Accelerated Ponseti method: First experiences in a more convenient technique for patients with severe idiopathic club feet |
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| Affiliation: | 1. Faculty of Medicine and Health Sciences, An-Najah National University , P.O. box 3985, Ramallah, Palestine;2. Faculty of Medicine and Health Sciences, An-Najah National University, Palestine;1. Dept of Orthopedic Surgery, UAB School of Medicine, 1802 6th Avenue South, Birmingham, AL, 35233, USA;2. Dept of Orthopedic Surgery, UAB School of Medicine, 1201 11th Ave, Birmingham, AL, 35294, USA;1. Assiut University, Orthpaedic Department, Assiut, Egypt;2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA;3. Department of Radiology, Passavant Hospital, Pittsburgh PA, USA;4. Orthopedic Partners, Pittsburgh PA, USA;5. Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA;6. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA;7. Orthopaedic Biomechanics Laboratory, Allegheny General Hospital, Pittsburgh, PA, USA;1. Laboratory of Morphology, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulianova Street, 640014 Kurgan, Russian Federation;2. Laboratory of Bone Infection Osteology and Limb Lengthening, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulianova Street, 640014 Kurgan, Russian Federation;3. Dept. of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences – Prasanthigram, Puttaparthi, Andhra Pradesh, 515134 India;1. Department of Orthopaedics, Hospital Dr. José de Almeida, Cascais, Portugal;2. NOVA Medical School, Lisbon NOVA University, Portugal;3. Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain;4. Director of the Department of Orthipaedics, Hospital Dr. José de Almeida, Cascais, Portugal;5. Vice Dean – Education NOVA Medical School, Lisbon NOVA University, Portugal;6. Director of the Orthopedic Department at CHLO – S F Xavier Central Hospital, Lisbon, Portugal;7. Professor of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada;8. Department of Orthopaedics, Clinica del Remei, Barcelona, Spain;1. Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea;2. Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea |
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| Abstract: | BackgroundCongenital Idiopathic Talipes Equinovarus (CTEV), or clubfoot, is a complex deformity that involves pathological anatomy in the foot with ankle equinus, hindfoot varus, midfoot cavus and forefoot adductus [1]. Universal agreement is established about Ponseti technique as the initial management for this deformity. This preliminary study aims to investigate the possibility of having a braceable foot through a proposed accelerated Ponseti method by which, manipulations, 5 castings and Achilles tendon tenotomy are implemented in a week.MethodsThis study included 11 patients with 16severe congenital idiopathic clubfeet treated by an accelerated Ponseti method. The method involves manipulation of the deformed foot, and 1st casting in one day, with the 2nd, 3rd, 4th, 5th castings in the 4th, 5th, 6th, 7th day post-manipulation. After the 4th cast removal, Achilles tenotomy was performed with subsequent three-week casting for all patients. Nonparametric tests were used for comparing the Pirani scores before starting the treatment and after removal of final cast.ResultsFive patients had bilateral club foot deformity. Average age at treatment was 54.8 days (range 8–150 days). All patients, who had severe congenital idiopathic club feet with a Pirani score of 6, underwent the accelerated Ponseti technique. After removal of the three-week cast, the scores median was 0.59, (range 0–1.5), indicating a correction of the deformity and having braceable feet in all patients without experiencing any short-term complication.ConclusionsThe first step accelerated Pnoseti technique was found to be safe and effective for initial correction of severe idiopathic clubfoot deformity in children below three months of age , though it is an initial study that needs more studies with more follow up data. |
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| Keywords: | Idiopathic congenital clubfoot Accelerated Ponseti technique Pirani score |
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