The Influence of Achilles Tenotomy and Compliance with Foot Abduction Orthosis on the Relapse Rate of Ponseti Treatment for Idiopathic Clubfoot: A Regional Study

Cohen, Eugen; Katz, Tiberiu; Rozen, Uri; Friesem, Tai; Leibovitz, Eugene

doi:10.1053/j.jfas.2019.12.007

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…A tenotomy is a very important part of the corrective phase for the correction of the equinus deformity in clubfoot. The relapse of clubfoot deformity is very controversial, and there are many factors that can influence it, including age, gender, laterality, severity of the deformity, non-compliance to the foot abduction brace, baby crying, and post-surgery patient care [ 20 , 21 ]. This study was retrospective, and only the documented data were evaluated.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Ponseti Technique in Different Types of Clubfoot—A Single Center Retrospective Analysis

Butt¹,

Perveen

Ciongradi

et al. 2023

Children

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Background: Clubfoot is a congenital deformity that can affect one or both of a newborn’s lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.

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Section: Discussionmentioning

confidence: 99%

Outcomes of the Ponseti Technique in Different Types of Clubfoot—A Single Center Retrospective Analysis

Butt¹,

Perveen

Ciongradi

et al. 2023

Children

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“…Equinus can be corrected with the progressive correction and replacement of casts at each stage. (31,32,33) In those equinovarus cases where equinus cannot be corrected by manipulation and casting, Achilles te-notomy is performed (17,34). It is safe to do a tenotomy up to one year of age, in local or general anaesthesia.…”

Section: Clubfoot Treatmentmentioning

confidence: 99%

“…It is safe to do a tenotomy up to one year of age, in local or general anaesthesia. Many authors perform achilles tenotomy under general anaesthesia, especially in patients older than three months of age, to facilitate casting and complete correction of the deformity (17,34,35). Following Achilles tenotomy, a cast is worn for three to four weeks.…”

Section: Clubfoot Treatmentmentioning

confidence: 99%

“…Once the last cast is removed, 3-4 weeks after Achilles tenotomy, a brace comprised of a metal bar (static or dynamic) with attached leather lace-up boots, is used. For unilateral CTEV cases, the brace is positioned so that the feet are placed shoulderwidth apart on the metal bar, with the affected foot abducted to about 60-70 degrees and the healthy foot positioned at about 30-40 degrees (34,35). Dorsiflexion is at about 10 degrees.…”

Section: Clubfoot Treatmentmentioning

confidence: 99%

“…After this period, the child wears the brace all night and 2-4 hours during the day, i.e. 14 to 16 hours per day (sleep time), until 3-4 years of age (34,35,36).…”

Section: Clubfoot Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

The Ponseti Method Followed by Minimally Invasive Surgery as Method of Choice in Treatment of Congenital Talipes Equinovarus: Review Article

Dučić

Lazović

Radlovic

et al. 2021

CEJoP

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The objective of the study was to evaluate minimally invasive methods in treatment of congenital clubfoot. Congenital talipes equinovarus (CTEV), or clubfoot, is the most common congenital foot deformity, occurring in 1 to 2 in 1000 live births. CTEV etiology is not yet completely clear. Essentially, the deformity is the result of an intrauterine dislocation of the joints between the talus, calcaneus, navicular and cuboid bone and it includes four components: cavus, adductus, varus and equinus (CAVE). The diagnosis is made by a clinical examination and foot radiography. The treatment is based on the repositioning of the dislocated joints. There are different treatment modalities available, from conservative to exclusively surgical CTEV treatment. The Ponseti method is a primarily conservative treatment method using corrective long-leg casts, sometimes associated with minimal surgical intervention -Achilles tenotomy, followed by the use of an abduction brace. If needed, less invasive surgery ("a la carte") might be used to correct uncorrected components of CTEV. Based on the reports published from 2010 to 2020, as retrieved from databases (PubMed, Medline, Scopus), pertaining mostly to conservative treatment methods and primarily to the Ponseti method and based on the comparison between the Ponseti method and surgical methods of treatment, as well as other conservative methods of treatment, it can be concluded that the Ponseti method is the method of choice for the treatment of congenital CTEV in children today. Conclusion − The Ponseti treatment method, if used on time, fulfills all requirements that are expected from a contemporary medical procedure: simplicity in performance, minimally invasive, wide availability, cost effectiveness and successful treatment results.

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Techniques, anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method of idiopathic clubfoot correction: A systematic review

et al. 2022

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The Influence of Achilles Tenotomy and Compliance with Foot Abduction Orthosis on the Relapse Rate of Ponseti Treatment for Idiopathic Clubfoot: A Regional Study

Cited by 5 publications

References 19 publications

Outcomes of the Ponseti Technique in Different Types of Clubfoot—A Single Center Retrospective Analysis

Outcomes of the Ponseti Technique in Different Types of Clubfoot—A Single Center Retrospective Analysis

The Ponseti Method Followed by Minimally Invasive Surgery as Method of Choice in Treatment of Congenital Talipes Equinovarus: Review Article

Techniques, anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method of idiopathic clubfoot correction: A systematic review

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