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Jose A Morcuende - One of the best experts on this subject based on the ideXlab platform.
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management of clubfoot relapses with the Ponseti Method results of a survey of the posna members
Journal of Pediatric Orthopaedics, 2017Co-Authors: Pooya Hosseinzadeh, Lewis E Zionts, Lori A Dolan, Gary M Kiebzak, Jose A MorcuendeAbstract:BACKGROUND Despite the high rate of initial success using the Ponseti Method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet. MethodS We created a survey to focus on the management of clubfeet after initial correction of deformity. The survey included questions on postcorrective bracing, clinical findings used to identify relapse, the observed frequency of relapsed deformity, and how relapses are managed. The questionnaire was approved by the POSNA Evidence Based Committee and was sent electronically to all POSNA members. RESULTS We received responses from 321 members (26%). Of those, 94% were fellowship trained in pediatric orthopaedics. The Ponseti Method was used by 98% of respondents. The Mitchell-Ponseti orthosis was most commonly used (51%), followed by the Denis-Browne brace (25%). The duration of bracing used varied among members with 23% recommending only 2 years, 33% recommending 3 years, and 34% recommending 4 years. A tight heel cord was felt to be the first sign of relapse by 59% of respondents, and dynamic supination by 30%. The rate of relapse was observed to be <10% by 22% of the respondents, 10% to 20% by 52%, and 20% to 40% by 25%. Manipulation and cast treatment alone (55%) and cast treatment with tenotomy (23%) were reported as the 2 most common initial treatment approaches for a relapsed deformity. Cast treatment to correct relapsed deformity before tibialis anterior tendon transfer was reported by 62% of respondents. Heel cord tenotomy (75%) and posterior capsular release (43%) were the 2 most common procedures used in addition to tibialis anterior tendon transfer for the treatment of clubfoot relapse. CONCLUSION This study highlights the wide variation with which clubfoot relapses are evaluated and treated among the POSNA membership with differences in the recommended duration of bracing, identification of relapses, and their management. These wide differences highlight the need for future research and educational programs to inform and standardize the management of clubfoot using the Ponseti Method. LEVEL OF EVIDENCE Not applicable.
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treatment of congenital clubfoot with the Ponseti Method the parents perspective
Journal of Pediatric Orthopaedics B, 2013Co-Authors: Monica Paschoal Nogueira, Mariana Farcetta, Mark Fox, Kathleen Miller, Tatiana S Pereira, Jose A MorcuendeAbstract:This study aimed to analyze the perceptions of parents of children with clubfoot regarding the Ponseti Method of treatment, and identify aspects of treatment that families found most difficult. Thirty families of children with clubfoot were treated with the Ponseti Method over a 4-year period, and questionnaires were distributed at the conclusion of treatment. The most difficult components of treatment were identified. However, these challenges did not impact treatment outcome negatively. We hypothesize that a strong physician-patient relationship and high levels of parental education may decrease perceived difficulties of treatment with the Ponseti Method.
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early effects of a train the trainer approach to Ponseti Method dissemination a case study of sri lanka
The Iowa orthopaedic journal, 2013Co-Authors: Asitha D L Jayawardena, Thomas M Cook, D Tennakoon, Jose A MorcuendeAbstract:Background The Ponseti Method has been established as the standard of care for the treatment of clubfoot in many developed countries for its utility, cost-effectiveness, and efficiency. However, despite its being described as the gold-standard for clubfoot treatment, there are still many areas of the world bereft in formal training in the Ponseti Method. This is especially important since 80% of patients with clubfoot are born in developing countries where the need is the greater for experienced providers. This study analyzes a ‘Train the Trainer’ approach, specifically in the island nation of SriLanka, as a model for future dissemination of the Ponseti Method throughout the developing world.
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management of idiopathic clubfoot after formal training in the Ponseti Method a multi year international survey
The Iowa orthopaedic journal, 2013Co-Authors: Jayawardena Asitha, Lewis E Zionts, Jose A MorcuendeAbstract:Background Over the past decade, the Ponseti Method has become the standard of care to treat clubfoot amongst orthopaedic surgeons around the world. Since 2001, the University of Iowa, under the guidance of the late Dr. Ignacio Ponseti, has been teaching the Ponseti Method through a standardized training course. This study examines the current clubfoot management practices of those who have participated in the course and the effectiveness of formal Ponseti Training Courses.
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the Ponseti Method of treatment for clubfoot in brazil barriers to bracing compliance
The Iowa orthopaedic journal, 2013Co-Authors: Monica Paschoal Nogueira, Mark Fox, Kathleen Miller, Jose A MorcuendeAbstract:Background Clubfoot is the most common extremity birth defect. It causes the feet of affected individuals to point inward and downward, preventing them from walking normally. Neglected clubfoot causes disabilities that result in a lack of social integration, creating a psychological and financial burden for the family and community. Clubfoot has been effectively treated through the Ponseti Method, a treatment utilizing serial casts to correct the deformity followed by use of an abduction brace for approximately 2-4 years. sustained use of the brace is necessary to prevent relapse and ensure a successful outcome. Brace compliance in the setting of limited resources in the developing world can be challenging. The purpose of this study was to identify the barriers to bracing compliance in southeastern Brazil. In addition to socioeconomic and cultural barriers, this study also looked at improper prescribing practices by physicians as a potential cause of noncompliance. The study sought to identify the role of physician education in the use of the Ponseti Method and physicians' knowledge of the bracing process. Purpose of the study Identify the barriers to bracing adherence that could negatively impact the treatment of children with clubfoot. Methods Forty-five orthopedists from several centers in southeastern Brazil were interviewed. Physicians were asked about their training in the Ponseti Method, their protocol when prescribing the brace, their evaluation of its importance, and a series of open-ended questions designed to identify the positive and negative qualities of local braces. They were also asked what they perceived to be the biggest challenges to sustained brace use. Results sixteen of the physicians interviewed were orthopedic residents, and 29 had completed their residencies. Of these two groups, only 25% and 65%, respectively, appropriately prescribe the abduction brace for patients, with the majority recommending use of the brace for an inadequate period of time. The high costs and delays in acquisition of the brace and a lack of orthopedic stores able to adequately construct the orthotic, also present considerable barriers to sustained brace use. Conclusions Many of the causes of noncompliance with bracing protocol stem from systemic inequities and challenges, rather than a lack of collaboration from the families themselves. Furthermore, insufficient prescription of the brace by physicians may represent a major barrier to bracing compliance in southeastern Brazil. This research indicates a need to evaluate physician training and continuing medical education in order to ensure that physicians are adequately utilizing the brace.
Lewis E Zionts - One of the best experts on this subject based on the ideXlab platform.
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sixty years on Ponseti Method for clubfoot treatment produces high satisfaction despite inherent tendency to relapse
Journal of Bone and Joint Surgery American Volume, 2018Co-Authors: Lewis E Zionts, Edward Ebramzadeh, Rebecca D Morgan, Sophia N SangiorgioAbstract:Background:Developed at the University of Iowa in 1950, the Ponseti Method to manage idiopathic clubfoot deformity was slow to gain wide acceptance until the mid-1990s. There is a paucity of intermediate and long-term outcome studies involving this technique, with nearly all such studies coming from
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management of the relapsed clubfoot following treatment using the Ponseti Method
Journal of The American Academy of Orthopaedic Surgeons, 2017Co-Authors: Pooya Hosseinzadeh, Derek M Kelly, Lewis E ZiontsAbstract:The Ponseti Method to treat idiopathic clubfoot deformity has proven to be reliable, and several centers have reported excellent outcomes. Although the Method has been dependable in obtaining initial correction of the foot, relapse rates ranging from 26% to 48% have been reported. When a relapsed de
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management of the relapsed clubfoot following treatment using the Ponseti Method
Journal of The American Academy of Orthopaedic Surgeons, 2017Co-Authors: Pooya Hosseinzadeh, Derek M Kelly, Lewis E ZiontsAbstract:The Ponseti Method to treat idiopathic clubfoot deformity has proven to be reliable, and several centers have reported excellent outcomes. Although the Method has been dependable in obtaining initial correction of the foot, relapse rates ranging from 26% to 48% have been reported. When a relapsed deformity is detected early, treatment with a short series of manipulations and cast applications followed by resumption of postcorrective bracing may be all that is required to regain and maintain correction. In patients aged >2.5 years, especially those who may be refractory to further brace use, deformity correction by preoperative cast treatment, followed by anterior tibial tendon transfer to the third cuneiform, is a good treatment option. Other procedures, such as combined cuboid-cuneiform osteotomy, posterior ankle and subtalar release, and, rarely, comprehensive posteromedial release or correction by gradual distraction, may be useful in select patients.
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management of clubfoot relapses with the Ponseti Method results of a survey of the posna members
Journal of Pediatric Orthopaedics, 2017Co-Authors: Pooya Hosseinzadeh, Lewis E Zionts, Lori A Dolan, Gary M Kiebzak, Jose A MorcuendeAbstract:BACKGROUND Despite the high rate of initial success using the Ponseti Method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet. MethodS We created a survey to focus on the management of clubfeet after initial correction of deformity. The survey included questions on postcorrective bracing, clinical findings used to identify relapse, the observed frequency of relapsed deformity, and how relapses are managed. The questionnaire was approved by the POSNA Evidence Based Committee and was sent electronically to all POSNA members. RESULTS We received responses from 321 members (26%). Of those, 94% were fellowship trained in pediatric orthopaedics. The Ponseti Method was used by 98% of respondents. The Mitchell-Ponseti orthosis was most commonly used (51%), followed by the Denis-Browne brace (25%). The duration of bracing used varied among members with 23% recommending only 2 years, 33% recommending 3 years, and 34% recommending 4 years. A tight heel cord was felt to be the first sign of relapse by 59% of respondents, and dynamic supination by 30%. The rate of relapse was observed to be <10% by 22% of the respondents, 10% to 20% by 52%, and 20% to 40% by 25%. Manipulation and cast treatment alone (55%) and cast treatment with tenotomy (23%) were reported as the 2 most common initial treatment approaches for a relapsed deformity. Cast treatment to correct relapsed deformity before tibialis anterior tendon transfer was reported by 62% of respondents. Heel cord tenotomy (75%) and posterior capsular release (43%) were the 2 most common procedures used in addition to tibialis anterior tendon transfer for the treatment of clubfoot relapse. CONCLUSION This study highlights the wide variation with which clubfoot relapses are evaluated and treated among the POSNA membership with differences in the recommended duration of bracing, identification of relapses, and their management. These wide differences highlight the need for future research and educational programs to inform and standardize the management of clubfoot using the Ponseti Method. LEVEL OF EVIDENCE Not applicable.
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walking age of infants with idiopathic clubfoot treated using the Ponseti Method
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Lewis E Zionts, Davida F Packer, Shannon D Cooper, Edward Ebramzadeh, Sophia N SangiorgioAbstract:Background: The Ponseti Method is an established approach to treating idiopathic clubfoot in infants. The Method involves a period of cast immobilization and postcorrective bracing that potentially interferes with normal movements of the lower extremities. In the present study, we investigated the age at which infants who had idiopathic clubfoot treated using the Ponseti Method achieved independent walking. Methods: We prospectively evaluated patients of a single surgeon. Included in the study were all patients with idiopathic clubfoot who were full term at birth, were no more than twelve weeks of age at the start of treatment, had received no prior outside treatment, and were followed for a minimum of twenty-four months. Results: Ninety-four patients were included. The mean age at which patients began walking independently was 14.5 ± 2.6 months (range, ten to twenty-two months). By eighteen months, 90% of the patients were walking without assistance. Patients with moderate or severe clubfoot deformity began walking earlier than did patients with very severe deformity (a mean of 14.2 months compared with 15.8 months; p = 0.03). Patients who experienced a relapse before learning to walk began walking later than those who did not relapse (a mean of 15.9 months compared with 14.2 months; p = 0.04). Other patient and treatment-related variables had no significant influence on the onset of walking. Conclusions: On the basis of our findings, parents of infants with idiopathic clubfoot treated using the Ponseti Method may expect their child to achieve independent walking approximately two months later than infants without clubfoot deformity. A greater delay may be expected for those patients who have a very severe deformity or those who experience a deformity relapse. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Matthew B. Dobbs - One of the best experts on this subject based on the ideXlab platform.
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does strict adherence to the Ponseti Method improve isolated clubfoot treatment outcomes a two institution review
Clinical Orthopaedics and Related Research, 2016Co-Authors: Nancy H Miller, Patrick M Carry, Bryan J Mark, Glenn H Engelman, Gaia Georgopoulos, Sue Graham, Matthew B. DobbsAbstract:Despite being recognized as the gold standard in isolated clubfoot treatment, the Ponseti casting Method has yielded variable results. Few studies have directly compared common predictors of treatment failure between institutions with high versus low failure rates. We asked: (1) is the provider’s rigid adherence to the Ponseti Method associated with a lower likelihood of unplanned clubfoot surgery, and (2) at the institution that did not adhere rigidly to Ponseti’s principles, are any demographic or treatment-related factors associated with increased likelihood of unplanned clubfoot surgery? After institutional review board approval, a consecutive series of patients with a diagnosis of isolated clubfoot who underwent treatment between January 2003 and December 2007 were identified. At Institution 1, 91 of 133 patients met the eligibility criteria and were followed for a minimum of 2 years compared with 58 of 58 patients at Institution 2. At Institution 1, 16 providers managed care using a conservative casting approach based on the Ponseti Method. However, treatment was adapted by the provider(s). At Institution 2, one orthopaedic surgeon managed care with strict adherence to the Ponseti Method. Surgical indications at both institutions included the presence of a persistent equinovarus foot position while standing. A chart review was used to collect data related to proportion of patients undergoing unplanned additional treatment for deformity recurrences after Ponseti casting, demographics, and treatment patterns. The proportion of subjects who underwent unplanned major surgical intervention was greater (odds ratio [OR], 51.1; 95% CI, 6.8–384.0; p < 0.001) at Institution 1 (60 of 131, 47%) compared with Institution 2 (two of 91, 2%). There was no difference (p = 0.200) in the proportion of patients who underwent additional casting, repeat tendo Achilles lengthening, and/or anterior tibialis tendon transfer only (minor recurrence) at Institution 1 (nine of 131, 7%) compared with Institution 2 (11 of 91, 13%). At Institution 1, an increase in the number of revision casts (multiple vs no casts, hazard ratio [HR] = 3.9; 95% CI, 2.0–7.6; p < 0.001) and an increase in the number of cast-related complications (multiple vs no complications, HR = 2.8; 95% CI, 1.2–6.7; p = 0.019) were associated with increased risk of major surgery in the multivariate analysis. Rigid commitment to the Ponseti Method in the conservative treatment of patients with isolated clubfoot was associated with a lower risk of subsequent unplanned surgical intervention. In addition, clubfoot treatment programs that use a care model that prioritizes continuity in care and dedication to the Ponseti Method may decrease the proportion of patients who undergo unplanned surgical intervention. Level III, therapeutic study.
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early results of the Ponseti Method for the treatment of clubfoot associated with myelomeningocele
Journal of Bone and Joint Surgery American Volume, 2009Co-Authors: David Gerlach, Noppachart Limpaphayom, Farhang Alaee, Christina A Gurnett, Zhongli Zhang, Kristina Porter, Melissa Kirchhofer, Matthew D Smyth, Matthew B. DobbsAbstract:Background: Myelomeningocele is a common birth defect that is often accompanied by clubfoot deformity. Treatment of clubfoot associated with myelomeningocele traditionally has consisted of extensive soft-tissue release operations, which are associated with many complications. The purpose of the present study was to evaluate the early results of the Ponseti Method for the treatment of clubfoot associated with myelomeningocele. Methods: Sixteen consecutive patients with myelomeningocele (twenty-eight clubfeet) and twenty consecutive patients with idiopathic clubfeet (thirty-five clubfeet) were followed prospectively while being managed with the Ponseti Method. The average duration of follow-up was thirty-four months for the myelomeningocele group and thirty-seven months for the idiopathic group. Clubfoot severity was graded at the time of presentation with use of the Dimeglio system. The initial correction that was achieved, casting and/or bracing difficulties, recurrences, and subsequent treatments were evaluated and compared between the two cohorts by means of appropriate statistical analysis. Results: Eleven (39%) of the twenty-eight clubfeet in the myelomeningocele group were graded as Dimeglio grade IV, compared with only four (11%) of the thirty-five clubfeet in the idiopathic group (p = 0.014). Initial correction was achieved in thirty-five clubfeet (100%) in the idiopathic group and in twenty-seven clubfeet (96.4%) in the myelomeningocele group (p = 0.16). Relapse of deformity was detected in 68% of the feet in the myelomeningocele group, compared with 26% of the feet in the idiopathic group (p = 0.001). Relapses were treated successfully without the need for extensive soft-tissue release surgery for all but four of the clubfeet in the myelomeningocele group and for all but one of the clubfeet in the idiopathic group (p = 0.16). Conclusions: Our data support the use of the Ponseti Method for the initial treatment of clubfoot deformity associated with myelomeningocele, although attention to detail is crucial in order to avoid complications. Longer follow-up will be necessary to assess the risk of late recurrence and the potential need for more extensive clubfoot corrective surgery in this patient population. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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early results of the Ponseti Method for the treatment of clubfoot in distal arthrogryposis
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: Stephanie Boehm, Noppachart Limpaphayom, Farhang Alaee, Marc Sinclair, Matthew B. DobbsAbstract:Background: Clubfoot occurs in approximately one in 1000 live births and is one of the most common congenital birth defects. Although there have been several reports of successful treatment of idiopathic clubfoot with the Ponseti Method, the use of this Method for the treatment of other forms of clubfoot has not been reported. The purpose of the present study was to evaluate the early results of the Ponseti Method when used for the treatment of clubfoot associated with distal arthrogryposis. Methods: Twelve consecutive infants (twenty-four feet) with clubfoot deformity associated with distal arthrogryposis were managed with the Ponseti Method and were retrospectively reviewed at a minimum of two years. The severity of the foot deformity was classified according to the grading system of Dimeglio et al. The number of casts required to achieve correction was compared with published data for the treatment of idiopathic clubfoot. Recurrent clubfoot deformities or complications during treatment were recorded. Results: Twenty-two clubfeet in eleven patients were classified as Dimeglio grade IV, and two clubfeet in one patient were classified as Dimeglio grade II. Initial correction was achieved in all clubfeet with a mean of 6.9 ± 2.1 casts (95% confidence interval, 5.6 to 8.3 casts), which was significantly greater than the mean of 4.5 ± 1.2 casts (95% confidence interval, 4.3 to 4.7 casts) needed in a cohort of 219 idiopathic clubfeet that were treated during the same time period by the senior author with use of the Ponseti Method (p = 0.002). Six feet in three patients had a relapse after initial successful treatment. All relapses were related to noncompliance with prescribed brace wear. Four relapsed clubfeet in two patients were successfully treated with repeat casting and/or tenotomy; the remaining two relapsed clubfeet in one patient were treated with extensive soft-tissue-release operations. Conclusions: Our early-term results support the use of the Ponseti Method for the initial treatment of distal arthrogrypotic clubfoot deformity. Longer follow-up will be necessary to assess the risk of recurrence and the potential need for corrective clubfoot surgery in this patient population, which historically has been difficult to treat nonoperatively. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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results of the Ponseti Method in patients with clubfoot associated with arthrogryposis
The Iowa orthopaedic journal, 2008Co-Authors: Jose A Morcuende, Matthew B. Dobbs, Steven L FrickAbstract:Clubfoot associated with arthrogryposis has been traditionally considered very resistant to manipulation and casting, and therefore has required surgical correction. The purpose of this study was to evaluate the results of the Ponseti Method of clubfoot casting in this patient population. We reviewed the records of patients with clubfoot associated with arthrogryposis consecutively treated at our respective institutions from January 1992 to December 2004. All patients were treated by serial manipulations and casting following the principles of the Ponseti Method. Main outcome measures included initial correction of the deformity, relapses and the need for surgical releases or any other surgeries. Average age at last follow up was 4.6 years. There were 16 patients, all with bilateral deformities (32 clubfeet). there were 11 males and 5 females. Nine patients had both upper and lower extremity involvement. Seven patients had previous treatment elsewhere and one patient had an Achilles tenotomy. Initial correction was obtained in all but 1 patient. Average number of casts required for correction was 7 (range: 5 to 12). Average post-tenotomy dorsiflexion was 5 degrees. One patient required a posterior-medial release (PMR) for insufficient initial correction. Four cases required subsequent surgery for relapses (1 bilateral PMR with a repeat left PMR; 2 posterior releases (PR), 1 PR and anterior tibialis transfer (ATT), and 1 ATT). No talectomies were required. This study demonstrates that the Ponseti Method is very effective for the correction of patients with clubfoot associated to arthrogryposis. Although this deformity is more rigid than in idiopathic clubfoot, many cases can be corrected when started in the first few weeks after birth.
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use of the Ponseti Method for recurrent clubfoot following posteromedial release
Indian Journal of Orthopaedics, 2008Co-Authors: Sumeet Garg, Matthew B. DobbsAbstract:Background: A child with recurrent or incompletely corrected clubfoot after previous extensive soft tissue release is treated frequently with revision surgery. This leads to further scarring, pain and limitations in range of motion. We have utilized the Ponseti Method of manipulation and casting and when indicated, tibialis anterior tendon transfer, instead of revision surgery for these cases. Materials and Methods: A retrospective review of all children treated since 2002 ( n = 11) at our institution for recurrent or incompletely corrected clubfoot after previous extensive soft tissue release was done. Clinical and operative records were reviewed to determine procedure performed. Ponseti manipulation and casting were done until the clubfoot deformity was passively corrected. Based on the residual equinus and dynamic deformity, heel cord lengthening or tenotomy and tibialis anterior transfer were then done. Clinical outcomes regarding pain, function and activity were reviewed. Results: Eleven children (17 feet) with ages ranging from 1.1 to 8.4 years were treated with this protocol. All were correctable with the Ponseti Method with one to eight casts. Casts were applied until the only deformities remaining were either or both hindfoot equinus and dynamic supination. Nine feet required a heel cord procedure for equinus and 15 required tibialis anterior transfer for dynamic supination. Seven children have follow-up greater than one year (average 27.1 months) and have had excellent results. Two patients had persistent hindfoot valgus which required hemiepiphyseodesis of the distal medial tibia. Conclusion: The Ponseti Method, followed by tibialis anterior transfer and/or heel cord procedure when indicated, can be successfully used to correct recurrent clubfoot deformity in children treated with previous extensive soft tissue release. Early follow-up has shown correction without revision surgery. This treatment protocol prevents complications of stiffness, pain and difficulty in ambulating associated with multiple soft tissue releases for clubfeet.
Lars B Engesaeter - One of the best experts on this subject based on the ideXlab platform.
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Ponseti Method compared to previous treatment of clubfoot in norway a multicenter study of 205 children followed for 8 11 years
Journal of Children's Orthopaedics, 2016Co-Authors: Christian Saetersdal, Jonas M Fevang, Lars B Engesaeter, John Asle BjorlykkeAbstract:Abstract Purpose Despite few studies comparing Ponseti treatment and traditional treatment of clubfoot (talipes equinovarus), the Ponseti Method is now accepted as standard treatment for this deformity. The Ponseti Method was introduced in Norway in 2003 and the purpose of this multicenter-study was to compare the results of Ponseti treatment with the results of the previous treatment for clubfoot in Norway. Methods 90 children (134 clubfeet) treated with previous treatment (pre-Ponseti group), were compared to 115 Ponseti treated children (160 clubfeet) (Ponseti group). The previous treatment consisted of casting and surgery if needed. At 8–11 years of age, all children were examined by the same orthopaedic surgeon, the parents answered a questionnaire, all feet were X-rayed and information about surgical procedures was obtained from the patient records. Results The number of surgeries was higher in the pre-Ponseti group, and the number of extensive surgeries was 119 in the pre-Ponseti group compared to ...
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good results with the Ponseti Method a multicenter study of 162 clubfeet followed for 2 5 years
Acta Orthopaedica, 2012Co-Authors: Christian Saetersdal, Jonas M Fevang, Lars Fosse, Lars B EngesaeterAbstract:Background and purpose In 2002–2003, several hospitals in Norway introduced the Ponseti Method for treating clubfoot. The present multicenter study was conducted to evaluate the initial results of this Method, and to compare them to the good results reported in the literature. Patients and Methods 116 children with 162 congenital idiopathic clubfeet who were born between 2004 and 2006 were treated with the Ponseti Method at 8 hospitals in Norway. All children were prospectively registered at birth, and 116 feet were assessed according to Pirani before treatment was started. 63% used a standard bilateral foot abduction brace, and 32% used a unilateral above-the-knee brace. One of the authors examined all feet at a mean age of 4 years. At follow-up, all feet were assessed by Pirani’s scoring system, and range of motion of the foot and ankle was measured. Results At follow-up, 77% of the feet had a Pirani score of 0.5 or better, good dorsiflexion and external rotation, and no forefoot adduction. An Achilles ...
Christof Radler - One of the best experts on this subject based on the ideXlab platform.
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results of gait analysis including the oxford foot model in children with clubfoot treated with the Ponseti Method
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Gabriel T Mindler, Charlotte Lipkowski, Andreas Kranzl, Rudolf Ganger, Christof RadlerAbstract:Background The aim of the study was to evaluate how clubfeet treated with the Ponseti Method compare with control feet in gait analysis and whether additional information can be provided by the Oxford foot model. Methods All patients with a minimum age of three years in our prospective database of clubfeet treated with the Ponseti Method were considered for inclusion. Exclusion criteria were an associated syndrome or neurological disease, positional (slight) clubfoot, and presentation at an age of more than three months. Of the 125 patients with 199 clubfeet who satisfied the criteria, thirty-six (29%) agreed to participate in the study. Four of these were excluded because of insufficient gait analysis data, leaving thirty-two patients with fifty clubfeet for evaluation. Clinical examination and three-dimensional gait analysis including the Oxford foot model were performed, and a disease-specific questionnaire was administered. Kinetic and kinematic results were compared with those of an age-matched control group (n = 15). Results The mean score on the disease-specific questionnaire was 83.5. Gait analysis showed significantly decreased range of motion, plantar flexion, and power of the ankle compared with controls. The mean external foot progression angle of 5.7° in the Ponseti group was slightly less than that in the controls. Slight intoeing occurred in 24%, and 12% did not achieve a neutral position during swing phase. Slight compensation was observed, including external rotation of the hip in 28%. The Oxford foot model revealed differences in foot motion between the groups. Conclusions Clubfoot treatment with the Ponseti Method yielded good clinical results with high functional scores. Three-dimensional gait analysis demonstrated distinctive but slight deviations. Intoeing was less frequent and less severe compared with groups in the literature. We recommend the use of three-dimensional gait analysis, including a foot model, as an objective tool for evaluation of the results of clubfoot treatment. Level of evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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the Ponseti Method for the treatment of congenital club foot review of the current literature and treatment recommendations
International Orthopaedics, 2013Co-Authors: Christof RadlerAbstract:The Ponseti Method has become the gold standard of care for the treatment of congenital club foot. Despite numerous articles in MEDLINE reporting results from around the globe there are still crucial details of the Ponseti Method which seem to be less commonly known or considered. The Ponseti Method is not only a detailed Method of manipulation and casting but also of preventing and treating relapse. Recommendations on how to correct complex club foot have resulted in an almost 100 % initial correction rate. The foot abduction brace is crucial for preventing relapse and is still a challenge for families and sometimes doctors alike. Experience and knowledge on how to support the parents, how to set and apply the brace in the best possible way and how to solve problems that can be encountered during the bracing period are essential to ensure compliance. Regular follow-up visits are necessary to be able to detect early signs of recurrence and prevent full relapse by enforcing abduction bracing, recasting or performing tibialis anterior tendon transfer. Recent midterm outcome studies have shown that by following the Ponseti treatment regime in all aspects it is possible to prevent open joint surgery in almost all cases. The body of literature of the last decade has evaluated many steps and aspects of the Ponseti Method and gives valuable answers to questions encountered in daily practice. This review of the current literature and recommendations on the different aspects of the Ponseti Method aims to promote understanding of the treatment regime and its’ details.
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midterm results of the Ponseti Method in the treatment of congenital clubfoot
International Orthopaedics, 2013Co-Authors: Christof Radler, Gabriel T Mindler, Karin Riedl, Charlotte Lipkowski, Andreas KranzlAbstract:Purpose The Ponseti Method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery.