ABSTRACT
O pé torto congênito é uma das deformidades mais frequentes de membro inferior que, por sua complexidade com relação às alterações anatômicas, é alvo de dúvidas e divergência de opinião dos profissionais da área quanto ao tratamento mais eficaz. No entanto, o método mais utilizado atualmente e que vem apresentando resultados positivos é o de Ponseti. O objetivo deste trabalho é analisar a eficácia do método de Ponseti e sua aplicabilidade pelo fisioterapeuta. Tratou-se de pesquisa do tipo revisão, com abordagem qualitativa por meio de consulta a publicações das bases de dados Scielo, Lilacs, Medline e Bireme, preferencialmente dos últimos dez anos, e a coleta de dados no mês de outubro de 2016. Foram encontradas 248 publicações e, após análise, foram selecionados 23 artigos para a pesquisa, distribuídas em duas categorias: Eficácia do método Ponseti e Eficácia das técnicas fisioterapêuticas. Diante do exposto, percebese que o método de Ponseti tem se mostrado o mais eficaz no tratamento do pé torto congênito, e suas técnicas são compatíveis com as utilizadas por fisioterapeutas, sendo possível sua aplicabilidade por este profissional, com exceção da tenotomia do calcâneo. Portanto, este trabalho abre espaço para novas pesquisas que corroborem esta temática. (AU)
The congenital club foot is one of the most frequent lower limb deformities that, due to its complexity in relation to anatomical changes, is the subject of doubts and divergence of opinion of professionals in the area regarding the most effective treatment. However, the method most used currently and that has presented positive results is that of Ponseti. The aim of this study was to analyze the effectiveness of the Ponseti method and its applicability by the physiotherapist. This research was a literature review, with a qualitative approach, through consultation of publications of Scielo, Lilacs, Medline and Bireme databases, preferably in the last ten years, and data collection in October 2016. We found 248 publications and after analysis, 23 articles were selected for the research, distributed in two categories: Efficacy of the Ponseti method and Efficacy of physiotherapeutic techniques. The Ponseti method has been shown to be the most effective in the treatment of congenital clubfoot, and its techniques are like those used by physiotherapists, being possible its applicability by this professional, except for tenotomy of the calcaneus. Therefore, this work opens space for new research that corroborates this theme. (AU)
Subject(s)
Humans , Clubfoot , Physical Therapy Modalities , Congenital Abnormalities , Calcaneus , Efficacy , Lower Extremity , MethodsABSTRACT
La investigación tuvo como objetivo rediseñar la órtesis utilizada post-tratamiento Ponseti, en niños con pie equino varo congénito, de forma tal que permita la reducción de rechazo a su uso. Método: Se identificaron las necesidades de los niños con pie equino varo congénito, para verificar los inconvenientes con respecto a la funcionalidad, diseño y adaptabilidad a la órtesis dado que si la férula no se usa adecuadamente el riesgo de recidiva es de 80 %, por el contrario con el uso de la férula el riesgo es de 4 %. Se realizó un estudio biomecánico del movimiento de un paciente durante el gateo, con y sin la órtesis. Resultados: Se elaboró un modelo 3D de la propuesta, para simular el diseño sometido a las fuerzas generadas por los bebés durante el pataleo en posición supina. Se evaluó experimentalmente el desempeño del prototipo alfa, para determinar si cumplía con la meta prevista. Se obtuvo la fabricación y pruebas de la órtesis en plataforma virtual y físico. Acorde al alcance del proyecto, se determinó que es probable que se reduzca el rechazo al uso y por consiguiente la formación de recidiva, al reducir los factores determinantes propios de la férula del mercado, que propiciaban el mal uso de esta en el tratamiento. La velocidad promedio de gateo es de 0.48 m/s y con la férula se reduce a 0.37 m/s. Discusión: La férula del mercado pesa 304.07 g y la propuesta pesa 209.26 g. Se sugiere que se continúe la investigación en el estudio biomecánico.
This research was developed with the objective of redesigning the orthosis used in the post- Ponseti treatment in children with clubfoot, with the intention of reducing the rejection to its use. Method: A research on the needs of children with congenital clubfoot was conducted to identify the disadvantages on functionality, design and adaptability of the orthosis if the splint is not used appropriately, the risk of relapse is 80 %, whereas using the splint, the risk is 4 %. A biomechanical study of a patient's movement during the crawl was performed with and without the orthosis. Results: A 3D model of the design was developed to simulate computationally its performance under the forces generated by the babies during the kick in supine position. Finally, an experimental evaluation of the alpha prototype performance was made to determine whether it met the intended goal. Thus, the manufacturing and testing of the orthosis on virtual and in physical platform took place. Taking in account the goal of this project, it 3 was determined that it is possible to reduce the reject to the use and therefore the formation of relapse by reducing the determinant factors of the common market splint, which promotes its incorrect use of this in the treatment. The average crawl speed is 0.48 m/s and with the splint, it decreases to 0.37 m/s. Discussion: The weight of the common market splint is 304.07 g and the weight of the one designed in the study is 209.26 g. Further biomechanical research is suggested to get conclusive results