CORR Insights®: Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review

Nogueira, Monica Paschoal

doi:10.1007/s11999-015-4600-7

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…That said, better brace use is well documented as being associated with lower relapse rates, which in turn is associated with parents continuing to ensure that the children wear the braces [28, 29]. …”

Section: Discussionmentioning

confidence: 99%

“…Congenital clubfoot deformity is a challenging condition to manage, and relapses following initial correction using Ponseti method have been reported as 30 % [19] and a fact intrinsic to the condition per se [27]. That said, better brace use is well documented as being associated with lower relapse rates, which in turn is associated with parents continuing to ensure that the children wear the braces [28, 29].…”

Section: Discussionmentioning

confidence: 99%

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Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Evans

Chowdhury

Kabir

et al. 2016

Journal of Foot and Ankle Research

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BackgroundCongenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a non-government organisation, Walk For Life (WFL). WFL has provided free treatment for over 17,500 Bangladeshi children with clubfeet since 2009, sustained by local ownership, and international support. This study assesses the 4-year results in children for whom treatment began before the age of 3 years.MethodsA centrally located WFL clinic at Mymensingh Medical College Hospital (MMCH), representative of the larger WFL clinics, which treats >100 cases annually, was reviewed. In 2015, 99 of the 147 eligible subjects who had begun treatment in 2011 were available for follow up. Specific assessment tools enabled evaluation of parent satisfaction, gait function, and relapse cases.ResultsResults for 99/147 cases were returned after four years: 72 males, 27 females. Typical clubfeet comprised 98/99 of cases, and 55/99 were bilateral. The tenotomy rate was 80 %. Brace use after 3 months was 90 %, at 12 months was 65 %, and at 4 years post treatment was 40 %. Functionally, 98/99 of children could walk and run (99 %). Relapsing deformity was found in 13 %. Relapse severity varied: eight were flexible and partial, five were rigid. Half of the children lost to follow were due to changed phone numbers. While parents were very happy with their child’s feet (97 %), a materials cost of 3000 Taka ($US40) was deemed unaffordable by 60 %.ConclusionsThe 4-year outcomes after Ponseti treatment for clubfoot deformity, showed that 99 % of children available for follow up, were walking independently. The relapse rate was low. Parent satisfaction was high, but those whose children required further treatment were less satisfied.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Evans

Chowdhury

Kabir

et al. 2016

Journal of Foot and Ankle Research

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“…Initially, Ponseti developed his method and its protocol for children with clubfoot below the age of two years. However, most of the clubfoot based review studies focused either the group of children with walking age or over the age of 10 years [ 45 ], and hence the future studies should be focused with number of casts, percentages of surgical procedures, frequency and management of clubfoot relapses [ 46 ]. Therefore, this systematic review study aims to investigate the following details in the children with less than 2 years treated with Ponseti method: A) to review how the Ponseti treatment technical regime strictly followed in their study to achieve the initial correction B) to find the outcome of the study, including success rate, number of casts and percentages of surgical recommendations, and to review the relapses and relapse pattern of the clubfoot causative factors for relapses.…”

Section: Introductionmentioning

confidence: 99%

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

et al. 2017

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BackgroundCongenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age.Materials and methodsArticles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age.ResultsOf the outcome of 1095 articles from four electronic databases, twelve articles were included in the review. Pirani scoring system, Dimeglio scoring system, measuring the range of motion and rate of relapses were used as outcome measures.ConclusionsIn conclusion, all reviewed, 12 articles reported that Ponseti method is a very effective method to correct the clubfoot deformities. However, we noticed that relapses occur in nine studies, which is due to the non-adherence of bracing regime and other factors such as low income and social economic status.

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“…Modifications to the Ponseti protocol were based on a detailed knowledge of the pathoanatomical features of complex clubfoot; therefore, meticulous attention must be paid to the details of this method. Accordingly, such "a world of difference" in relapse rates could be related to imprecise adherence to Ponseti's recommendations [32,33]. Our review found that relapse rates in complex clubfoot patients increased with time.…”

Section: Discussionmentioning

confidence: 79%

Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

Al-Mohrej

Alshaalan

Alhussainan

2021

International Orthopaedics (SICOT)

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Purpose In 2006, Ponseti modified the standard technique to treat cases of "atypical" and "complex" clubfoot. To determine the outcomes of Ponseti's modified method to treat complex idiopathic clubfoot patients, we asked the following: (1) What is the deformity correction success rate? (2) What is the relapse rate after the correction? (3) What is the incidence of complications? Materials and methods We performed a systematic review by searching the EMBASE, MEDLINE, Cochrane Library, and Web of Science databases from inception to March 1, 2021. All studies on idiopathic, complex, and atypical clubfoot that assessed Ponseti's modified technique were included. Of 699 identified articles, ten met the inclusion criteria. The mean index for non-randomized studies score for the included studies was 11.8 ± 1.7. Results Early detection of the deformity and modifying the standard protocol, as described by Ponseti, resulted in a high rate of success. Initial correction occurred in all children, with a mean ankle dorsiflexion of 15°. Relapse occurred often ranging between 10.5 and 55%. The incidence of complications associated with the modified Ponseti method ranged from 6 to 30%. Conclusions Studies using the modified Ponseti technique have shown high initial correction rates and a smaller number of relapses. However, studies with prospective designs and long-term follow-up are required to conclude whether these observations are due to properly performing the modified method or if higher rates of relapse increase with further follow-up.

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CORR Insights®: Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review

Cited by 3 publications

References 3 publications

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

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