Joint hyperlaxity prevents relapses in clubfeet treated by Ponseti method—preliminary results

Cosma, Dan; Corbu, Andrei; Nistor, Dan Viorel; Todor, Adrian; Văleanu, Mădălina; Morcuende, José A.; Man, Sorin Claudiu

doi:10.1007/s00264-018-3934-7

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Next, we assumed that more severe initial deformities underlie higher congenital deforming forces and are asso- (Avilucea et al 2009), (Dinesh et al 2017), (Chong et al 2014), (Haft et al 2007), (Limpaphayom and Sailohit 2019), (Mahan et al 2017), (Cosma et al 2018), (Mootha et al 2011), (Morcuende et al 2004), (Morcuende et al 2005), (Gelfer et al 2014), (Panjavi et al 2012), (Ramírez et al 2011), (Sangiorgio et al 2016), (Kang and Park 2015), (Sangiorgio et al 2017), (Zhao et al 2018) (Kuzma et al 2019), (Little et al 2019), (Vo and Huynh 2016) ciated with a higher recurrence risk. However, our analysis revealed inconclusive findings.…”

Section: Discussionmentioning

confidence: 99%

“…Average compliance rate was 89% in those studies that did not report associations, ranging from 70% to 100% in the recurrent group, whereas average compliance rate was 66% in those studies reporting significant associations, ranging from 0% to 40% in the recurrent group. (Chong et al 2014) (Dinesh et al 2017), (Gelfer et al 2014), (Haft et al 2007), (Hallaj-Moghaddam et al 2015), (Kuzma et al 2019), (Little et al 2019), (Morcuende et al 2004), (Morcuende et al 2005), (Shabtai et al 2015), (Zhao et al 2018) Initial age at start of treatment (Willis et al 2009) (Chong et al 2014), (Gelfer et al 2014), (Haft et al 2007), (Hallaj-Moghaddam et al 2015), (Kang and Park 2015), (Kuzma et al 2019), (Limpaphayom and Sailohit 2019), (Little et al 2019), (Liu et al 2018), (Ramírez et al 2011), (Mootha et al 2011), (Morcuende et al 2004), (Morcuende et al 2005) (Cosma et al 2018), (Mootha et al 2011), (Morcuende et al 2005), (Morcuende et al 2004), (Ramírez et al 2011), (Willis et al 2009) Surgeon vs. physiotherapist directed treatment (Janicki et al 2009) Tenotomy (Chong et al 2014), (Cosma et al 2018), (Dinesh et al 2017), (Hallaj-Moghaddam et al 2015, (Kuzma et al 2019), (Little et al 2019), (Panjavi et al 2012)…”

Section: Behavioral Factorsmentioning

confidence: 99%

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Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

et al. 2021

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Background and purpose After initial clubfoot correction through Ponseti treatment, recurrence rates range from 26% to 48%. Even though various factors have been associated with increased recurrence risk, systematic assessments of the prognostic capacity of recurrence risk factors and their clinical relevance are lacking. Therefore we assessed clinically relevant prognostic factors for recurrent idiopathic clubfoot deformity after initial correction through Ponseti treatment. Methods PubMed, Embase, Cinahl, and Web of Science were systematically searched for studies investigating the association between clinically relevant factors and recurrence rates. Prognostic factors were qualitatively assessed and included in the meta-analysis if ≥ 2 studies investigated the same factor and methods were comparable. Results 34 articles were included in the qualitative synthesis, of which 22 were also included in the meta-analysis. Meta-analysis revealed that poor evertor muscle activity (OR = 255, 95% CI 30–2,190), brace non-compliance (OR = 10, CI 5–21), no additional stretching (OR = 31, CI 10–101), more casts (OR = 3.5, CI 1.6–7.8), lower education level of parents (OR = 1.8, CI 1.2–2.6), non-marital status of parents (OR = 1.8, CI 1.1–3.0), and higher Dimeglio scores (OR = 1.9, CI 1.2–3.3) were associated with higher recurrence rates. Interpretation Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are therefore important to be closely monitored during clinical follow-up of clubfoot patients. Adding additional stretching during the bracing protocol might be promising in the quest to prevent relapse, but scientific evidence for clear clinical treatment recommendations is still limited.

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Section: Discussionmentioning

confidence: 99%

Section: Behavioral Factorsmentioning

confidence: 99%

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

et al. 2021

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“…Ponseti suggested that clubfeet in children having "loose ligaments" were less prone to relapses (24). Recently, Cosma et al (46) suggested that joint hyperlaxity could be a protective factor for relapse; a finding they considered preliminary given the small number of patients in their study. We sought to determine if generalized joint hypermobility, influenced the Ponseti treatment of clubfoot in a cohort of 57 patients with clubfoot deformity (47).…”

Section: Influence Of Generalized Joint Hypermobility On Clubfoot Treatmentmentioning

confidence: 94%

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Zionts¹,

Ebramzadeh²,

Sangiorgio³

2021

Ann Transl Med

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The Ponseti method of manipulative treatment for clubfoot deformity became widely adopted by pediatric orthopaedic surgeons beginning in the mid-1990s. The technique allows correction of most idiopathic clubfeet using gentle manipulation and cast application. The treatment represents a marked advance over past efforts to gain correction of the foot through extensive release surgery. In 2006, we began a Clubfoot Clinic at the Orthopaedic Institute for Children in Los Angeles, California dedicated to managing clubfoot patients using Ponseti's method. An IRB-approved database of patient-related, treatment related, and demographic variables was assembled and used to ascertain the outcome of treatment as well as to address parental questions regarding certain aspects of treatment. Here, we present a review of our body of work, which has improved clinical decision making as well as our ability to better inform our patients' parents regarding the treatment and prognosis of the Ponseti method. Studies from our institution showed that while relapses and the need for extra-articular tibialis anterior tendon transfer (TATT) surgery remain common to the Ponseti method, these events do not adversely affect overall patient function or satisfaction. These findings were not unlike those of classic studies reported from Ponseti's institution. We conclude that the Ponseti method is not only a technique to achieve initial correction of an idiopathic clubfoot, but also how to manage relapses that will inevitably occur in many patients. While relapses and tendon transfer surgery are likely to remain common with this treatment method, these events do not adversely affect overall patient function or satisfaction. The parents of infants whose clubfeet are managed using the Ponseti method should be counselled accordingly.

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“…As joint hyperlaxity can be a protective factor against relapse in clubfeet and we considered that it might influence the stiffness of tendons on elastograms, we also decided to exclude patients who exhibited any sign of hyperlaxity from the study. 12 Further, we opted to exclude patients who had report any type of foot or ankle pain in the three months prior to the evaluation as this could have been correlated with tendinopathy, which might influence stiffness measurements. None of the patients included in this study practised performance sports, which can also influence results as athletes can have stiffer tendons than the general population.…”

Section: Methodsmentioning

confidence: 99%

Sonoelastographic Findings in Clubfeet

Corbu¹,

Cosma

Vasilescu³

et al. 2021

IJGM

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Purpose One of the main features of congenital idiopathic clubfoot is the increased stiffness of soft tissues. With the growing popularity and availability of sonoelastography as a method to assess the stiffness of different tissues, we considered applying it to congenital clubfeet in order to to determine whether sonoelastography can be a useful imaging method for the evaluation of clubfeet, to assess whether there are any differences in stiffness of specific tendons between clubfeet and normal contralateral feet and to observe which treatment methods have an impact on the aspect of these structures on the elastograms. Patients and Methods A case-control study was performed involving 10 adolescent patients with unilateral idiopathic congenital clubfeet who were treated either with the Ponseti method or surgically with posteromedial release (PMR) during early infancy. Using compression sonoelastography, we obtained semi-quantitative data expressed as fat to tendon ratios in treated clubfeet and normal contralateral feet. The tendons of the following muscles were examined: tibialis anterior, tibialis posterior, flexor hallucis longus, peroneus longus and Achilles tendon at three levels (calcaneal insertion, lengthened zone and musculotendinous junction). Results The only statistically significant difference in the strain ratio (p = 0.023) between clubfeet and normal feet was at the level of the calcaneal insertion of the Achilles tendon, which was stiffer in clubfeet. Although other differences were not statistically significant, they may reflect some of the pathological modifications of clubfeet. Conclusion Overall, sonoelastography may be a useful examination tool in the quantitative and qualitative assessment of soft tissue stiffness in clubfeet, but further research is necessary.

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Joint hyperlaxity prevents relapses in clubfeet treated by Ponseti method—preliminary results

Abstract: Joint hyperlaxity could be a protective factor for clubfoot relapse.

Cited by 10 publications

References 25 publications

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Sonoelastographic Findings in Clubfeet

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