Prognosticating Factors of Relapse in Clubfoot Management by Ponseti Method

Zhao, Dahang; Li, Hai; Zhao, Li; Kuo, Ken N.; Yang, Xuan; Wu, Zhihua; Liu, Jianlin; Zhu, Jie

doi:10.1097/bpo.0000000000000870

Cited by 28 publications

(46 citation statements)

References 37 publications

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“…Zhao et al. ( 2016 ) also showed that difficulty in correcting the initial deformity was predictive for a relapse. Furthermore, Ponseti et al.…”

Section: Discussionmentioning

confidence: 99%

Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children

Steen

2018

Acta Orthopaedica

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Background and purpose — The Ponseti treatment is successful in idiopathic clubfoot. However, approximately 11–48% of all clubfeet maintain residual deformities or relapse. Early treatment, which possibly reduces the necessity for additional surgery, requires early identification of these problematic clubfeet. We identify deformities of residual/relapsed clubfeet and the treatments applied to tackle these deformities in a large tertiary clubfoot treatment center.Patients and methods — Retrospective chart review of patients who visited our clinic between 2012 and 2015 focused on demographics, deformities of the residual/relapsed clubfoot, and applied treatment. Residual deformities were defined as deformities that were never fully corrected and needed additional treatment. We defined relapse as any deformity of the clubfoot reoccurring, after initial successful treatment, with necessity for additional treatment.Results — We identified 33 patients with residual and 55 patients with relapsed clubfeet. In both groups decreased dorsal flexion and adduction were the most often registered deformities. Furthermore, often equinus/decreased dorsiflexion, active supination, and varus occurred. In more than half, typical profiles of combined deformities were found. Relapses occurred at all stages of treatment and follow-up; half of the residual or relapsed clubfeet were identified before the end of the bracing period. In half of the patients, additional treatment consisted of the Ponseti treatment, one–quarter also required adaptation of the brace protocol, and one–quarter needed additional surgery. The Ponseti treatment was mainly reapplied if feet presented with relapses or residues until the age of 5.Interpretation — Practitioners should especially be aware of equinus/decreased dorsiflexion, adduction, and active supination as a sign of a residual or relapsed clubfoot. Due to the heterogeneous profiles of these clubfeet, treatment strategy should be based on a step-by step approach including recasting, bracing, and if necessary surgical intervention.

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“…Zhao et al. ( 2016 ) also showed that difficulty in correcting the initial deformity was predictive for a relapse. Furthermore, Ponseti et al.…”

Section: Discussionmentioning

confidence: 99%

Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children

Steen

2018

Acta Orthopaedica

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“…Idiopathic clubfoot or congenital talipes equinovarus (CTEV) is a well-known complex, congenital foot deformity composed of four components, namely: equinus, hindfoot varus, forefoot adduction and cavus 1 . Conservative treatment by manipulating and casting utilised the Ponseti method is the mainstay of practice and satisfactory results have been achieved by several authors 2-6 . The use of a foot abduction brace (FAB) after initial correction is mandatory to maintain the correction and to prevent the recurrence of CTEV 1, 6-9 .…”

Section: Introductionmentioning

confidence: 99%

“…Conservative treatment by manipulating and casting utilised the Ponseti method is the mainstay of practice and satisfactory results have been achieved by several authors 2-6 . The use of a foot abduction brace (FAB) after initial correction is mandatory to maintain the correction and to prevent the recurrence of CTEV 1, 6-9 . However, this is a challenging process, which requires cooperation from the parents or guardians 1, 3, 10, 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Factors associated with the recurrence of CTEV could be the patient, physician, or caregiver-associated characteristics 1, 12-15 . Non-modifiable factors include high grade of deformity, ethnicity, and parental educational level 1, 6, 12, 16 . An important modifiable factor is non-compliance to FAB or practice of stretching exercise 1, 6, 9, 15, 16 .…”

Section: Introductionmentioning

confidence: 99%

“…Non-modifiable factors include high grade of deformity, ethnicity, and parental educational level 1, 6, 12, 16 . An important modifiable factor is non-compliance to FAB or practice of stretching exercise 1, 6, 9, 15, 16 . Physicians managing patients with CTEV should be aware of these factors before initiating the Ponseti method.…”

Section: Introductionmentioning

confidence: 99%

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Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method

Limpaphayom¹,

Sailohit²

2019

Malays Orthop J

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Introduction: Idiopathic clubfoot or congenital talipes equinovarus (CTEV) is managed by the Ponseti method worldwide; however, the recurrence of the deformity is a challenging problem. The purpose was to review the factors associated with early recurrence of CTEV post the Ponseti method.Materials and Methods: During 2011-2016, 34 infants with 52 CTEV, who underwent the Ponseti method and a minimum follow-up period of six months, were reviewed. Twenty-two infants (65%) were male, and 18 infants (53%) had bilateral CTEV. Recurrence of CTEV was defined as a reappearance of at least one of the four components of the deformity. The association between recurrence and factors, including age, gender, bilaterality, family geography, type of principal caregiver, severity at presentation, centre where the Ponseti method was initiated, compliance to foot abduction brace (FAB), practice of stretching exercise, type of FAB, and complications of casting, were evaluated using univariate logistic regression analysis.Results: The median age at initiation of the treatment was 3.4 (IQR; 2.1-12.6) weeks. A median of six (range; 3-12) casts were required. Tenotomy was performed in 32/34 (94%) of cases. Recurrence occurred in 14/52 feet (27%) at an average follow-up period of 2.3±1.1 years. Non-compliance to FAB protocol began at an average age of 11.2±6.5 months, and significantly increased the risk of recurrence during the weaning phase [OR (95%CI)=8.4 (1.2-92.4), p=0.03]. Other factors were not associated with the recurrence.Conclusion: Non-compliance to FAB occurred early during the treatment and related to a risk of recurrence of CTEV. Physicians should encourage the parents and/or guardians to follow the protocol to decrease the risk of recurrence.

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Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method

Lampasi

Abati

Bettuzzi

et al. 2018

International Orthopaedics (SICOT)

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Prognosticating Factors of Relapse in Clubfoot Management by Ponseti Method

Abstract: Level II-prognostic.

Cited by 28 publications

References 37 publications

Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children

Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children

Factors Related to Early Recurrence of Idiopathic Clubfoot Post the Ponseti Method

Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method

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