Clinical Experiences and Midterm Results of the Treatment of Clubfoot with the Ponseti Method

Abstract

IntroductionTalipes Equinovarus (TEV) is a fairly common birth defect in which males are affected twice as often as females and 50% of the cases show bilateral defects [1]. In the United States, the overall prevalence of clubfoot is 1.29 per 1000 live births [2].Although the Ponseti method of treatment was first described many years ago, it recently became the standard method of treating TEV due to its successful long-term results.Several scoring methods have been developed to assess the foot before, during, and after treatment for TEV. For this study, we incorporated data from two of the most commonly used scoring systems, Dimeglio and Pirani. Dimeglio and his colleagues divide a clubfoot deformity into four measurable anatomical features, or subgroups, which are scored on a scale of 20 points. These subgroups are equinus in the sagittal plane, varus deviation in the frontal plane, derotation around the talus of the calcaneo-forefoot block, and adduction of the forefoot on the hindfoot in the horizontal plane. Each subgroup is assessed in severity from 1 to 4 points. In the presence of a posterior or medial fold, extreme cavus and/or muscle weakness, another point is added to each category for a possible total of 5 points [3]. The second scale, the Pirani scoring system, evaluates six parameters of the foot separately as normal (0 points), moderate to severe (0.5 points), or severe (1 point). These anatomical parameters are the curvature of the lateral border of the foot, degree of medial skin fold, covering of the head of talus, degree of posterior skin fold, equinus or extreme plantar flexion at the ankle joint, and the presence of a free heel [4]. The Dimeglio and Pirani scoring systems are useful in evaluating the degree of correction of the foot as well as the potential for the prognosis of the disease.In the following study, we examine the components of the Ponseti method and share our experiences and results. Materials and MethodsIn this study, we analyzed 92 feet from a total of 60 patients with idiopathic talipes equinovarus. Of the total, 43 patients were males and 17 were females. All patients started treatment with the Ponseti method on the same day that they presented to our clinic. Patients with accompanying anomalies or dysmelias were excluded. The patients' families were given detailed information regarding the clubfoot deformation as well as the Ponseti treatment process, other available treatment options, the usage of orthoses, possible complications, and the potential prognosis. We explained how crucial the family's compliance and cooperation are to the success of the treatment and collected the family's fully informed consent.For casting the legs after manipulation, we used the classic casting method of combining 5 or 10 cm of cotton with plaster of Paris. No synthetic casting materials were used. A trained orthopedic surgeon and a resident performed the Ponseti manipulations. We encouraged feeding of the infants prior to cast molding and placement. HSOA Journal of Orthopedic Research and P...

Descriptive epidemiology and predisposing factors to idiopathic talipes equinovarus in South South Nigeria

“…The findings regarding laterality in our study was not different from other epidemiologic studies but a study by Sayit and Sayit (2015) reported the incidence of foot affected amongst and within the gender, their findings was similar to our study. The tendency that the foot affected would be right or left was not statistically significant.…”

“…The Atypical variety is syndromic and is associated with other congenital malformations. There are various scoring systems but the most commonly used is the Pirani scoring and its modifications, also the Dimeglio scoring system (Werler et al, 2013;Sayit and Sayit, 2015;Adegbehingbe et al, 2015;Lynn,2009;www.global-help.org).…”