Modified Ponseti technique for management of neglected clubfeet

Mehtani, Anil; Prakash, Jai; Vijay, Vipul; Kumar, Nishikant; Sinha, Abhinav

doi:10.1097/bpb.0000000000000450

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…Mehtani et al [ 14 ] went beyond simple variations and truly modified the Ponseti method: they reapplied the post-tenotomy cast at two weeks in the maximum achievable dorsiflexion and abduction. In addition, they switched to below-knee, weight-bearing casts in maximum dorsiflexion and external rotation after removal of the post-tenotomy cast.…”

Section: Discussionmentioning

confidence: 99%

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Ferreira¹,

Stéfani²,

Haje

et al. 2018

PLoS ONE

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BackgroundThe prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children.MethodsA metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.ResultsTwelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82–0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14–0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03–0.15, p = 0.19).ConclusionApplication of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.

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Section: Discussionmentioning

confidence: 99%

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Ferreira¹,

Stéfani²,

Haje

et al. 2018

PLoS ONE

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“…No special footwear was given for day time. 13 Patients were followed-up every six weeks for the first six months and then every three months.…”

Section: Methodsmentioning

confidence: 99%

Relapse following use of Ponseti method in idiopathic clubfoot

Chand

Mehtani

Sud

et al. 2018

Journal of Children's Orthopaedics

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PurposeWe assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well.MethodsWe evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol.ResultsNon-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%.ConclusionWe conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol.Level of evidence:IV

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“…De modo análogo as repercussões sobre a qualidade de vida citadas, essa revisão demonstrou que 86,7% dos artigos que compuseram o corpus documental apontaram para a eficácia elevada no tratamento do PTC de crianças mediante Técnica de Ponseti e a melhora significativa nos níveis de qualidade de vida (BHASKAR;PATNI, 2013;AYANA;KLUNGSØYR, 2014;MAHAPATRA;HAMPANNAVAR, 2014;MINDLER et al, 2014;ELGOHARY;ABULSAAD, 2015;HALLAJ-MOGHADDAM et al, 2015;SUGANDHAVESA et al, 2015;YILDIRIM et al, 2015;AGARWAL et al, 2016;CARPIAUX et al, 2016;EL BATTI et al, 2016;GRIMES et al, 2016;HECK;HECK;PLACZEK, 2016;JAQUETO et al, 2016;KHAN;KHANZADA, 2016;SEEGMILLER et al, 2016;LEBEL et al, 2017;MARQUEZ et al, 2017;MATAR et al, 2017;SHAH et al, 2017;SMYTHE et al, 2017;AGARWAL et al, 2018;DREW;GOOBERMAN-HILL;LAVY, 2018;JOCHYMEK;TUREK, 2018;MEHTANI et al, 2018). É importante destacar que a maior parte dos estudos apresentou nível de evidência I e II, os quais são os melhores e mais confiáveis.…”

Section: Discussionunclassified

Qualidade de vida de crianças com pé torto congênito e a técnica de Ponseti

Cunha¹,

Souza

Sousa

et al. 2019

R. bras. Qual. Vida

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OBJETIVO: Analisar a contribuição da técnica de Ponseti para a qualidade de vida de crianças portadoras do pé torto congênito.MÉTODOS: A elaboração do trabalho foi realizada através de uma revisão sistemática da literatura, utilizando-se como descritores em Ciência da Saúde (DeCS) (português): pé torto congênito, qualidade de vida, técnica de Ponseti; e os medical subject headings (MeSH) (inglês): congenital biceps foot, quality of life e Ponseti technique. Foram selecionados artigos nas bases de dados: Public Medicine (Pubmed), Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrievel System Online (MEDLINE) e Biblioteca Virtual de Saúde (BVS). Os artigos selecionados foram analisados quanto ao título, ao ano, à formação e ao tema principal. A pesquisa compreendeu artigos publicados entre 2013 e abril de 2018. Foram identificados 110 artigos, dos quais foram selecionados 30 artigos que se encaixaram nos critérios de inclusão.RESULTADOS: A partir dos estudos analisados, observou-se que 83,3% destes apontaram eficácia elevada no tratamento do pé torto congênito de crianças por meio da técnica de Ponseti associada a uma melhora na qualidade de vida.CONCLUSÕES: A técnica de Ponseti é altamente eficaz para correção da deformidade e propicia melhoria da qualidade de vida das crianças que são portadoras da patologia.

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Modified Ponseti technique for management of neglected clubfeet

Cited by 17 publications

References 16 publications

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Relapse following use of Ponseti method in idiopathic clubfoot

Qualidade de vida de crianças com pé torto congênito e a técnica de Ponseti

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