Quantifying the Ponseti method

Giesberts, Robert Bram; Hekman, Edsko E.G.; Maathuis, Patrick G. M.; Verkerke, Gijsbertus Jacob

doi:10.1016/j.jmbbm.2016.10.021

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…It was supposed that the maximum stress may range from 4 to 7 N to avoid the injury of soft tissues. Also, it was previously reported that the applied force on the first metatarsal was 4.2 N during the manipulation based on an instrumented clubfoot model [26]. There was the similar stress distribution and intensity on the first metatarsal head (maximum from 4 to 7 N) presented in this study.…”

Section: Discussionsupporting

confidence: 82%

Effect of Achilles tendon on kinematic coupling relationship between tarsal bones: a pilot finite element study

Tang

Zhao³

et al. 2020

J Orthop Surg Res

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Background: The procedure of percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method. However, few studies reported the influence of Achilles tendon on kinematic coupling relationship between tarsal bones. The purpose of present study was to demonstrate the effect of Achilles tendon on the kinematic coupling relationship between tarsal bones, and to illustrate how kinematic coupling relationship between tarsal bones works in term of finite element analysis. Methods: A three-dimensional finite element model of foot and ankle was constructed based on the Chinese digital human girl No.1 (CDH-G1) image database using the software of mimics, Geomagic studio, HyperMesh, and Abaqus. The last manipulation of the Ponseti method before the procedure of PAT was simulated. The talus head and the proximal tibia and fibula bone were fixed in all six degrees of freedom, and the outward pressure was added on the first metatarsal head to investigate the kinematic coupling relationship between tarsal bones. Results: The least relationship of kinematic coupling between tarsal bones was found in calcaneus. Stress concentration was mainly observed at the navicular, talus and the medial malleolus. The difference in displacement of the navicular was only found with the Achilles tendon stiffness of 0 N/mm and others. No difference in the navicular displacement was found in the stiffness of Achilles tendon between 40, 80, 200, 400, and 1000 N/mm. The maximum displacement of navicular was observed at the ankle position of PF-20°(plantar flexion-20°). The difference in displacement of the navicular was greater at the ankle position of PF-20°with the Achilles tendon stiffness of 0 N/mm than that at the ankle position of PF-40°with the Achilles tendon stiffness of 40 N/mm. Conclusions: Based on the findings from this study, it was demonstrated that the Achilles tendon existence or not and ankle position had great influence, while increased stiffness of Achilles tendon had no influence on kinematic coupling relationship between tarsal bones. For the cases with severe equinus, earlier implementation of PAT procedure (with the purpose of release the Achilles tendon and reduce the degree of ankle plantar flexion) may be beneficial to the deformity correction.

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Section: Discussionsupporting

confidence: 82%

Effect of Achilles tendon on kinematic coupling relationship between tarsal bones: a pilot finite element study

Tang

Zhao³

et al. 2020

J Orthop Surg Res

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“…Previous authors have estimated the forces 14 and torque 15 on the clubfoot. Ours is the first report of force measurements in many children over several weeks of treatment each.…”

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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“…In serial casting of contracted elbows, knees and ankles, it was observed that the tension within the cast dropped by 80% within the first 24 hours [ 32 ]. A high initial pressure was measured underneath the Ponseti cast although pressure sores are rarely observed, which suggests a rapid decrease of this pressure resulting from a short adaptation time [ 33 ]. Preliminary cast / clubfoot interface pressure measurements by one of the authors suggest that the tissues may have reached full adaptation just several hours after casting.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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BackgroundClubfeet are commonly treated using the Ponseti method. This method involves weekly manipulation and casting which gradually corrects the position of the foot. However, the reasons for following a weekly interval are not clear.Question / PurposeThe aim is to investigate the influence of the cast change interval on treatment outcomes in the Ponseti method.MethodsWe performed a systematic review of comparative studies in which the cast change interval was varied. Scientific databases were searched for relevant publications, screened for eligibility and assessed for a risk of bias. A 'best evidence' synthesis tool was used to synthesize the results of the included studies and draw conclusions from relevant clinical outcomes.ResultsNine papers matched the inclusion criteria, which provided data of 587 subjects who had a total of 870 clubfeet. There is strong evidence for a positive relation between cast change interval and treatment duration. However, there is no evidence for any relation between the cast change interval and the required number of casts, tenotomy rate, required surgery or failure rate.ConclusionsAccelerated versions are as effective and safe as the traditional Ponseti method. However, more research is needed to assess the long-term results and to identify an optimal cast change interval.

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Quantifying the Ponseti method

Cited by 6 publications

References 18 publications

Effect of Achilles tendon on kinematic coupling relationship between tarsal bones: a pilot finite element study

Effect of Achilles tendon on kinematic coupling relationship between tarsal bones: a pilot finite element study

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

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

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