A preliminary study on the ultrasonic evaluation of deformity changes during the treatment of congenital clubfoot in infants / 中华超声影像学杂志

Objective:To evaluate the deformity changes in the treatment of congenital clubfoot in infants by ultrasound, and to explore its clinical application value.Methods:Seventeen infants with congenital clubfoot treated in the Department of Pediatric Orthopaedics of the Third Affiliated Hospital of Zhengzhou University from March 2020 to June 2021 and 27 normal infants in the same period were selected. The distance between medial malleolus and scaphoids (MM-N distance) of all feet was measured by ultrasound. The distance from the tangent line of the lateral edge of calcaneus to the midpoint of the lateral edge of the chondroid bone (C-C distance), medial soft tissue thickness and tibial calcaneal angle were measured by ultrasound. The data before, after treatment and during follow-up were statistically analyzed.Results:A total of 88 feet of 44 infants were evaluated. The mean number of cast was 4.7±1.1, the follow-up time was (96.9±59.3)days. The MM-N distance, C-C distance and posterior tibial calcaneal angle in the clubfoot group were improved after treatment and at the last follow-up, and the differences were statistically significant (all P<0.01). During the treatment, 1 case had false correction, and 2 cases recurred in the last follow-up. Conclusions:Ultrasound can clearly display the medial, dorsal, lateral and posterior articular structures of normal and clubfoot, and can observe the deformity changes of clubfoot during the correction process, which can provide guidance for the clinical treatment of clubfoot.

Pé torto congênito: método de Ponseti e sua aplicabilidade pelo fisioterapeuta / Congenital clubfoot: Ponseti method and its applicability by the physiotherapist

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)

Outcome of clubfoot treatment in the pre-ponseti period in a Nigerian teaching hospital: a 14 year review

Background: Congenital Talipes Equinovarus (CTEV) is a common musculoskeletal congenital disorder. Historically, surgical treatment of various types was popular; however, currently the gold standard of treatment is non-operative care using the Ponseti method. This work evaluates the outcome of this former method of managing CTEV before author adopted the Ponseti Method and compares it with the reported outcomes of the Ponseti method in published literature.Methods: A retrospective review of this data from January 1990 to December 2003 was done, the patients demographics, treatment given, duration and outcome of care were analysed using descriptive statistics. This finding was then compared with outcomes of Ponseti method in literature.Results: Here, 145 patients had initial non operative care; eighteen of those patients (12.4%), eventually require either a posteromedial release, a combined posteromedial and posterolateral releases or a triple arthrodesis.Conclusions: The study shows that the success rate of this method of manipulation preceding the adoption of the Ponseti method is 87.6%. This outcome is inferior when compared to the outcome of Ponseti method in published literature. Also, the extensive nature of eventual surgical intervention required to achieve correction is in contrast to the minimal surgeries needed achieve correction of residual deformities following the use of the Ponseti method.

Major Predisposing Factors Influencing the Suicide by Hanging: A Retrospective Study from a Tertiary Care Government Hospital in Kerala State, South India

Introdcution: A variable incidence of hanging is found assecond major group among the total number of autopsiesdone in the Department of Forensic Medicine, Govt. MedicalCollege, Calicut, Kerala state, South India. The incidences arefound to be varying according to the social and economic statusof the society. This retrospective study was done in a tertiarycare Government Hospital to find the major predisposingfactors influencing the suicide by hanging.Material and Methods: Case history were taken in detailfrom questionnaires to the relations of the deceased and fromPolice. The results were analyzed on the basis of history,postmortem findings and results of laboratory investigations.Results: The age group 16-25 was found to be the mostprevalent (75%) for suicidal hanging. Among the religion,Hindu religion showed the highest (80%) number. Morecases were found among the manual labourers and lowermiddle class people. People without children were moreprone to suicide by hanging. Among the precipitating factors,mental illness was the highest factor. Fracture of hyoid bonewas found during autopsy in majority of cases of completehanging.Conclusion: Psychological upset and educational statusplayed an important role in suicidal hanging. The highestincidence was seen among those with lower educational status.Hence, proper identification of such people and presentingthem to effective counselling may reduce the incident rate.

Reliable Radiologic Parameters to Predict Surgical Management for Clubfoot Treated with the Ponseti Method / 대한정형외과학회잡지

PURPOSE: Several radiologic reference lines have been used to evaluate individuals with a clubfoot but there is no consensus as to which is most reliable. The aim of this study was to identify which radiologic parameters have relevance to the predictability of additional surgery after Ponseti casting on clubfoot and the effect of clubfoot treatments that contain Ponseti casting and additional surgery. MATERIALS AND METHODS: A total of 102 clubfeet (65 patients, 37 bilateral) were reviewed from 2005 to 2013. The patients were divided into two groups (Group A, those for whom the result of the Ponseti method was successful and did not require additional surgery; and Group B, those for whom the result of the Ponseti method was unsuccessful and required additional surgery), and the following parameters were measured on the plain radiographs: i) talo-calcaneal angle on the anteroposterior and lateral view, ii) talo-1st metatarsal angle on the anteroposterior view, and iii) Tibio-calcaneal angle on the lateral view with the ankle full-dorsiflexion state. Each radiograph was reviewed on two separate occasions by one orthopedic doctor to characterize the intra-observer reliability, and the averages were analyzed. Next, 20 cases were chosen using a random number table, and two orthopedic doctors measured the angle separately to characterize the inter-observer reliability. RESULTS: Groups A and B included 73 clubfeet (71.6%) and 29 clubfeet (28.4%), respectively. The initial talo-calcaneal angle and tibio-calcaneal angle in the lateral view were significantly different among the groups. In addition, inter- and intra-observer biases were not detected. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view were significantly different after treatment in both groups. CONCLUSION: Congenital clubfeet treated with the Ponseti method showed successful results in more than 70% of patients. The initial talo-calcaneal angle and tibio-calcaneal angle on the lateral view were the radiologic parameters that could predict the need for additional surgical treatments. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view could effectively evaluate the changes in clubfoot after treatment.

Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method

@#Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.

Can the Pirani Score Predict the Number of Casts and the Need for Tenotomy in the Management of Clubfoot by the Ponseti Method?

@#Introduction:We assessed the role of the Pirani score in determining the number of casts and its ability to suggest requirement for tenotomy in the management of clubfoot by the Ponseti method. Materials and Methods:Prospective analysis of 66 (110 feet) cases of idiopathic clubfoot up to one year of age was done. Exclusion criteria included children more than one year of age at the start of treatment, non-idiopathic cases and previously treated or operated cases. Results: The initial Pirani score was (5.5±0.7) for the tenotomy group and the initial Pirani score was (3.3±1.6) for the non-tenotomy group. There was a significant difference between the initial Pirani score for the tenotomy and the nontenotomy group with t= -7.9, df= 64 p<0.0001. The tenotomy group had a significantly higher number of casts (four to seven) compared to non-tenotomy group (two to five) t=-10.4, df=64, p<0.0001. Spearman’s rank correlation coefficient was significant and confirmed positive correlation between the initial Pirani score and the number of casts required to correct the deformity (r = 0.931, p<0.0001). Conclusion: Initial high Pirani score suggests the need for greater number of casts to achieve correction and probable need for tenotomy. The number of casts required in achieving complete correction increases with increase in the initial Pirani score. The initial high hindfoot score (2.5-3) signifies the probable need of a minor surgical intervention of percutaneous tendoachilles tenotomy. Based on the initial Pirani score, parents can be informed about the probable duration of treatment and the need for tenotomy.

Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis

Ponseti clubfoot treatment has become more popular during the last decade because of its high initial correction rate. But the most common problem affecting the long-term successful outcome is relapse of the deformity. Non-compliance with Ponseti brace protocol is a major problem associated with relapse. Although more comfortable braces have been reported to improve the compliance, they all have the same design and no significant changes have been made to the protocols. After refinement in the Ponseti method and emphasizing the importance of brace to parents, the relapse rate has been markedly decreased. Nevertheless, there are patients who do not have any recurrence although they are not completely compliant with the brace treatment, whereas other patients have a recurrence even though they are strictly compliant with the brace treatment. The aim of this article is to review the relapse of clubfoot and the function of the brace and to develop an individualized brace protocol for each patient by analyzing the mechanism of the brace and the biomechanical properties of muscles, tendons, and ligaments.

Congenital Clubfoot Treated with the Ponseti Method / 대한정형외과학회잡지

PURPOSE: This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot. MATERIALS AND METHODS: A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace. RESULTS: Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace. CONCLUSION: The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.

Application of Ponseti method in patients older than 6 months with con-genital talipes equinovarus / 北京大学学报(医学版)

Objective:To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months. Methods: Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was: (1) Ⅰ Group (6 months to 12 months),113 feet in 81 cases; (2) ⅡGroup (1 to 3 years old), 78 feet in 52 cases; (3) Ⅲ Group (>3 years old), 36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree : (1) Mild Group (scoring 1-2. 5) , 85 feet in 56 cases; (2) Moderate Group (scoring 3-4. 5) , 104 feet in 71 cases; (3) Severe Group (scoring 5-6) , 38 feet in 30 cases. A Pirani score of 0-0. 5 is regarded as an excellent result. For each group, we evaluated the number of casts used, the percentage of excellent result according to the Pirani score, and the percentage of percutaneous achillotenotomy. The result was compared among different groups. Results: The overall percentage of excellent result among all cases was 96.92%. A-mong the age groups, the percentage of excellence was not statistically different between Ⅰ Group and Ⅱ Group (P>0. 05). The percentage of excellence was lower in the Ⅲ group than the other groups (P> 0. 01). Among the groups classified by deformity degree, the percentage of excellence was the lowest in severe group (P<0. 05), and the difference between the mild group and moderate group was not statistically different (P>0. 05). The number of casts used among different groups were different (P<0. 01). Among different groups, the percentages of percutaneous achillotenotomy were significantly different (P<0. 01). 209 feet in 148 caseswere followed up for average time duration of 3 years and 11 months. Re-lapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P>0. 05). Conclusion: Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.

Application of Ponseti method in patients older than 6 months with congenital talipes equinovarus / 北京大学学报(医学版)

0.01). Among the groups classified by deformity degree,the percentage of excellence was the lowest in severe group (P0.05). The number of casts used among different groups were different (P0.05). Conclusion:Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.