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Paediatric and adolescent foot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
The Ponseti method (7) of casting and treatment remains popular. His innovative concept was to avoid any manipulation of the hindfoot (where the bulk of the deformity resides) and to instead unlock and correct it by just manipulating the forefoot and the midfoot, followed by correction of the equinus with a percutaneous Achilles tenotomy.
Review of literature
Published in R. L. Mittal, Clubfoot, 2018
Ganesan et al.30 reviewed the literature from 2000 to 2015 from four electronic databases, namely, Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus, for efficacy of the Ponseti method in the treatment of clubfoot (casting, heel cord tenotomy, and bracing) in children less than two years of age. Out of 1,095 identified articles, only 12 satisfied their inclusion and exclusion criteria. In most of them, treatment was started soon after birth. Out of 12 studies, relapses were noticed in nine, with maximum of 27.1% in one study (Hallaj et al. 2015). They quoted from many studies in the literature that 10%–30% relapses are very common with the Ponseti treatment. Relapses can be prevented only if the treatment is started soon after birth and casting with the right technique, and continued bracing for four years the way is it advised. Many of the reasons for relapses are still not clear. About 78% of relapses occur due to noncompliance of bracing, which is the most difficult part of treatment. Even in the bracing-compliant patients, 7% relapse is quoted by the authors as being reported in these studies. Other factors responsible are illiteracy and poverty. Improper casting, percutaneous tenotomy, and poor follow-up are other factors. Moreover, this report did not included children with clubfeet more than two years of age and older age groups.
Paediatric orthopaedics
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Feet treated with the Ponseti method are less stiff, less likely to be painful and less subject to overcorrection than those treated surgically. The Ponseti method is significantly better than other reported conservative regimes. It also works reasonably well in non-idiopathic feet but both the failure and relapse rates are higher.
Timing for Ponseti clubfoot management: does the age matter? 90 children (131 feet) with a mean follow-up of 5 years
Published in Acta Orthopaedica, 2018
Yu-Bin Liu, Song-Jian Li, Li Zhao, Bo Yu, Da-Hang Zhao
Idiopathic clubfoot appears with an incidence of 5/104 in China (Yi et al. 2013). Nowadays, the Ponseti method has been widely accepted as the treatment of choice, and its safety and efficacy has been extensively demonstrated around the world (Zhao et al. 2014a, Liu et al. 2016). Generally, treatment with the Ponseti method is started within the first few weeks of life (Ponseti 1996, Dobbs and Gurnett 2009, Zhao et al. 2014b, Liu et al. 2016). In the study by Alves et al. (2009), the patients were divided into 2 groups (younger or older than 6 months) and no difference was found in the number of casts, tenotomies, success in terms of rate of initial correction, rate of recurrence, or rate of tibialis anterior transference. Iltar et al. (2010) reported that casting treatment beginning later than age 1 month or with an affected foot ≥8 cm in length had better treatment outcome. Zionts et al. (2016) reported that the age at the onset of treatment did not appreciably influence the cast phase of treatment or the initiation of post-corrective bracing, with the exception of cast slippage. Awang et al. (2014) have demonstrated that the total number of castings required to treat clubfoot was determined by the severity of clubfoot but not by the weight and age of patients. Other authors have reported that children presenting late with clubfoot can also be successfully treated by the Ponseti method (Bor et al. 2006, Lourenco and Morcuende 2007, Haj Zargar Bashi et al. 2016). It is still unclear if the treatment outcome is related to the age when the treatment was initiated. We assessed whether age at start of treatment influences the number of casts, tenotomies, the correction rates, recurrence rates, ankle dorsiflexion after treatment, final Demeglio and international clubfoot study group score (ICFSG) with a mean follow-up of 5 years.
Ten cold clubfeet
Published in Acta Orthopaedica, 2018
Robert B Giesberts, Edsko E G Hekman, Gijsbertus J Verkerke, Patrick G M Maathuis
The common treatment of idiopathic clubfoot (talipes equinovarus) consists of serial manipulation and casting, known as the Ponseti method (Ponseti 2008). The treatment is started in the first weeks after birth and includes on average 5 cast changes, often followed by a percutaneous Achilles tenotomy. The deformity is successfully corrected in over 90% of all cases (Morcuende et al. 2004). An abduction orthosis is worn for several years to prevent relapse (Dobbs et al. 2004).