The currently accepted interval of weekly cast changes in the treatment of clubfeet seems unsubstantiated. A force sensor is needed to determine the adaptation rate of a clubfoot to establish what cast change interval would be most effective and efficient. We developed a force sensor based on the principle that the resonance frequency of an LC-tank changes when a metal target is brought in close proximity. A thin rubber ring between the LC-tank and the metal target transformed this proximity sensor into a force sensor. With a static load test and an incremental load test, the performance of the constructed force sensors was characterized. The custom-made sensor showed excellent sensitivity ((1.7±0.8×105) counts/N), resolution ((0.15±0.06) mN), and accuracy ((3.5±3.0) %) for the application. The observed drift was (2.1±0.7) %/log10(h), which is lower than other thin force sensors. Preliminary results of measurements in the treatment of Dupuytren fingers and clubfeet show good functioning for long-term force measurements.
Study Design: Basic research (cross-sectional). Introduction: Dupuytren disease can cause disabling contractures of the finger joints. After partial fasciectomy, postoperative hand splinting helps to maintain extension range of motion. Purpose of the Study: To measure how the contraction forces of the finger on the splint change over time. Methods: Subjects who were treated for Dupuytren contracture with partial fasciectomy were invited to participate in this study. Force sensors were placed in their dorsal extension splint, and the applied force was measured continually for several weeks. Results: Eleven subjects (aged 59-75 years) with the metacarpophalangeal (8) or proximal interphalangeal (3) as their most severely affected finger joint participated. Each night, the measured force consistently decreased to reach a plateau after about 3 hour (adaptation time, 2.55; 95% confidence interval, 0.2-31.8 hours). The time to reach this plateau decreased with time after surgery (z5%/day, P ¼ .0005, R 2 ¼ 0.08). Discussion and Conclusions: The observed rate of decrease in the measured force indicates a tissue adaptation time of approximately 3 hours.
AimsThe Ponseti method is an effective evidence-based treatment for clubfoot. It uses gentle manipulation to adjust the position of the foot in serial treatments towards a more physiological position. Casting is used to hold the newly achieved position. At first, the foot resists the new position imposed by the plaster cast, pressing against the cast, but over time the tissues are expected to adapt to the new position and the force decreases. The aim of this study was to test this hypothesis by measuring the forces between a clubfoot and the cast during treatment with the Ponseti method.Patients and MethodsForce measurements were made during the treatment of ten idiopathic clubfeet. The mean age of the patients was seven days (2 to 30); there were nine boys and one girl. Force data were collected for several weeks at the location of the first metatarsal and the talar neck to determine the adaptation rate of the clubfoot.ResultsIn all measurements, the force decreased over time. The median (interquartile range) half-life time was determined to be at 26 minutes (20 to 53) for the first metatarsal and 22 minutes (9 to 56) for the talar neck, suggesting that the tissues of the clubfoot adapt to the new position within several hours.ConclusionThis is the first study to provide objective force data that support the hypothesis of adaptation of the idiopathic clubfoot to the new position imposed by the cast. We showed that the expected decrease in corrective force over time does indeed exist and adaptation occurs after a relatively short period of time. The rapid reduction in the forces acting on the foot during treatment with the Ponseti method may allow significant reductions in the interval between treatments compared with the generally accepted period of one week.
BackgroundClubfeet are commonly treated using the Ponseti method. This method involves weekly manipulation and casting which gradually corrects the position of the foot. However, the reasons for following a weekly interval are not clear.Question / PurposeThe aim is to investigate the influence of the cast change interval on treatment outcomes in the Ponseti method.MethodsWe performed a systematic review of comparative studies in which the cast change interval was varied. Scientific databases were searched for relevant publications, screened for eligibility and assessed for a risk of bias. A 'best evidence' synthesis tool was used to synthesize the results of the included studies and draw conclusions from relevant clinical outcomes.ResultsNine papers matched the inclusion criteria, which provided data of 587 subjects who had a total of 870 clubfeet. There is strong evidence for a positive relation between cast change interval and treatment duration. However, there is no evidence for any relation between the cast change interval and the required number of casts, tenotomy rate, required surgery or failure rate.ConclusionsAccelerated versions are as effective and safe as the traditional Ponseti method. However, more research is needed to assess the long-term results and to identify an optimal cast change interval.
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