was 6.9 years. The PROM score of clubfoot children was statistically lower than the healthy controls (p < 0.001). Of the individual domains, the physical domain was the most affected. On calculating the Pirani scores, 10 out of 140 feet (7 %) had some form of persistent deformity. The children with persistent deformity had lower Oxford scores than healthy children or those with corrected feet. The physical domain followed by the emotional domain scored low when persistent deformity was present.
Conclusions
Most children (98 %) had a plantigrade foot following Ponseti treatment at follow-up. However, PROM score of the clubfoot children did not correspond to the clinical outcome. Persistent deformity, even minor, was a cause of parental concern and resulted in a low PROM score.
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NewsBot · Nov 23, 2024

The kinematic coupling during Ponseti correction in idiopathic clubfoot: A quantitative analysis
Anil Agarwal et al
Journal of Clinical Orthopaedics and Trauma Volume 59, December 2024

Background
The study aimed to quantify and correlate kinematic coupling linkage of foot abduction (correction of adduction) and inversion, heel varus and ankle equinus for clubfeet corrected by Ponseti technique.
Methods
Measurements of foot abduction (derotation of carpopedal block), heel varus and ankle equinus were available from Dimeglio scores in 25 feet. Radiological angles were considered for foot inversion-eversion. Values of above parameters were obtained at the start of treatment (T1), pre tenotomy (T2) and after tenotomy (T3). The values of T2-T1 corresponded to the manipulative phase of Ponseti technique while T3-T2 corresponded to the Achilles tenotomy.
Results
During the manipulative phase, coupling rhythm between foot abduction to correction of equinus, heel varus and inversion was calculated to be 1:0.3, 1:1.1 and 1:0.5 respectively. Post tenotomy, coupling rhythm between ankle dorsiflexion to changes in foot abduction, heel varus and inversion was calculated to be 1:0.5, 1:0.1 and 1:0.4 respectively. A moderate significant correlation was obtained on comparison of T3-T2 values between clinical equinus and foot abduction (r = 0.54, p = 0.05).
Conclusion
The foot inversion, heel varus and ankle equinus corrected at 1.1, 0.5 and 0.3 times respectively of foot abduction in the manipulative phase. The phenomenon of kinematic coupling between various foot movements was however inconsistent during Ponseti treatment of clubfoot. More significant associations were obvious towards late phase of deformity correction when foot alignments were much improved. Larger prospective studies are needed to delineate the precise linkage between foot movements in a pathological condition such as clubfoot.
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NewsBot · Dec 4, 2024

The Ponseti Method vs. Surgical Treatment for Idiopathic Clubfoot: A Prospective Long-Term Follow-Up
Martin Svehlik et al
Children 2024, 11(12), 1422; https://doi.org/10.3390/children11121422

Background: Idiopathic clubfoot is a common skeletal deformity in newborns that can cause functional limitations, pain, and reduced quality of life. The Ponseti method has become the gold standard for clubfoot treatment, replacing previous extensive surgical approaches. However, there is a lack of prospective long-term data comparing surgical and Ponseti treatments. Methods: This is a follow-up on a single-center, prospective, randomized clinical trial that started in 2001. The aim of this study was to compare the Ponseti method with surgical treatment. The current report presents the long-term results at adulthood of 12 clubfeet (9 subjects) in the Ponseti group and 9 clubfeet (5 subjects) in the surgical group. The evaluation included morphology, function, and quality of life, which were assessed through gait analysis, X-rays, and standardized questionnaires (FRS, ICFSG, AOFAS, SF-36). A Functional Rating System for clubfeet was defined as the primary outcome. Results: The Ponseti group had higher Functional Rating System scores, better ankle dorsiflexion mobility, and lower pain levels. Additionally, they reported better quality of life according to the Short Form 36 survey. However, neither group achieved radiographically normal foot morphology. Conclusions: The 18-year follow-up results indicate that the Ponseti method produces superior outcomes in terms of mobility, gait, function, and quality of life when compared to surgically treated feet, despite the presence of persistent morphological deviations.
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NewsBot · Dec 4, 2024

Kite Versus Ponseti Method in the Treatment of
Idiopathic Congenital Clubfoot: A Systematic
Review and Meta-Analysis
Elshymaa E. Raslan , Basel H. Bakhamees , Leenah A. Turjoman , Noor N. Alalqam , Batool N. Alalqam ,
Bahja J. Alhaddad , Abdallah Alim , Asma M. Alharbi , Ali H. Alqahtani , Olaa M. Omaish ,
Batoul AlEdwani , Rawyah Dawas
Source

Kite and Ponseti methods are two popular manipulating methods for correcting the deformity of idiopathic
congenital clubfoot. We aimed to compare the efficacy of Kite and Ponseti methods in the treatment of
children with idiopathic congenital clubfoot. A search was launched on Medline/PubMed, Cochrane Central
Register of Controlled Trials, the Web of Science, ProQuest, and Scopus without limits, from inception to
May 1, 2024. The outcomes included the rates of initial correction and relapse (primary) as well as the
number of casts and duration of treatment (secondary). Mean difference (MD) and risk ratio (RR) were
calculated for numerical and dichotomous outcomes, respectively, with 95% confidence intervals (CIs). Nine
studies were included. Meta-analysis showed the Ponseti method is significantly associated with a higher
probability of correction (n = 6, RR = 1.23 [95% CI = 1.14, 1.32], p < 0.001) and a lower risk of relapse (n = 5,
RR = 0.50 [95% CI = 0.36, 0.71], p < 0.001) compared to the Kite method. The Ponseti method utilized a lower
number of casts (MD = -3.0 [95% CI = -5.8, -0.2], p = 0.04) and took a shorter duration (MD = -39.76 [95% CI =
-67.22, -12.30], p = 0.02) than the Kite method. Evidence suggests that the Ponseti method results in better
outcomes than the Kite method in terms of successful initial correction and lower relapse rates. However,
the available studies showed varying degrees of risk of bias, and the length of follow-up was inadequate in
some studies.
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NewsBot · Dec 4, 2024

Pitfalls and complications in the treatment of clubfoot by the Ponseti method: A literature review
Authors: Derevyanko D.V.1, Trofimova S.I.2
Source

BACKGROUND: At every step of clubfoot treatment using the Ponseti method, pitfalls leading to complications, both minor and potentially dangerous, may occur. Any doctor involved in the treatment of clubfoot may encounter similar difficulties in their practice; however, publications devoted to this problem are limited, and in some cases, experts cannot reach a consensus regarding the interpretation of actions that entail undesirable consequences.
AIM: This study aimed to analyze pitfalls and complications associated with the Ponseti method for the treatment of clubfoot using modern literature data.

MATERIALS AND METHODS: Articles were searched for in PubMed, Science Direct, Google Scholar, and eLibrary databases using the following keywords: idiopathic clubfoot, Ponseti method, serial casting, bracing, Achilles tenotomy, pitfalls, and complications. The search was performed without language restrictions. Most of the studies included were published no more than 10 years ago.

RESULTS: Current literature data present on the pitfalls and complications encountered in the treatment of clubfoot using the Ponseti method. The review also covered associated complications and unfavorable prognostic factors. The restrictive measures during the COVID-19 pandemic have affected the treatment of clubfoot.

CONCLUSIONS: Analysis of the causes of pitfalls and complications and control of unfavorable prognostic factors will help reduce complications of clubfoot treatment using the Ponseti method and optimize orthopedic care for children.
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Ponseti Method for clubfoot

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