Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: Should it affect bracing protocol when using the Ponseti method?

Abstract

Purpose To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF). Methods Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF. Results The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot. Conclusion Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management. Level of Evidence V

A modification of the Ponseti method for clubfoot management: A prospective comparative study

“…These are the most widely used and accepted parameters, as they reflect the anatomical relationship between the talus and the calcaneus. 4 , 6 , 7 , 30 , 31 The children in group A had a mean AP, lateral TCA and TCI of 13.98º, 32.78º and 35.28º, respectively, in the diseased feet. However, the measurements were 29.05º, 41.26º and 58.65º in the normal feet.…”

“…Non- or poor compliance with the Ponseti brace protocol was identified as the leading cause of relapse, and it directly affects the success of treatment. 4 , 5 , 7 , 9 , 25 , 26 , 28 , 33 Other factors, such as the low educational level of parents and low annual family income, were associated with poor compliance with bracing and recurrences. 14 , 19 , 32 , 33 , 36 , 39 Some parents wrongly think that once the feet are corrected, it can never recur.…”

“…This is in agreement with several previous studies. 4,7,[32][33][34][35] Segev et al 33 compared their unaffected value with the standard Ponseti method and showed that the TCA on the AP view ranged from 30º to 531º (mean 41.4º) for the unaffected side and from 17º to 451º (mean 31.4º) for the affected side. The TCA on the lateral view ranged from 37º to 501º (mean 44.9º) for the unaffected side and from 12º to 351º (mean 24.5º) for the affected side.…”

“…1 This method involves serial manipulations, casting of the clubfoot, tenotomy in most cases and long-term bracing using a foot abduction brace (FAB) as a retention programme to prevent the recurrence of deformity. [2][3][4] Although using the foot abduction brace is an essential part of the treatment, it does not dramatically improve the foot's appearance or function. 2,4 The use of FAB could be challenging to the child, family and healthcare team with variable compliance rates.…”

Special symposium issue: Clubfoot

“…However, some aspects of the Ponseti treatment protocol still remain a challenge as can be read in Alves’s ‘Bracing in clubfoot: do we know enough?’ 3 or are not yet fully understood, as shown in Hemo et al’s paper ‘Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: should it affect bracing protocol when using the Ponseti method?’. 4 Lööf discusses ‘Additional challenges in children with idiopathic clubfoot: is it just the foot?” 5 and van Bosse evaluates the need for modifications in “Challenging clubfeet: the arthrogrypotic clubfoot and the complex clubfoot’. 6…”