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Background: Clubfoot management according to the Ponseti method, including 4–5 years of bilateral foot abduction bracing to prevent relapse, is widely accepted as gold standard. Adherence to bracing is often low, despite non-adherence being associated with poor outcomes. Objectives: This systematic scoping review aimed to identify and synthesize factors associated with brace adherence and non-adherence in the Ponseti method, to identify strategies shown to improve adherence, and to provide a clinically meaningful synthesis of available evidence. Methods: This scoping review utilized systematic search and formal guidance on conduct and reporting. Medline, SCOPUS, Informit, EmCare, CINAHL, and PEDro databases were searched for peer-reviewed primary research reporting factors associated with brace adherence or non-adherence during Ponseti management. Factors were identified, then grouped using inductive then deductive methods and reported in a narrative synthesis. Results: A total of 413 studies were identified and 42 were included in the review: 31 quantitative and 11 qualitative, generally of low quality. Meta-analysis was not feasible. Factors associated with non-adherence were identified more often than with adherence, and findings for both were inconsistent. Fifty-three factors were investigated, with conflicting findings common. No studies evaluating strategies to improve brace adherence were identified. Conclusions: Available evidence does not indicate that any one factor or set of factors is consistently associated with adherence or non-adherence to bracing in Ponseti clubfoot management, and so clinically meaningful factors are proposed. Adequately powered longitudinal studies of adherence to bracing are required. Mixed methods approaches would help to inform and evaluate strategies to improve adherence, particularly those routinely recommended in clinical practice. [ABSTRACT FROM AUTHOR]

Case: Traumatic pediatric Achilles ruptures are rare, and few cases have been reported among patients with a history of Achilles tenotomy. A 17-year-old boy with a history of Achilles tenotomies for congenital clubfoot as an infant presented with acute midsubstance Achilles tendon rupture of the right leg. The gastrocnemius fascia was dissected to allow for approximation of the ruptured Achilles tendon segments. Furthermore, the plantaris tendon was harvested and sutured around the Achilles tendon-rupture site to improve strength. Conclusions: Patients with a history of clubfoot and chronic Achilles tendon pain should be alerted to the risk of Achilles tendon rupture. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. Methods: A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. Results: Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1–10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0–25°) and mean plantarflexion range of 37.95° (10–40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17–30) and mean height of heel rise of 6.29 cm (range 4–10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3–16 mm) and thickness of 5.1 mm (1.8–15 mm), comparable with unaffected feet. Conclusions: Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles. [ABSTRACT FROM AUTHOR]

Amniotic band syndrome (ABS) and clubfoot are distinct congenital musculoskeletal conditions that can occasionally co-occur, creating unique challenges in their management. This paper summarizes the comprehensive discussion on the management of amniotic band syndrome (ABS) and clubfoot, emphasizing the critical role of the Ponseti method and the challenges faced in treatment, thereby providing a basis for further research and improved patient care. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of complex atypical clubfoot poses many challenges. In this paper, we report on the course of complex clubfoot, primary correction using the modified Ponseti method and midterm outcomes. Special consideration is given to clinical and radiological changes in cases of relapse. Materials and methods: Twenty-seven cases of complex, atypical, non-syndromic clubfoot were treated in 16 children between 2004 and 2012. Patient data, treatment data, functional outcomes and, in the relapse cohort, radiological findings were documented during the course of treatment. The radiological findings were correlated with the functional outcomes. Results: All atypical complex clubfeet could be corrected using a modified form of the Ponseti method. Over an average study period of 11.6 years, 66.6% (n = 18) of clubfeet relapsed. Correction after relapse showed an average dorsiflexion of 11.3° during a 5-years' follow-up period. Radiological results showed residual clubfoot pathologies such as a medialized navicular bone in four clubfeet. There were no instances of subluxation or dislocation of the talonavicular joint. Extensive release surgery was not necessary. Nevertheless, after 2.5 preoperative casts (1–5 casts), bone correction was performed in n = 3 feet in addition to Achilles tendon lengthening and tibialis anterior tendon transfer. Conclusion: Good primary correction of complex clubfoot using the modified Ponseti technique results in a high recurrence rate in the medium term. Relapse treatment without peritalar arthrolysis procedures produces good functional results even though minor residual radiological pathologies did persist in a minor number of cases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To investigate maternal psychological status of children with congenital talipes equinovarus in different periods, and to clarify the influence on maternal psychological status of congenital talipes equinovarus treated with the Ponseti method. Methods: Sixty-seven mothers of children with congenital talipes equinovarus were investigated. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the psychological stress of the mothers at different periods. Paired-samples t-test was used to analyze the results. Results: The mothers of 67 children with congenital talipes equinovarus ranged from 25 to 38 years old, with an average of 33.5 years old. Before prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 42.537 ± 10.476, and the average score of Self-rating Depression Scale was 47.254 ± 12.846; after prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 54.224 ± 13.050, and the average score of Self-rating Depression Scale was 57.403 ± 13.649 points. Before the postpartum treatment of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 53.388 ± 12.716, the average score of Self-rating Depression Scale was 56.284 ± 13.617; after the treatment of congenital talipes equinovarus with the Ponseti method, the average score of Self-rating Anxiety Scale was 47.731 ± 12.259, and the average score of Self-rating Depression Scale was 51.910 ± 13.878 points. The above differences were statistically significant (P < 0.001). Conclusion: The prenatal diagnosis of congenital talipes equinovarus will increase the maternal psychological stress, and the maternal psychological status will be significantly improved after the deformity of congenital talipes equinovarus is corrected effectively by the Ponseti method. Level of evidence: level III, retrospective study. [ABSTRACT FROM AUTHOR]

Introduction:-Congenital Talipes Equinovarus (CTEV) is a common deformity of the foot in all races. Turco advocated open tenotomy of the Achilles tendon at musculotendinous junction under direct vision but Ponseti reported the use of subcutaneous tenotomy in 70-90% cases of club feet treated conservatively and dorsiflexion beyond 15 degrees was not possible at the ankle. Aims and objective: Evaluation of effectiveness of tenotomy in clubfoot by demiglio score and footprint angle. Material and method: Patients with idiopathic CTEV who presented less than 2 year age in the outpatient department were included in the study in the period of 2 years. Study design is prospective cohort study included 35 patients. 5 patients lose to the follow up hince study composed of 30 patients with 47 feet. Quantification of various components of clubfoot deformity was done by using the Dimeglio score. Result: Quantification of various components of clubfoot deformity was done by using the Dimeglio score. Total cases 17 (56.6%) cases have bilateral presentation and 13 (43.4%) cases have unilateral presentation (Right sided 9 cases and left sided 4 cases). Satisfactory outcome was noted in 43 feet. Conclusion: Achieved a successful correction by Ponseti method with tenotomy less than two year age group patients was 91.4% feet according to Dimeglio scoring system. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic talipes equinus varus (TEV) or club foot is a common developmental disorder that affects about 1 - 2 per 1000 births. The Ponseti method for correction of the deformity has become the gold standard for club foot management. The objective of this study was to increase awareness of the high rate of success of the Ponseti technique for the management of club foot. Materials and Methods: The study was conducted at Isra University, Hyderabad Sindh, from April 2017 to July 2018. It was a retrospective audit. Patients presenting with idiopathic Clubfoot between birth and 12 months of age of either sex were included. The patients were followed at 6 months, 12 months, and the final follow-up was done 24 months after the removal of their last cast. Results: At twenty-four months follow-up, twenty patients (71.4%) showed no recurrence of deformity, one patient (3.6%) showed recurrence, and this patient too had a history of non-compliance with brace protocol. This case was also successfully treated with repeat castings. 7 patients (25%) were not available for follow-up at this point in time. Significantly higher chances of recurrence of deformity were noticed in patients who were noncompliant with the brace. Conclusion: Ponseti technique is now considered the most efficient way to treat club foot deformity. For public awareness, our study reassures the families that the clubfoot deformity can easily be corrected with the casting technique, and correction may remain maintained if the brace-wearing protocol is followed. Furthermore, as this method is associated with a significant decrease in the number of extensive surgeries for correction of club foot, this may help tertiary care hospitals to pay attention to other surgical orhopaedic problems that may have crucial implications, especially in a developing country. [ABSTRACT FROM AUTHOR]

The number of clubfoot new cases in Romania is on the rise. According to orthopedic research, the Ponseti method is the elective treatment for clubfeet. This paper aims to provide an overview of the current facilitators and barriers in accessing clubfoot treatment services in Romania and to assess the impact of care-related factors on patients' well-being. Our research shows that nationally, few orthopedic surgeons are using the Ponseti method and most of them are concentrated only in Cluj-Napoca. Moreover, gynecologists, neonatologists, and family physicians were not informed about the initial diagnosis and the current treatment of clubfoot. Primary medical care was significantly postponed in some cases. Moreover, no clubfoot organizations were mentioned by the parents included in the study, and psychological support was provided neither for the parents nor for the children. Based on the results of our study, we conclude that more efforts need to be done for the diagnosis and treatment of children with clubfeet. These include actions which are focused on raising awareness around this abnormality and more well-developed treatment guidelines. [ABSTRACT FROM AUTHOR]

Objectives: We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method.Methods: We retrospectively reviewed all children with congenital clubfoot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples' Hospital Ethics Committee.Results: In this study, there were 148 cases (164 ft) in total that underwent the Ponseti method, with the follow-up period at least 5 years. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50 ± 2.15 months. The average initial Pirani score was 4.98 ± 1.33, and the average number of casts was 5.71 ± 2.28 times. The mean age of mothers at birth was 25.81 ± 2.38 years old. The walking age of children was at a mean of 14.83 ± 1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 ft (76.4%). The average follow-up period was 7.27 ± 1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group .Conclusion: The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot. [ABSTRACT FROM AUTHOR]

Purpose: The Ponseti method has revolutionized the clubfoot treatment and has been adopted globally in the past couple of decades. However, most reported results of the Ponseti method are either short or midterm. Studies reporting long-term outcomes of the Ponseti method are limited. The following systematic review aimed to provide a comprehensive overview of the published articles on long-term outcomes of the Ponseti method. Material and methods: A literature search was performed for articles published in electronic database PubMed (includes Medline) and Cochrane for broad keywords: "Clubfoot"; "Ponseti method/technique"; "long term outcomes/results." Studies selected included full-text articles in English language on children less than one year with primary idiopathic clubfoot treated by the Ponseti method with mean ten year follow-up. Non-idiopathic causes or syndromic clubfoot and case reports/review articles/meta-analyses were excluded. The following parameters were included for analysis: number of patients/clubfeet, male/female, mean age at treatment, mean/range of follow-up, relapses, additional surgery, range of motion, various outcome scores, and radiological variables. Results: Fourteen studies with 774 patients/1122 feet were included. The male:female ratio was 2.4:1. Mean follow-up recorded in studies was 14.5 years. Relapses occurred in 47% patients with additional surgery being required in 79% patients with relapses. Of these, 86% of surgery were extra-articular while 14% were intra-articular. Plantigrade foot was achieved in majority patients with mean ankle dorsiflexion of 11 degrees. The outcome scores were in general good in contrast to radiological angles which were mostly outside normal range with talar flattening/navicular wedging/degenerative osteoarthritis changes occurring in 60%, 76%, and 30%, respectively. Conclusions: Long-term follow-up of infants with primary idiopathic clubfeet treated by the Ponseti method revealed relatively high relapse and additional surgery rates. Radiologically, the various angles were inconsistent compared to normal ranges and anatomical deformations/degenerative changes were present in treated feet. Moreover, the relapse rates and requirement of additional surgery increased on long-term follow-up. Despite this, majority feet were plantigrade and demonstrated good clinical results as measured by various outcome tools. There should be emphasis on long-term follow-up of children with clubfeet in view of late relapses and secondary late changes. [ABSTRACT FROM AUTHOR]

Purpose: Recurrences following clubfoot correction by the Ponseti method can be prevented by regular use of a foot abduction brace (FAB) until the child is four to five years old. However, there is a lack of an objective method to measure actual hours of brace usage. The aim was to develop a functional prototype of a SMART (Sensor-integrated for Monitoring And Remote Tracking) clubfoot brace to record accurate brace usage and transmit the data remotely to healthcare providers treating clubfoot. Methods: A collaborative team of engineers and doctors was formed to investigate various types of sensors and wireless technologies to develop a functional prototype of a SMART brace. Results: Infrared sensors were used to detect if the feet were placed inside the shoes and magnetic Hall effect sensors to detect that the shoes were latched on to the bar of the existing FAB. Brace usage data were captured by the sensors every 15 minutes and stored locally on a data card. A Bluetooth low energy (BLE)-based wireless transmission system was used to send the data daily from the brace to the remote cloud server via a smartphone application. Accurate brace usage data could be recorded by the sensors and visualized in real time on a web-based application in a pre-clinical setting, demonstrating feasibility in clinical practice. Conclusion: The low-cost SMART brace prototype that we have developed can accurately measure and remotely transmit brace usage data and has the potential to transform caregivers' behaviour towards brace adherence, which could result in a tangible reduction in recurrence rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate concordance between prenatal and postnatal diagnosis of congenital talipes equinovarus (cTEV), rates of surgery and postnatal outcomes in relation to the prenatal classification of severity.Study Design: This is a retrospective observational cohort study on fetuses with a prenatal diagnosis of cTEV between 2004 and 2018. All cases of isolated cTEV in singleton pregnancies were included. Postnatally, the Ponseti method was applied. Children were followed-up postnatally for at least two years, with a specific focus on neurodevelopmental outcome.Results: The cohort included 81 fetuses with a prenatal diagnosis of cTEV confirmed postnatally in 86.4% of cases. Concordance between prenatal and postnatal assessment was good for both laterality and degree of severity (k = 0.61 and 0.66, respectively). The average Pirani score, number of casts and rates of Achilles tendon tenotomy were higher for III degree cTEV (p < 0.001). Within this group only, the rate of relapse was 11% and the rates of major surgery was 6%. The postnatal outcome was normal in 68.6% newborns, while 14% of cases had a diagnosis of minor additional findings and 17% had an impairment of neurological development. None of the outcome was statistically correlated to the prenatal assessment of laterality or degree.Conclusions: The accuracy of prenatal ultrasound for isolated cTEV is 86% with a false positive diagnosis of 14%. The grade of cTEV assigned prenatally correlates to postnatal severity and longer orthopedic rehabilitation in terms of number of casts and need of surgery. The assessment of the correlation between cTEV and neurological impairment requires further prospective studies on larger cohorts. [ABSTRACT FROM AUTHOR]

Since Hippocrates, the treatment of idiopathic clubfoot has undergone many changes, with surgical techniques and conservative approaches evolving over the centuries. Today, a wide variety of practices exist in France and throughout the world; consequently, the treatment of idiopathic clubfoot remains controversial, but the Ponseti method and the functional method seem to stand out. Nevertheless, has one of them demonstrated superiority? The purpose of this review is to compare these two methods. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 recommendations, this research was conducted on Pubmed, Web of Science, and 1Findr. Only articles concerning patients with moderate or severe idiopathic clubfoot (10–17 on the Dimeglio scale) treated early using the Ponseti method or the functional method were eligible. After reviewing 49 studies, seven published between 2008 and 2018 were selected: five prospective cohort studies, one retrospective cohort study, and one meta-analysis. Each method, according to morphological and kinetic criteria, seems to have advantages that the other does not have. Although the Ponseti method is becoming the gold standard and appears more appropriate in poor countries, it is impossible to affirm its superiority over the functional method. Therefore, the combination of their advantages deserves attention: a hybrid method could be an appealing prospect for the future. [ABSTRACT FROM AUTHOR]

Background: The Ponseti method is the standard of care for managing idiopathic congenital talipes equinovarus (clubfoot) in the outpatient setting, but there are no clinical guidelines for inpatient treatment. Children in the neonatal intensive care unit (NICU) with clubfoot often delay treatment initiation due to medical reasons.Methods: We systematically reviewed literature related to the treatment of clubfoot in the NICU, non-idiopathic clubfoot, and older infants, as well as barriers to care.Results: In a mixed NICU population of syndromic and idiopathic clubfoot, the Ponseti method has good functional outcomes with minimal interference with medical management. The Ponseti method has good functional outcomes with reduced need for extensive surgical procedures in non-idiopathic clubfoot and idiopathic clubfoot with delayed presentation (under one year of age).Conclusions: It is possible to begin Ponseti treatment in the NICU without compromising medical management. It is not clear if this confers an advantage over waiting for outpatient casting. [ABSTRACT FROM AUTHOR]

Background: Clubfoot is a relatively common congenital foot deformity. Ponseti demonstrated correction of clubfoot in infants using manipulation followed by application of well-molded, long-leg plaster casts. Objective: In the current study, we evaluated the efficacy and safety of percutaneous Achilles tenotomy as an office procedure during the Ponseti technique in the correction of CTEV deformity of the foot. Patients and Methods: This randomized clinical trial study was conducted in the Orthopedic Outpatient Clinic of Zagazig University Hospitals on 12 patients with idiopathic clubfoot managed with the Ponseti technique during the period from April 2020 to September 2020. Results: This study showed, 13 feet had a favorable outcome (8 cases (53.3%) excellent and 5 cases good 33.3%) and 2 feet had fair outcome (13.3); these 2 feet had a relapse (13.3%), one foot relapsed equinus deformity and one adducts foot deformity, The equinus deformity patient responded to repeated tendo-Achilles tenotomy and further Ponseti casting and adductus foot deformity responded to adductor tenotomy and cast. Both two cases obtained satisfactory outcomes after the completion of treatment. Conclusion: Achilles tenotomy as an out-patient procedure using topical and/or local anesthesia is a safe procedure and is an important step in the successful treatment of congenital clubfoot. [ABSTRACT FROM AUTHOR]

Talipes equinovarus (TEV) or clubfoot is one of the most common congenital deformities of the musculoskeletalsystem. The aim of thisstudy was to present the results of Ponseti treatment of TEV in patients aged 1 to 5 years. This was a retrospective, cross-sectional, analyticalstudy from September 2011 to October 2015 of clubfoot in patients aged 12 to 60 months treated with the Ponseti technique. The mean age of the patients was 26 months with extremes of 12 and 60 months. There were 60 boys for 18 girls with a sex ratio of 3.3. The notion of heredity wasfound in 9 cases (11.5%). Clubfoot was bilateral in 44 cases (56.4%). The mean initial Pirani score was 4.21/6 (1/6 to 5.5/6) and the mean final Pirani score was 1.03/6 (0 to 3.5/6). There was an overall success rate of 71.8% and a recurrence rate of 12.7%. The Ponseti technique is a credible alternative in the non-surgical management of TVE in children, even when used late in life. [ABSTRACT FROM AUTHOR]

Background: Congenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial. Methods: Patients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented. Results: One hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %(n = 12). The mean initial Pirani score (P < 0.001) and the mean initial Dimeglio score (P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) (P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction. Conclusion: In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature. [ABSTRACT FROM AUTHOR]

Background: A prospective study of motor milestones achieved in severe clubfeet treated by Ponseti method and comparison between unilateral and bilateral clubfoot will help us gain further insight of motor milestones in these children. Methods: Prospective study of 150 consecutive children with idiopathic clubfoot who were treated by Ponseti method and in whom percutaneous tendoachilles tenotomy was performed. The gross motor milestones recorded were: rolls from back to stomach, sitting without support, standing with assistance, walks with assistance, standing alone, walking alone. This was compared with published regional and World Health Organization (WHO) normal data. Result: 15 patients were excluded due to non-compliance and recurrence. Children with unilateral clubfoot (80 children) and bilateral clubfoot (55 children) showed a delay of 0.2–2.1 months in various milestones, and this was statistically significant when compared with both normal data. 95% children with unilateral clubfoot had independent ambulation by 17 months and in bilateral ambulation by 17.8 months. There was also a statistically significant difference in unilateral and bilateral clubfeet in all variables except sitting without support and walking with support. Conclusion: There is a delay in achievement in all children with clubfoot, with more delay in bilateral clubfoot as compared to unilateral clubfoot. The probable reasons could be plaster treatment, possible weakness due to tendoachilles tenotomy, use of orthosis or the inherent pathology associated with clubfeet. Parents hence need to be explained about this delay. [ABSTRACT FROM AUTHOR]

Introduction: Ponseti technique is the treatment of choice for idiopathic congential talipes equino varus (ICTEV) since 1950s with excellent treatment outcomes reported worldwide. However, despite the popularity of this technique, Uganda adapted it as a treatment modality for ICTEV in May 2005. Since then, the effectiveness of delivered Ponseti care to children with this very common orthopaedic deformity under the supervision of an orthopaedic surgeon was unknown. The implication of this undertaking was that, satisfactory outcomes would then support the Ministry of Health (MOH)-Uganda´s decision to embrace this mode of treatment and if the outcomes were unsatisfactory, MOH would then consider a policy revision in this regard. To assess the midterm treatment outcomes of children with ICTEV who had been enrolled for treatment at Mulago National Referral Hospital in the period of 2006-2009. Methods: in November/December 2013, a cross-sectional study was conducted to assess the treatment outcomes of 68 feet of 45 children using the designed questionnaire and the PBS score; a pilot study of 10 neonates was performed prior to research. A good treatment outcome meant having a foot or feet that did not require any major or minor surgery. Results: fortyfive (45) children with 68 ICTEV feet were evaluated; males 29 (64.4%) and 16 (35.6%) females with a mean age of 73.22 months (SD 11.364, range 48-96 months). Among the feet assessed, 46 (68%) had good to excellent outcomes while 22 (32%) had a relapse of moderate and severe deformity. Good functionality was seen in 61.8% out of which, 69% and 55.9% had no limitation in walking or running respectively. Conclusion: Ponseti treatment technique in children with ICTEV under the care of predominantly orthopaedic officers with some supervision from orthopaedic surgeons had fair to good midterm outcomes even in low resource settings like Uganda. Public health approach should be embraced in the management of clubfoot in Uganda by enhancing adequate comprehensive support supervision and establishment of reliable institutionalized systems for patient follow up which will lead to early detection and treatment of relapsed ICTEV cases or neglected clubfeet in the communities. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate minimally invasive methods in treatment of congenital clubfoot. Congenital talipes equinovarus (CTEV), or clubfoot, is the most common congenital foot deformity, occurring in 1 to 2 in 1000 live births. CTEV etiology is not yet completely clear. Essentially, the deformity is the result of an intrauterine dislocation of the joints between the talus, calcaneus, navicular and cuboid bone and it includes four components: cavus, adductus, varus and equinus (CAVE). The diagnosis is made by a clinical examination and foot radiography. The treatment is based on the repositioning of the dislocated joints. There are different treatment modalities available, from conservative to exclusively surgical CTEV treatment. The Ponseti method is a primarily conservative treatment method using corrective long-leg casts, sometimes associated with minimal surgical intervention - Achilles tenotomy, followed by the use of an abduction brace. If needed, less invasive surgery ("a la carte") might be used to correct uncorrected components of CTEV. Based on the reports published from 2010 to 2020, as retrieved from databases (PubMed, Medline, Scopus), pertaining mostly to conservative treatment methods and primarily to the Ponseti method and based on the comparison between the Ponseti method and surgical methods of treatment, as well as other conservative methods of treatment, it can be concluded that the Ponseti method is the method of choice for the treatment of congenital CTEV in children today. Conclusion - The Ponseti treatment method, if used on time, fulfills all requirements that are expected from a contemporary medical procedure: simplicity in performance, minimally invasive, wide availability, cost effectiveness and successful treatment results. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of Pirani scoring system in predicting the need of percutaneous Achilles tenotomy in cases of idiopathic club foot. Study Design: Case control study. Place and Duration of Study: Orthopaedic department of CMH Kohat, from Mar 2017 to Aug 2018. Methodology: This study included newborn babies to the age of 3 months with idiopathic club foot. The patients were treated by Ponseti method. The Pirani Score was calculated at initial presentation before starting treatment with casting according to Ponseti method. After three months percutaneous tenotomy was performed based on progression. The data was analyzed by applying unpaired t-test to determine the statistical significance keeping p-value <0.05. Binary regression was evaluated to determine the odds ratio. Results: A total of 39 patients were included in study with 67 club feet. There were 26 (66.6%) males and 13 (33.3%) females. The mean Pirani score of patients who had tenotomy was 4.45 ± 0.74, whereas, it was 3.476 ± 0.48 in patients who did not underwent tenotomy (p-value ≤0.001). There were higher odds of tenotomy in patients who have high Pirani score at initial presentation (OR=19.61, p-value ≤0.001). The cut off limit of pirani score beyond which tenotomy was essential was 3.95. Conclusion: Higher Pirani score was associated with higher chances of percutaneous Achilles Tenotomy in cases of Idiopathic Club foot. [ABSTRACT FROM AUTHOR]

This paper aims to assess the status of scientific literature on talipes equinovarus (TEV) published from Pakistan, to get an insight into the trend in knowledge over the years, and to highlight study gaps in this area. A detailed review of published literature was conducted from November 2019 to January 2020. ‘Talipes/ congenital talipes’, ‘clubfoot/congenital clubfoot’, ‘talipes equinovarus /congenital talipes equinovarus’ AND ‘Pakistan’ were used as key terms. Different search engines, PubMed, PakMediNet, ScienceDirect, Embase and Google Scholar were utilized to retrieve articles. A total of 63 articles were retrieved. The hotspot of TEV research in Pakistan has been its treatment and management. Over the years, treatment trend has shifted from operative to conservative; Ponseti method is predominantly employed. Hospitalbased studies focusing on pediatric patients are common while population-based studies are devoid. In majority of cohorts, there is preponderance of male patients, idiopathic and unilateral cases. There is, however, scarcity of basic research on the prevalence, etiology, risk factors, clinical heterogeneity, associated anomalies, genetics, and molecular diagnostics of TEV. In conclusion, prudent scientific evidence is required for any policy-making and relevant public health action. Hence, large scale population-based studies are required for a broader overview and understanding the clinical spectrum of TEV. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) or clubfoot refers to congenital anomalies in the feet with complex deformities. The non-surgical technique with the Ponseti method for clubfoot treatment has been adopted as initial therapy and proven effective for clubfoot treatment. Purpose: This study aims to evaluate the results of Ponseti therapy in patients with clubfoot who came to the Ponseti Clinic at the Dr. Soetomo Regional Public Hospital, Surabaya. Method: 14 patients consisting of nine men and five women were involved in the study. Based on the data obtained, ANOVA statistical test was performed on the Pirani score (total score), hindfoot score, and midfoot score. Furthermore, the statistical hypothesis testing was performed by comparing the degree of clubfoot severity with Pirani scores using the independent t-test. Results. The mean Pirani Score in the research subjects reached 1.178. The mean Hindfoot score of research subjects reached 0.5. The mean Midfoot Score of the Research Subject was 0.642. The statistical hypothesis testing results revealed that the mean Pirani Score in the degree of severity for the severe category was higher than the mean Pirani Score for the moderate category, which was statistically insignificant with a p-value of 0.126). Conclusion: Pirani score can be a reference as a clinical evaluation of patients with clubfoot who undertake conservative treatment with the Ponseti technique. Moreover, the Pirani score can also provide predictions of clubfoot severity. [ABSTRACT FROM AUTHOR]

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 whether 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. 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. [ABSTRACT FROM AUTHOR]

Purpose Epidemiological studies on idiopathic clubfeet have shown a typical distribution consistent across ethnic groups: bilaterality in about 50% of cases and a male to female ratio of 2:1. Whether this corresponds also to differences in severity according to laterality and sex has been poorly evaluated. As well, the correlation between family history and severity has not been previously investigated. The aim of this study was to investigate how laterality, sex and family history influence severity and treatment. Methods In all, 97 infants with idiopathic clubfoot (81 male, 16 female; 55 unilateral, 42 bilateral; 19 with a first or second- degree relative affected) consecutively treated with Ponseti method were prospectively enrolled. Initial severity (according to Dimeglio and Pirani scores) and treatment (number of casts and need for tenotomy) were analyzed in the different subgroups. Results Initial severity according to Pirani (p = 0.020) and Dimeglio score (p = 0.006), number of casts (p = 0.000) and tenotomy (p = 0.045) were significantly higher in bilateral than in unilateral cases. In bilateral cases, a significant correlation was found between the right and left foot of each patient in terms of initial severity, number of casts and tenotomy performed. No statistically significant difference was found according to sex and family history. Conclusions This study has confirmed the different behaviour of bilateral cases reported by previous studies; bilateral cases are more severe and show similar features in their right and left foot. This could be the result of different pathogenic mechanisms, likely on a genetic basis. Sex and family history did not seem to influence severity. [ABSTRACT FROM AUTHOR]

Background: The clubfoot is one of the commonly found congenital deformities in newborn. The Ponseti method is the most effective nonoperative clubfoot management method. It is based on understanding of pathoanatomy of clubfoot. For classifying severity of clubfoot, Pirani score is used. The number of cast required for clubfoot correction is dependent on its initial Pirani score. This study aimed on how the number of cast for correction of clubfoot deformity depends on starting time of casting and pretreatment Pirani score. Materials and Methods: This study comprises of 200 patients with 297 affected foot nonoperatively managed with Ponseti technique of casting. We measured initial and final Pirani scores of patients with different age groups. Results: We found that initial severity was less in 0–1 month age group children but mean casting number was more while initial severity was more in 1–2 month age group, the mean number of casting was less. Tenotomy requirement was also less in 1–2 month age group. Conclusion: We concluded that casting according to the Ponseti method should be started in 1–2 months age group which shows better results than the other age groups in clubfoot. [ABSTRACT FROM AUTHOR]

Purpose A mild delay in gross motor milestones and walking age has been reported in infants with clubfoot. The influence of different treatments on motor development has been poorly investigated. Some parents and physical therapists express concern that the Ponseti method (PM) and its constraints (abduction brace, casts) would affect development more than the French physical therapy method (FM) due to greater immobilization and lesser stimulation. The purpose of this study was to evaluate achievement of three motor milestones (pull-to-standing, cruising and independent walking) in two groups of clubfoot patients treated at two experienced institutes respectively with the PM and FM. Methods In all, 52 consecutive infants (full-term at birth, mean age at beginning of treatment 24.3 days (sd 10), mean Dimeglio score 12 (sd 3.4)) were prospectively enrolled (26 patients per centre) and followed up to walking age recording milestones. Results The two groups were not different in terms of age at the beginning of treatment (p = 0.067) and rate of tenotomy. Age at tenotomy was significantly lower in the PM group (p = 0.000). Severity (p = 0.004) and number of bilateral cases (p = 0.012) were higher in the PM group. A non- significant difference was found for age of achievement of pull-to-standing (p = 0.109), cruising (p = 0.253) and independent ambulation (p = 0.349) between the two groups. Overall, milestones were achieved approximately two months later than normal population. Sex, severity, laterality and need of tenotomy were not found to significantly influence milestones. Conclusion Our results confirmed that infants with clubfoot are expected to have a minimum delay in motor development. Infants treated with the PM and those treated with the FM did not show significant differences in gross motor milestones achievement at walking age. [ABSTRACT FROM AUTHOR]

Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. [ABSTRACT FROM AUTHOR]

It was the aim of this study to examine the motor and cognitive development of infants with congenital idiopathic clubfoot, compared with typically developing infants. We repeatedly tested the gross motor, fine motor, and cognitive abilities of 12 infants with clubfoot and 12 typically developing infants at the ages of 4, 6, 9, and 12 months with the Bayley-III Scales. All infants with clubfoot were treated with the Ponseti method, which led to a restriction of normal movements of the lower extremities in the first months of life. They showed a great delay in gross motor development but not in fine motor or cognitive development. However, in the clubfoot group, we found some slight deficits in specific cognitive tasks, including problem solving and spatial memory. In addition, our results revealed significant correlations between gross and fine motor performance and cognitive performance in the control group but only between fine motor and cognitive performance in infants with clubfoot, indicating that both, fine and gross motor skills, are related to cognitive processes and can mutually replace each other to a certain degree. Further research is needed to gain a deeper understanding of clubfoot infants' development and to clarify the need for mobility training. [ABSTRACT FROM AUTHOR]

Background and Objective: As a highly common congenital deformity which can lead to serious walking problems, clubfoot has long been treated using the Ponseti method which is usually carried out without complete percutaneous tenotomy of tendoachillis. The present study was aimed at investigating the effects of early management of clubfoot by the Ponseti method with a complete percutaneous tenotomy of tendoachillis in Erbil Teaching Hospital located in Erbil, the Kurdistan Region of Iraq. Methods: Thirty neonates <3 months of age who had congenital idiopathic clubfoot were randomly selected. They were treated by the Ponseti method. For this purpose, successive casts were applied for them for 3 weeks, with changing the casts on a weekly basis. For those who did not respond to the first 3 weeks of casting, the classical Ponseti method was utilized along with complete percutaneous tenotomy of tendoachillis based on the theory of stem cell regeneration. Then, the casting was performed for 6 weeks, followed by foot abduction brace and maintained using a foot abduction brace (Dennis brown splint) until school age 5-6 years. The collected data were analyzed using the χ2 test through SPSS 22.0. Results: The results of the present study indicated that the most prevalent type of clubfoot was the unilateral type with 73.3% prevalence rate. Treating the newborns with clubfoot by the Ponseti method along with complete percutaneous tenotomy of tendoachillis led to good results in 86.7% of the cases, medium in 3 cases (10%), and poor only in 1 case (3.3%). Conclusion: Ponseti method along with complete percutaneous tenotomy of tendoachillis was proved to be an efficient method to treat clubfoot during the first few weeks of life. [ABSTRACT FROM AUTHOR]

Purpose The Ponseti method is widely used in clubfoot treatment. Long-term follow-up shows high patient satisfaction and excellent functional outcomes. Clubfoot tendency to relapse is a problem yet to solve. Given the importance of bracing in relapse prevention, we ought to discuss current knowledge and controversies about bracing. Methods We describe types of braces used, with its advantages and disadvantages, suggesting bracing schedules and duration. We identify bracing problems and pinpoint strategies to promote adherence to bracing. Results When treating a clubfoot by the Ponseti method, the corrected foot should be held in an abducted and dorsiflexed position, in a foot abduction brace (FAB), with two shoes connected by a bar. The brace is applied after the clubfoot has been completely corrected by manipulation, serial casting and possibly Achilles tenotomy. Bracing is recommended until four to five years of age and needs to be fitted to the individual patient, based on age, associated relapse rate and timing when correction was finished. Parental non-adherence to FAB use can affect 34% to 61% of children and results in five- to 17-fold higher odds of relapse. In patients who have recurrent adherence problems, a unilateral lower leg custom-made orthosis can be considered as a salvage option. Healthcare providers must communicate with patients regarding brace wearing, set proper expectations and ensure accurate use. Conclusion Bracing is essential for preventing clubfoot relapse. Daily duration and length of bracing required to prevent recurrence is still unknown. Prospective randomized clinical trials may bring important data that will influence clinicians' and families' choices regarding bracing. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV) is the most common disorder of foot. Conservative treatment is the first line management for CTEV. Our objective was to determine the frequency of successful outcome of non-surgical correction of CTEV deformity between 6month to 2year age using Dimeglio scoring system. Method: This multicenter descriptive case series was done using non-probaility consecutive sampling technique. Total 62 cases, having age of 06 months to 02-year, of both genders, with failed conservative treatment of clubfoot diagnosed on history and clinical examination were enrolled. They were treated with six ponseti cast at one-week interval. Cast was removed in out patient departm ent and after manipulation new cast was applied. The last cast was applied for two weeks. Patients were followed up at two weeks, one month, three months and after six months. We record findings at six months only. Results: There were 43 males (69.4%) and 19 females (30.6%). Mean age was 11.16±5.52 months. Frequency of outcome results was excellent in 30 patients (48.4%), good in 20 patients (32.3%), fair in 08 patients (12.9%) and poor in 04 (6.5%). Frequency of successful surgical correction of CTEV with posteromedial soft tissue release is 50 (80.6%). Statistically significant difference was found between age of children hindfoot varus (p<0.05) and between age of children and ankle dorsiflecion (p<0.05). Conclusion: There were more male population than female in our study. The radiological outcome was excellent to good in majority of the patients treated with ponseti cast with minimum failed treatment. [ABSTRACT FROM AUTHOR]

Purpose: Several radiologic reference lines have been used to evaluate individuals with a clubfoot but there is no consensus as to which is most reliable. The aim of this study was to identify which radiologic parameters have relevance to the predictability of additional surgery after Ponseti casting on clubfoot and the effect of clubfoot treatments that contain Ponseti casting and additional surgery. Materials and Methods: A total of 102 clubfeet (65 patients, 37 bilateral) were reviewed from 2005 to 2013. The patients were divided into two groups (Group A, those for whom the result of the Ponseti method was successful and did not require additional surgery; and Group B, those for whom the result of the Ponseti method was unsuccessful and required additional surgery), and the following parameters were measured on the plain radiographs: i) talo-calcaneal angle on the anteroposterior and lateral view, ii) talo-1st metatarsal angle on the anteroposterior view, and iii) Tibio-calcaneal angle on the lateral view with the ankle full-dorsiflexion state. Each radiograph was reviewed on two separate occasions by one orthopedic doctor to characterize the intra-observer reliability, and the averages were analyzed. Next, 20 cases were chosen using a random number table, and two orthopedic doctors measured the angle separately to characterize the interobserver reliability. Results: Groups A and B included 73 clubfeet (71.6%) and 29 clubfeet (28.4%), respectively. The initial talo-calcaneal angle and tibiocalcaneal angle in the lateral view were significantly different among the groups. In addition, inter- and intra-observer biases were not detected. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view were significantly different after treatment in both groups. Conclusion: Congenital clubfeet treated with the Ponseti method showed successful results in more than 70% of patients. The initial talocalcaneal angle and tibio-calcaneal angle on the lateral view were the radiologic parameters that could predict the need for additional surgical treatments. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view could effectively evaluate the changes in clubfoot after treatment. [ABSTRACT FROM AUTHOR]

Purpose Although non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method. Methods PubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies. Results In all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 versus 5.4) and had a higher rate of ATT (89.4% versus 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% versus 11.5%) and a lower rate of successful treatment at final follow-up (69.3% versus 95.0%). Complications were found in 20.3% of the non-idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 versus 7.2) and a higher rate of successful treatment at final follow-up (81.8% versus 58.2%). Conclusion The Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect. [ABSTRACT FROM AUTHOR]

Objective: To describe the long-term outcomes of children at school age who were thought to have isolated idiopathic congenital talipes equino varus (ICTEV) at birth.Method: A retrospective review of all children attending a regional talipes clinic who had achieved school age.Results: One hundred sixty-three children were followed up. ICTEV was more common in Maori and other Polynesian children and in males. Additional abnormalities were apparent in 30.1% overall, but higher in New Zealand Europeans (43%) than Maori (21%) or other Polynesians (22%). Of the abnormalities, 41% were associated with the central nervous system or with neurodevelopmental delay. Conventional G-band karyotyping, where performed, was not informative.Conclusions: The rate of additional abnormalities was higher than previous reports. This has implications for prenatal counseling and postnatal follow-up as a prenatal diagnosis of ICTEV may subsequently be found to have longer term implications in addition to orthopedic treatments of the clubfeet. [ABSTRACT FROM AUTHOR]

Purpose: The Dimeglio and the Pirani scores are largely used to rate clubfoot at presentation and monitor correction. To date, the accuracy of these scores in predicting appropriate treatment is controversial. The aim of this study was to investigate the accuracy of Dimeglio and Pirani scores in predicting the number of casts and the need for tenotomy in clubfoot correction using the Ponseti method.Methods: Ninety-one consecutive feet (54 patients; mean age at presentation: 28 ± 15 days) undergoing clubfoot correction using the Ponseti method were prospectively followed from first casting to correction. All feet were scored according to the Dimeglio and Pirani score. The relationships between the two scores, the number of casts and the need for tenotomy were analysed.Results: Initial correction was achieved in all feet. Both Dimeglio (r = .73; p value < .0005) and Pirani scores (r = .56; p value < .000) showed good association with the number of casts. Multiple linear regression showed a high collinearity of the two scores but a more significant contribution of the Dimeglio score. Among subcomponents, hindfoot score, midfoot score, varus and muscular abnormality were independent predictors of the number of casts. Both Dimeglio and Pirani scores were significantly associated with the need for tenotomy (p value = .0000), and odds ratios and cut-off points were calculated. The receiving operator curve (ROC) analysis showed slightly better performance of the Dimeglio in comparison with the Pirani score in predicting the need for tenotomy, but the difference between the two areas under the curve (AUC) was not significant (p = .48).Conclusions: A quite accurate prediction of the number of casts and the need for tenotomy can be performed in most cases. The Dimeglio score showed slightly better accuracy in predicting both steps of Ponseti treatment. [ABSTRACT FROM AUTHOR]

It was the aim of this study to examine the motor and cognitive development of infants with congenital idiopathic clubfoot, compared with typically developing infants. We repeatedly tested the gross motor, fine motor, and cognitive abilities of 12 infants with clubfoot and 12 typically developing infants at the ages of 4, 6, 9, and 12 months with the Bayley-III Scales. All infants with clubfoot were treated with the Ponseti method, which led to a restriction of normal movements of the lower extremities in the first months of life. They showed a great delay in gross motor development but not in fine motor or cognitive development. However, in the clubfoot group, we found some slight deficits in specific cognitive tasks, including problem solving and spatial memory. In addition, our results revealed significant correlations between gross and fine motor performance and cognitive performance in the control group but only between fine motor and cognitive performance in infants with clubfoot, indicating that both, fine and gross motor skills, are related to cognitive processes and can mutually replace each other to a certain degree. Further research is needed to gain a deeper understanding of clubfoot infants' development and to clarify the need for mobility training. [ABSTRACT FROM AUTHOR]

Purpose Previous reports have demonstrated diminished size of the hindfoot bones in patients with idiopathic clubfoot deformity. However, no study has quantified the percentage of hypoplasia as a function of early growth, during the brace phase of Ponseti treatment. Methods We measured the dimensions of ossified structures on radiographs in patients with unilateral Ponseti-treated clubfeet to determine changes in the percentage of hypoplasia between two and four years of age. Results The degree of hypoplasia varied among the osseous structures in Ponseti-treated clubfeet at age two years, with greater hypoplasia being observed in the talus (7.3%), followed by calcaneus (4.9%) and the cuboid (4.8%). Overall, the degree of hypoplasia diminished by four years, such that the degree of hypoplasia was greatest in the talus (4.2%) and the calcaneus (4.2%) followed by the cuboid (0.6%). At four years of age, the greatest degree of hypoplasia persisted in the talus and calcaneus. Conclusions Changes occurred in the size of the ossification of hindfoot bones between two and four years of age, and the observed changes in the percentage of hypoplasia varied among the different structures. At four years of age, the greatest percentage of hypoplasia was observed in the talus and calcaneus at values similar to those previously reported in skeletally mature patients. The results suggested that the relative difference in size of the feet may be expected to remain constant in a child with a unilateral clubfoot after this age. [ABSTRACT FROM AUTHOR]

Introduction. Clubfoot is the second most common birth defect of the lower limb. In Europe (including Poland) it concerns about 1-2 in 1000 newborns. What is characteristic for a clubfoot, is change in the foot shape and its impairment with preserving anatomical structures. Aim. The aim of this work is to gather opinions of orthopedic physicians on the effectiveness of the two methods used to treat congenital clubfoot: the Turco method and the Ponseti method. Material and methods. The research method used in the work was a diagnostic survey and research technique was the author's questionnaire designed to gather opinions of orthopedic surgeons on the two methods of clubfoot treatment. The questionnaires were collected in the Orthopaedic Clinics in Lublin and Rzeszów, as well as during the specialization courses for orthopaedic surgeons in Lublin. Results. The most important advantages of the Ponseti method according to respondents are high clinical effectiveness (average 4.48) and short duration of hospitalization (average 4.31). While the most important disadvantages of the method is length of rehabilitation (average 2.85) and convalescence (average 2.36). Top assets of the Turco method in turn, according to respondents, are high clinical efficiency (average 2.92) and certainty of the patient's recovery (2.74). In turn, the downsides of the Turco method according to the respondents are high invasiveness (average 4.11) and length of convalescence (average 3.87). Conclusion. The Ponseti method is the surveyed doctors' preferred method of congenital clubfoot treatment. [ABSTRACT FROM AUTHOR]

Purpose: The modality of progression of the correction along casting sessions of Ponseti method has been poorly investigated and information regarding evolution of muscular abnormalities is missing. The aim of the study was to investigate dynamics of correction of the different components of clubfoot deformity in a clinical setting.Methods: In a prospective study, 124 clubfeet consecutively treated by a single orthopaedic surgeon were evaluated with the Dimeglio system at each casting session and score progression was determined.Results: For each component a typical pattern was recorded. Cavus and medial crease showed a rapid correction. Rotation, adduction and varus corrected gradually and simultaneously. The posterior crease usually persisted until final cast was discontinued. Equinus improved progressively after each cast and then to a larger extent with Achilles tenotomy. The parameter describing poor muscular condition, reported at presentation in 39 feet (31.5%), was the only item showing extremely different dynamics of correction (from rapid and complete resolution to persistence at last cast removal), which could be explained by the large diversity of entities included (hypertonia, imbalance, fatty infiltration, fibrosis, aplasia).Conclusions: This study confirmed that dynamics of correction in clinical setting correspond essentially to theoretical principles of Ponseti method. Muscle abnormalities are not uncommon in clubfeet and have great influence on the progression of correction. If abnormalities are recorded, their evolution along the treatment should be monitored. A more objective evaluation would be required. [ABSTRACT FROM AUTHOR]

The article reviews the different types of conservative management and the assessment of clubfoot, a paediatric foot deformity. Topics include the four complex foot abnormalities such as forefoot adductus, midfoot cavus, and hindfoot varus and ankle equinus, the prevalence of clubfoot in different populations, and the causes of clubfoot. The surgical techniques used to correct clubfoot, as well as complications, are discussed.

Objective: To evaluate the effectiveness of the Ponseti method of clubfoot management in neonates and infants and to see which factors affect outcome. Study Design: Retrospective study. Place and Duration of Study: Department of Paediatric surgery, Military Hospital, Rawalpindi, from October 2012 to September 2014. Material and Methods: The Ponseti method for the management of congenital talipes equinovarus was applied in children of 7 days to 6 months age. While those with complex neurological problems, pathological clubfeet, syndromic clubfeet and older than 6 months at the time of presentation were excluded from the study. Assessment was done at presentation, at the removal of the last plaster cast and after one-year use of the foot abduction splint. Results: A total of 124 clubfeet of 89 children, including 63 males (70.78%) and 26 females (43.82%) were treated as outdoor cases. Eighteen feet (14.51%) were of rigid (atypical) type whilst 106 (85.5%) were of flexible (typical) type. Bilateral involvement was seen in 35(37.31%) children. The mean pretreatment Pirani score was 5.4 and the mean number of plaster casts required was 5.8. The mean Pirani score at 1-year follow-up was 0.5 with successful outcome in 82.3 % of all cases (96.9 % of neonates). Poor compliance with the use of the foot abduction splint adversely affected outcomes. Conclusion: The Ponseti method of treatment of congenital clubfeet is safe and easy to learn with effective and reproducible results. Early start of treatment and compliance with the use of the foot abduction splint during the maintenance phase are crucial to successful outcome. [ABSTRACT FROM AUTHOR]

In this study, we analyzed the patients who had applied to Yüzüncü Yıl University Medical Faculty due to pes equinovarus between 2011 and 2013 and treated with the Ponseti method. Thus we evaluated 56 feet of 38 patients in the early-treatment period and the factors affecting the treatment. All of the patients were systematically examined before and after the treatment. For the feet that had anomaly we used the scale that was used by Dimeglo et.al. Averagely 7.5 plaster casts were applied to the feet of the patients (range: 3-16). In patients with PEV, after the recovery of hindfoot varus and forefoot adduction in 48 feet in which equine deformity, achillotomy operation was applied under local anesthesia with mini open technique. After plastering, Steenbeek orthosis was applied to the feet. Average follow-up time was 14 months (range 5-28 months). In patients with PEV, the most commonly recurred component was metatarsus adductus. While this rate was 36% in idiopathic PEVs, in complex PEVs it was 83%. The plantigrade walking ratio in patients with idiopathic PEV was 92%. In patients with idiopathic PEV, the compliance with orthosis was 81% whereas in patients with complex PEV it was 33%. In addition to this, except one patient, in all patients with complex PEV recurrence was observed and additional treatments were made for these patients. The final Dimeglio score of the patients with idiopathic PEV was very good in 16 feet, good in 6 feet. On the other hand, in patients with complex PEV, this score was very good in 4 feet, good in 3 feet, and bad in 1 foot. The most important recurrence reason for PEV was non-compliance with orthosis. The reasons for non-compliance with foot abduction orthosis are as follows: long processing time the negative psychological effects of orthosis on families and considering orthosis as unnecessary since the correction in the feet was seen by the family. The education level of the family is an important risk factor for the development of recurrence. In this sense, it was determined that the recurrence risk was 10 times higher in the families whose education level was high school and below in comparison to the families with university degree. We achieved success at a rate of 92% in manipulation and plastering treatment of PEV which was materialized by Ponseti method. The most important factor affecting the treatment was the continuity of the treatment and the compliance with orthosis. [ABSTRACT FROM AUTHOR]

Purpose: The prediction of number of casts in the Ponseti method has always remained a subject of interest. We investigated the correlation of the number of casts before tenotomy with the age and initial Pirani score in Ponseti treatment of club foot. Methods: Inclusion criteria were idiopathic clubfeet corrected by Ponseti method requiring tenotomy for equinus correction in children up to ten years of age. Defaulters (noncompliance with serial casting schedule), children with postural, non idiopathic, previously surgically treated, recurrent clubfoot and clubfoot not requiring tenotomy were not included in this study. Further, children who did not require tenotomy were also excluded. ANOVA regression analysis was used for finding correlation between initial Pirani score, age in months and number of corrective casts prior to tenotomy. Results: There were a total of 297 children (442 feet) in the study. The average age of the child at presentation was 10.3 months and the average initial Pirani score was 4.8. The average number of corrective casts was seven per child (range, two to18). The regression analysis showed both Pirani and age had positive correlation with number of casts, although weak (r = 0.05-0.20). The initial Pirani scoring correlated ten times more than age (in months) to the number of casts. Conclusion: The number of casts for correction in idiopathic clubfoot, although variable, is influenced by both initial Pirani score and age. [ABSTRACT FROM AUTHOR]

Congenital talipes equinovarus, also referred to as clubfoot is one of the most common pediatric orthopaedic conditions requiring comprehensive treatment. The aim of this study is to provide an overview of the cases of congenital talipes equinovarus that underwent treatment in the Clinic for Pediatric Surgery and Orthopedics of the Emergency Children's Hospital "Louis Turcanu" Timişoara, Romania between January 2007 and December 2013. We retrospectively analyzed the clinical data of 321 patients with congenital talipes equinovarus. They have been taken in consideration gender, groups of age, localisation, associated abnormalities, type of treatment (orthopaedic and/or surgical). The treatment was orthopaedic in all 321 patients and 100 patients had indication for surgical treatment. The Ponseti method had been introduced in our clinic three ago being treated with this method a number of 15 patients. The results using Ponseti method were good and after the orthopaedic treatment the surgical treatment is less necessary, this method being also the most effective and least expensive treatment of clubfoot. [ABSTRACT FROM AUTHOR]

Purpose: Congenital club foot is one of the most common birth defects involving the musculoskeletal system. At present two methods are used for the treatment of this deformity: French and Ponseti method. The purpose of this study was to compare the short-term (up to three years) and long-term (three to seven years) results of treatment with the Ponseti method. Methods: A total of 195 consecutive infants (143 boys and 52 girls) with idiopathic club foot treated with the Ponseti method in the period of 2005-2012 were included in this study; the total number of feet was 303. The severity of the foot deformity was classified according to Diméglio. When relapse occurred up until three years of age, we started with the casting again. If conservative treatment was unsuccessful we proceeded to surgical treatment. Results: Primary correction was attained in all cases. Surgical correction of relapses was performed in 30 % of patients according to the Ponseti method (re-tenotomy of the Achilles tendon and transposition of the tibialis anterior) and in 70 % by alternative techniques. The number of relapses indicated for surgery increased with increasing period of follow-up: whereas in patients where the treatment started already in 2005 relapses occurred in 72 %, in patients included in 2011 the number of recurrences only reached 3 %. Conclusions: It follows from our results that it is impossible to cure all club feet with casting, tenotomy of the Achilles tendon and transposition of the tibialis anterior only. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the early results of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot in patients treated in Children's Orthopaedic Clinic and Rehabilitation Department Medical University of Lublin between the years 2007-2011. Thirty-five patients with 47 idiopathic clubfeet were followed prospectively while being managed with the Ponseti method. Clubfoot severity was graded with use of the Dimeglio system. The initial correction was achieved, and early results were measured by using Pirani scoring method. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine the efficacy of the physical therapy program as an adjunct to the Ponseti technique in the treatment of idiopathic clubfoot. This study was carried out with the presumption of a difference in results between the study group who were included in the physiotherapy program and the control group who performed home exercises. Patients and method: Forty affected feet of 29 patients were included in the study. The average ages of the control and study groups were 15.00 1 21.33 and 20.30 1 15.78 months, respectively. Passive range of motion of dorsiflexion, plantar flexion, inversion, eversion, rear foot varus angle and forefoot adduction angle were measured and the Dimeglio classification system was utilized in order to determine the severity of clubfoot deformity. Reassessments were carried out for the study group at the end of 1 month's therapy and for the control group during the first month follow-up. Results: Comparison of pre- and post-treatment assessment results revealed a difference in terms of recovery, concerning all parameters except passive inversion values in the study group and for all parameters in the control group (P < 0.05). For study and control group comparisons, since deformity severity was higher in the study group an effect size analysis was carried out. The effect size analysis showed that the change in range of motion of dorsiflexion and Dimeglio and decrease of rear foot varus angle was higher in the study group. Conclusion: The results of this study imply that an intensive physiotherapy program may enhance the effectiveness of the Ponseti protocol. [ABSTRACT FROM AUTHOR]