Temporal Variation of Scores Along the Course of the Ponseti Treatment in Older Children: A Ready Guide to Progress of Treatment

Abstract

Purpose: We aimed to graphically study the correction trend along the course of Ponseti treatment in older children with idiopathic clubfeet. Methods: The temporal variation of total Pirani and Dimeglio scores and their individual components at each casting session was represented graphically. Tenotomy correction was accounted for separately. We classified 0 to 4 as early, 4 to 8 as midlevel, and beyond 8 as late casts to describe the sequence of treatment. Results: A total of 27 patients (39 feet; bilateral in 12) were studied. The average patient age was 4.78±2.36 years. Rigid equinus was the more severe pretreatment deformity in Pirani system and also the most difficult to treat component. Posterior crease and medial crease were least severe and were treated in early casts. Reducibility of lateral head of talus, curved lateral border of foot, and empty heel were moderately severe and showed a gradual improvement pattern over subsequent casting sessions. For Dimeglio components, equinus was the most resistant deformity, and it persisted until late casts. Adduction, rotation, and varus were moderately severe, and they followed a gradual improvement slope. Several components/scores did not turn 0 after correction for older clubfoot children. Conclusions: The treatment graphs for older clubfoot children adequately illustrated the initial severity, number of Ponseti casts used, correction of total scores and their individual components over sequential casting sessions, tenotomy influence, and the residual deformities.

What is New in Pediatric Orthopaedic Foot and Ankle

“…Ponseti manipulation and casting is effective in treating idiopathic as well as all other types of clubfoot including relapsed clubfoot,12–14 complex clubfoot,15,16 tethered cord,17 spina bifida/myelomeningocele,18,19 neglected clubfeet in adolescents,20–22 arthrogryposis,23,24 and amniotic band syndrome 25. Orthopaedic surgeons should be aware that ∼9% of patients with presumed idiopathic clubfeet have an underlying diagnosis 26.…”

“…10 Following casting, one can expect that the foot will adapt to the new position within several hours as the force exerted by the cast significantly decreases over time, especially in the first hour after casting. 11 Ponseti manipulation and casting is effective in treating idiopathic as well as all other types of clubfoot including relapsed clubfoot, [12][13][14] complex clubfoot, 15,16 tethered cord, 17 spina bifida/myelomeningocele, 18,19 neglected clubfeet in adolescents, [20][21][22] arthrogryposis, 23,24 and amniotic band syndrome. 25 Orthopaedic surgeons should be aware that ∼9% of patients with presumed idiopathic clubfeet have an underlying diagnosis.…”

The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically

“…This led to multiple plots in a single graph. We used a slightly different method for our graphs [6]. At each casting session, the mean total score (Pirani or Dimeglio) or mean of individual components was determined.…”

“…Graphical representation of deformity correction in idiopathic clubfoot during casting sessions is a well-established practice [1][2][3][4][5][6]. The visual record can readily differentiate a typical from an unusual course.…”