Ponseti method treatment of neglected idiopathic clubfoot: Preliminary results of a multi-center study in Nigeria

Adegbehingbe, Olayinka O; Adetiloye, Adeoye J; Adewole, OA; Ajodo, Dennis U; Bello, Nosirudeen; Esan, Oluwadare; Hoover, Alex C; Ior, James; Lasebikan, Omolade Ayoola; Ojo, Owolabi; Olasinde, AA; Songden, David; Morcuende, José A.

doi:10.5312/wjo.v8.i8.624

Cited by 28 publications

(21 citation statements)

References 22 publications

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“…[ 19 – 22 ] Many groups though have reported varying degrees of success using this method in older patients when necessary. [ 10 , 13 , 14 , 23 – 32 ] After 4–6 weeks of manipulations and weekly castings, the cavus, adduction, and varus deformities are typically corrected, as well as some or all of the equinus deformity. [ 19 , 20 , 33 – 36 ] Any residual equinus is treated with a percutaneous Achilles tenotomy followed by 3 weeks in a cast.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti

et al. 2019

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PurposeThe Ponseti Method has dramatically altered the management of clubfoot, with particular implications for limited-resource settings. We sought to describe outcomes of care and risk factors for sub-optimal results using the Ponseti Method in Haiti.MethodsWe conducted a records review of patients presenting from 2011–2015 to a CURE Clubfoot clinic in Port-au-Prince, Haiti. We report patient characteristics (demographics and clinical), treatment patterns (cast number/duration and tenotomy rates), and outcomes (relapse and complications). We compared treatment with benchmarks in high-income nations and used generalized linear models to identify risk factors for delayed presentation, increased number of casts, and relapse.ResultsAmongst 168 children, age at presentation ranged from 0 days (birth) to 4.4 years, 62% were male, 35% were born at home, 63% had bilateral disease, and 46% had idiopathic clubfeet. Prior treatment (RR 6.33, 95% CI 3.18–12.62) was associated with a higher risk of delayed presentation. Risk factors for requiring ≥ 10 casts included having a non-idiopathic diagnosis (RR 2.28, 95% CI 1.08–4.83) and higher Pirani score (RR 2.78 per 0.5 increase, 95% CI 1.17–6.64). Female sex (RR 1.54, 95% CI 1.01–2.34) and higher Pirani score (RR 1.09 per 0.5 increase, 95% CI 1.00–1.17) were risk factors for relapse. Compared to North American benchmarks, children presented later (median 4.1 wks [IQR 1.6–18.1] vs. 1 wk), with longer casting (12.5 wks [SD 9.8] vs. 7.1 wks), and higher relapse (43% vs. 22%).ConclusionsHigher Pirani score, prior treatment, non-idiopathic diagnosis, and female sex were associated with a higher risk of sub-optimal outcomes in this low-resource setting. Compared to high-income nations, serial casting began later, with longer duration and higher relapse. Identifying patients at risk for poor outcomes in a low-resource setting can guide counseling, program development, and resource allocation.

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Section: Methodsmentioning

confidence: 99%

Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti

et al. 2019

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“…Studies about the effectiveness of Ponseti treatment in children above walking age in LMICs show promising results. Extensive soft tissue releases have been avoided in 66-92% of cases above 1 year of age [8,25,26]. The Ponseti treatment remains the golden standard for clubfoot treatment in low-, middle-, and high-income countries [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Extensive soft tissue releases have been avoided in 66-92% of cases above 1 year of age [8,25,26]. The Ponseti treatment remains the golden standard for clubfoot treatment in low-, middle-, and high-income countries [7][8][9]. As such, we strongly believe that Ponseti casting should remain the treatment of first choice, including for older children, when available and appropriate.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings

Pigeolet

Imam²,

Ninulescu

et al. 2021

International Orthopaedics (SICOT)

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Purpose Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80–91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, after receiving surgical treatment. Methods Patients received a posteromedial release (PMR) with or without an additional soft tissue intervention (group 1), a PMR with an additional bony intervention (group 2), or a triple arthrodesis (group 3) according to our surgical algorithm. Patients were followed until two year post-intervention. Evaluation was done using a modified International Clubfoot Study Group Outcome evaluation score and the Laaveg-Ponseti score. Results Twenty-two patients with 32 neglected clubfeet (ages 2–24 years) received surgical treatment. Nineteen patients with 29 clubfeet attended follow-up. At two year follow-up an excellent, good, or fair Laaveg-Ponseti score was obtained in 81% (group 1), 80% (group 2), and 0% (group 3) of the patients (p value 0.0038). Age at intervention is inversely correlated with the Laaveg-Ponseti score at two year follow-up (p < 0.0001). All patients attended school or work and were able to wear normal shoes. Conclusion Our treatment algorithm is in line with other surgical algorithms used in LMICs. Our data reconfirms that excellent results can be obtained with a PMR regardless of age. Our algorithm follows a pragmatic approach that takes into account the reality on the ground in many LMICs. Good functional outcomes can be achieved with PMR for neglected clubfoot. Further research is needed to investigate the possible role of triple arthrodesis.

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“…Starting with the worldwide adoption of the Ponseti method as first option in clubfoot treatment, the age interval for using this method has increased. Usually, the mean age at treatment initiation is between 2 and 5 years, but children of older age can be found dispersed in the literature throughout different published studies (9,11,12). Correction rates ranging from 67% to 100% have been reported using the Ponseti method, without associated extensive surgery, which is remarkable taking into consideration that almost all neglected clubfeet are very stiff and severe (7,13,14).…”

Section: Discussionmentioning

confidence: 99%

Ponseti method as a treatment option for neglected clubfoot: a case report and literature review

Corbu

Elena

Maxim

et al. 2021

MSJ

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Congenital clubfoot is a common congenital malformation, whose conservative treatment using the Ponseti method achieves excellent initial correction rates and good long-term results. On the other hand, neglected clubfeet, which are typically more frequent in underdeveloped and developing countries, pose treatment difficulties and render corrective surgery necessary. The main problems with correction are raised by the increasing stiffness present in the soft tissues and the dy splastic development of bones. Furthermore, the hyperlaxity of young children decreases with growth, contributing to the reduced overall elasticity of the affected soft tissues and clubfeet. Deciding upon which type of treatment would be appropriate is not always facile. In our clinic, we tend to start the treatment of neglected clubfeet with the modified Ponseti method, which can achieve partial correction or full correction in most cases, diminishing the need for extensive surgical procedures. The case report of a long time neglected bilateral cl ubfoot successfully corrected using the modified Ponseti method is presented below, followed by a relevant review of the literature.

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Ponseti method treatment of neglected idiopathic clubfoot: Preliminary results of a multi-center study in Nigeria

Cited by 28 publications

References 22 publications

Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti

Clinical outcomes and risk-factor analysis of the Ponseti Method in a low-resource setting: Clubfoot care in Haiti

Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings

Ponseti method as a treatment option for neglected clubfoot: a case report and literature review

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