Influence of cast change interval in the Ponseti method: A systematic review

Giesberts, Robert Bram; Steen, M. C. van der; Maathuis, Patrick G. M.; Besselaar, A. T.; Hekman, Edsko E.G.; Verkerke, G.J.

doi:10.1371/journal.pone.0199540

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…16) The traditional Ponseti technique of weekly manipulation and casting is inexpensive, has a relatively short learning curve, and has yielded excellent results in both in short-and longterm studies. 17) Although Giesberts et al 18) have published a review article showing that accelerated protocols have a similar efficacy and safety profile as the traditional protocols, no ideal casting interval has been suggested. Our aim was to establish the effectiveness of a twice-weekly accelerated protocol vis-à-vis the standard protocol in our population cohort.…”

Section: Discussionmentioning

confidence: 99%

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

et al. 2020

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Congenital clubfoot, or congenital talipes equinovarus (CTEV), is one of the most common congenital deformities. 1) It most likely represents congenital dysplasia of all musculoskeletal tissues (musculotendinous, ligamentous, osteoarticular, and neurovascular structures) distal to the knee. This conclusion is based on multiple investigators' observations of a myriad of different abnormal anatomic findings and on the functional outcome of patients who were believed to have received optimal non-operative or operative treatment but nevertheless subsequently always had some degree of impairment. 2) Congenital clubfoot is a complex three-dimensional deformity consisting of four components: cavus, adductus, varus, and equinus. The incidence of congenital clubfoot is approximately 1.2 per 1,000 live births. 3) If a clubfoot is allowed to remain deformed, many other late adaptive changes occur in the bones. These changes depend on the severity of soft-tissue contractures and the effects of walking. In untreated adults, some joints may spontaneously fuse or degenerative changes secondary to the contractures may develop. On the basis of a proper understanding of the

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Section: Discussionmentioning

confidence: 99%

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

et al. 2020

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“…18 With studies which have showed a positive correlation between compliance with bracing and incidence of relapse, the earlier introduction of patients into bracing phase might be more beneficial than as thought. 19,20 Such relapses can be decreased by parental counselling at each successive visit and explaining them the need to wear abduction brace.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of correction of idiopathic congenital talipes equinovarus by conventional and accelerated Ponseti method with minimum 12 months follow up in a tertiary care hospital in North India

et al. 2021

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Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle affecting 1/1000 live birth approximately. With a male dominance pattern, this deformity is bilateral in 50% cases. It has four basic components: cavus, adduction, varus and equinus. Severity of clubfoot is accessed using Pirani score (0 to 6). Insights into the basic pathoanatomy of this complex 3 dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopaedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in Steenbeek splint initially for 23 hours day for 3 months and then 12 hours a day for 3 years. The most important component of this treatment is parental counselling regarding the need for compliance with treatment which is often loophole responsible for relapse in initially corrected feet.Methods: This was a prospective study including 40 patients (61 feets) of idiopathic clubfoot with age <3 month at presentation who were randomly distributed in two groups, group 1 (accelerated Ponseti casting group) in which twice weekly casts were applied and group 2 (standard Ponseti casting group) in which weekly casts were applied. Initial Pirani score was calculated in all the patients and was rechecked and documented in every successive visit. All the patients were followed upto 12 months and there was no lost to follow up in this study.Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p value <0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0).Conclusions: Accelerated biweekly Ponseti casting reduces the overall days of treatment with similar results compared to standard weekly casting regime.

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“…24 The studies all report a reduced time of treatment without adverse effects. 25 More research is needed to find the optimal interval between changes of casts. Our findings suggest that if there is a limit to the reduction in the interval between cast changes, it is more likely to be related to biological rather than mechanical factors.…”

Section: Discussionmentioning

confidence: 99%

Rapid decrease of cast-induced forces during the treatment of clubfoot using the Ponseti method

Giesberts

Hekman

Verkerke

et al. 2018

The Bone & Joint Journal

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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.

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Influence of cast change interval in the Ponseti method: A systematic review

Cited by 7 publications

References 28 publications

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

Comparative analysis of correction of idiopathic congenital talipes equinovarus by conventional and accelerated Ponseti method with minimum 12 months follow up in a tertiary care hospital in North India

Rapid decrease of cast-induced forces during the treatment of clubfoot using the Ponseti method

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