The significance of delayed ossification in the treatment of congenital clubfoot

Purpose There is conflicting evidence related to factors affecting the rates of recurrence of idiopathic club feet using the Ponseti method. We attempt to evaluate the predictors of success and failure in our physiotherapy-led Ponseti club foot clinic. Methods We evaluated 189 children with 279 club feet with a mean follow-up of 6.3 years for the following: Pirani score at presentation, number of casts for correction, indication for Achilles tenotomy, and the duration of foot abduction brace (FAB) use, in relation to outcome. Outcome measures were the need for additional surgery and functional scores. Based on the pattern and rate of ossification of the tarsal bones in idiopathic club foot, a much longer FAB weaning protocol was designed and practiced since 2000. The objective of this study was to answer the question of whether a prolonged period of FAB use reduces the need for surgery in Ponseti-treated idiopathic club foot. Results Thirty-six feet (12.9 %) underwent additional surgery. The Pirani score and the number of cast changes had no influence on the rate of surgery. The duration of FAB use had a significant effect on the outcome, i.e., the rate of surgery and functional scoring. Operated children used the FAB for 28 months versus 33 months in the nonoperated group (p \ 0.05). Only a minor delay in the attainment of walking age was noted (average 15 months). ConclusionsThe duration of FAB treatment was found to be the most influential on the functional results and on rate of surgery. Close follow-up and longer FAB weaning program reduced the rates of recurrence.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prolonged use of foot abduction brace reduces the rate of surgery in Ponseti-treated idiopathic club feet

Shabtai

Segev

Yavor

et al. 2015

“…In 1945 Leonard 8 emphasized the importance of using physical force to correct the deformity and mechanical fixation to maintain the correction until certain changes in the structural elements of the foot have taken place. Failure of treatment is thought to be the result of insufficient rather than wrong management.…”

Section: Evidence On the Dysplastic Nature Of Tarsal Bonesmentioning

confidence: 99%

“…Based on ossification index of foot, Leonard 8 made a comparative study of congenital CF. His conclusion was that the usual normal variation in appearance of OC exists in the feet of children under treatment for congenital CF.…”

Section: Evidence On the Dysplastic Nature Of Tarsal Bonesmentioning

confidence: 99%

Delayed ossification and abnormal development of tarsal bones in idiopathic clubfoot: Should it affect bracing protocol when using the Ponseti method?

Hemo

Gigi

Wientroub

2019

Purpose To point out the need to take into account the dysplastic nature of tarsal bones when treating idiopathic clubfoot (CF). Methods Review the published evidence on the developmental abnormalities of tarsal bones in idiopathic CF. Results The literature review provides abundant proof of the existence of delayed appearance and slower development of ossification centres of tarsal bones in idiopathic clubfoot. Conclusion Gentle manipulations and casting are the cornerstone of the Ponseti method. The biological response of all foot elements is critical for a successful outcome. Delayed ossification and abnormal development of tarsal bones in idiopathic CF may affect the results. Development of a personalized tailored bracing protocol based on severity assessment and response to casting treatment will improve results and quality of care in CF management. Level of Evidence V

“…Delayed development and ossification process of the tarsal bones in CF has been shown in many studies 14-20 to have resulted in a smaller foot size. Furthermore, the three muscle compartments of the CF leg are shorter and thinner than normal in unilateral CF compared with the unaffected side 21 while the leg muscular atrophy is a primitive pathological component of CF and is present at an early stage of foetal development.…”

Section: Introductionmentioning

confidence: 99%

The significance of foot length at the initiation of the Ponseti method: A prospective study

Hemo

Yavor

Gigi

et al. 2019

Objectives We sought to evaluate foot length (FL) and forefoot circumference (FC) and their impact on the severity of idiopathic clubfoot (CF) and results of treatment. We hypothesized that a smaller foot size at birth that represents a lesser than term newborn may affect the response of the CF to the treatment. Methods We conducted a prospective study documenting FL and FC of all neonates presented with idiopathic CF. Additional demographic information was collected. Outcome measures were number of casts needed for correction, need for recasting, additional surgery and functional score. Results In all, 52 children with 73 CF with a minimum mean follow-up of two years (2.0 to 5.6; sd 1.08) were evaluated. Mean gestational age was 38.63 weeks and mean birth weight (BW) was 3184 g. The mean FL at presentation was 74 mm (5.70 to 9.00), initial Pirani score was 5.5 (2.5 to 6.0) while number of casts was 6.9 (4.0 to 11.0). The FL was significantly correlated both to initial Pirani score (r = -0.35; p < 0.01) and number of casts (r = -0.33; p < 0.05). Positive correlation was found between the number of casts to Pirani score and number of additional procedures (r = 0.39; r = 0.36; p < 0.01, respectively). A foot size of up to 8 cm, needed 7.3 casts (4 to 7) compared with a FL of 8 cm or longer who needed 4.7 casts (4 to 6; t = 7.11; p < 0.001). Conclusion FL is a simple approach to identify preterm babies. It can be used as part of the initial evaluation of CF and help in predicting the course of treatment. We recommend adding FL to the existing classification. Level of Evidence I - Prognostic study