First Trimester Fetal Clubfoot: A Novel Presentation of Severe Osteogenesis Imperfecta.

Talipes equinovarus, also called clubfoot, is a relatively common congenital defect affecting approximately one in every 1000 live births. Most cases of clubfoot are expected to be idiopathic and unrelated to an underlying genetic syndrome. In approximately 20% of cases, a clear genetic etiology is identified. Here we present two cases of bilateral clubfoot identified via fetal ultrasound in the first trimester associated with osteogenesis imperfecta diagnosed in the second trimester. Both fetuses presented with multiple fractures and were identified to have loss-of-function variants in COL1A1. An association between clubfeet in the first trimester and osteogenesis imperfecta has not been previously reported to the best of our knowledge, which leads to unique opportunities for prompt diagnosis, genetic counseling and testing, and appropriate management.

[Physical self-concept and health perception in treated for congenital clubfoot]. / Autoconcepto físico y percepción de salud en pacientes tratados de pie equino varo aducto congénito.

BACKGROUND: the clubfoot is one of the most common pathologies in pediatric orthopedics. There are few studies of physical self-concept and perception of health in these patients. MATERIAL AND METHODS: observational, descriptive, and cross-sectional study. Population aged 16 to 18 years with the diagnosis of clubfoot. Being a sample of 55 patients, who underwent the SF-36, Laaveg-Ponseti Health Questionnaire, and the Physical Self-Concept Questionnaire. Evaluating physical abilities, physical condition, physical attractiveness. Presence of pain, general health, total function, emotional role, mental health, and satisfaction after treatment.There were 3 groups, according to the treatment received. Group 1, made up of 16 patients, treated only with the Ponseti method. Group 2 with 13 patients who received treatment with the Ponseti method, postero-medial release and osteotomies in the midfoot and/or hindfoot. And group 3 with 26 patients, who received postero-medial release and midfoot and/or hindfoot osteotomies. RESULTS: for the Laaveg-Ponseti questionnaire, comparing the score between the three groups, a statistically significant difference was found in group 1, with a higher score. In the Physical Self-Concept questionnaire and the SF-36 health questionnaire, no significant difference was found between the groups. CONCLUSION: the quality of life of patients with clubfoot are from excellent to good, no matter of the group to which they belonged. The state of physical and mental health by the SF-36 scale were fined. And physical self-concept evaluated was higher than the average. With these studies, we can expose a more comprehensive management. We find that the satisfaction of these patients will be fine in the future.

ANTECEDENTES: el pie equino varo aducto congénito es de las patologías más comunes en ortopedia pediátrica. Encontramos pocos estudios que investiguen el autoconcepto físico y percepción de salud en estos pacientes. MATERIAL Y MÉTODOS: estudio observacional, descriptivo y transversal. Población entre 16 a 18 años con el diagnóstico de pie equino varo aducto congénito. Siendo una muestra de 55 pacientes a quienes se les realizó el cuestionario de salud SF-36, Laaveg-Ponseti y el cuestionario de autoconcepto físico. Evaluando habilidades físicas, condición física, atractivo físico. Presencia de dolor, salud en general, función total, rol emocional, salud mental y satisfacción ante el resultado final obtenido posterior a tratamiento. Se crearon tres grupos de acuerdo con el tratamiento recibido. El grupo 1 integrado por 16 pacientes, tratamiento únicamente con método Ponseti. El grupo 2 integrado por 13 pacientes, quienes recibieron tratamiento con método Ponseti, liberación posteromedial (LPM) y osteotomías en mediopié y/o retropié. Y el grupo 3 integrado por 26 pacientes, quienes recibieron manejo con LPM y osteotomías de mediopié y/o retropié. RESULTADOS: para el cuestionario de Laaveg-Ponseti comparando el puntaje entre los tres grupos se encontró una diferencia estadísticamente significativa en el grupo 1, con un mayor puntaje. En el cuestionario de autoconcepto físico y el cuestionario de salud SF-36 no se encontró diferencia significativa entre los grupos. CONCLUSIÓN: la calidad de vida de un paciente con pie equino varo aducto congénito fue de excelente a buena sin importar el grupo al que pertenecían. El estado de salud física y mental valorado mediante escala de SF-36 se encuentra en un adecuado estado. Y el autoconcepto físico evaluado es superior a la media. Con estos estudios podemos llevar un manejo más integral. Encontramos que la satisfacción que tendrán a futuro estos pacientes puede ser adecuada.

Congenital Clubfoot: Difficulties in Maintaining the Use of the Dennis-Brown Orthosis by Caregivers.

Objective This study aimed to identify the main difficulties faced by the family when a child with congenital clubfoot (CC) uses the Dennis-Brown orthosis. Method This study interviewed via Google Forms caregivers of children treated from 2015 to 2018 regarding their difficulties in orthosis use. Results The answers revealed that orthosis-related difficulties are independent of the child's gender, age, or affected side. We noted that 41.7% of the respondents reported some difficulty, especially the child's irritation when using the orthosis (93.3%). Conclusion The main factor in CC relapses is poor adherence to orthosis use. As a result, studying factors causing or increasing the probability of interrupting orthosis use is significant in creating strategies to facilitate their use, potentially reducing CC recurrence.

Club Foot with Contralateral Congenital Amniotic Band Syndrome Amputation Successfully Treated with Ponseti Method: Case Report.

Introduction: Constriction amniotic band syndrome (CABS) is a rare condition associated with the fibrous amniotic bands that restrict and ensnare the fetus in utero resulting in malformations at birth in one per around 15,000 live births. CABS associated with clubfoot, historically required extensive soft-tissue release due to its propensity for relapse. Case Report: A 2-day-old Caucasian male infant born at 27 weeks gestation through emergency cesarean section due to concern for placental abruption and premature rupture of membranes in the setting of a prenatal history significant for oligohydramnios. The patient presented with non-viable tissue in the right leg requiring amputation with a left-sided clubfoot deformity. Following amputation of the right leg, the clubfoot was corrected with Ponseti method of serial casting and Achilles tenotomy. Three-week post-tenotomy and 6 months of age, a custom fit prosthesis of the right leg allowed for the application of a left abduction foot orthosis which maintained the correction. Conclusion: This case study supports recent literature that CABS-associated clubfoot can be corrected with the Ponseti method. While a contralateral amputation can prevent the use of a traditional bilateral abduction foot orthosis, a custom fitted prosthesis can allow for its use and prevention of a relapse of deformity.

A novel STAG1 variant associated with congenital clubfoot and microphthalmia: A case report.

The cohesin protein complex plays a vital role in various cellular processes such as sister chromatid cohesion, chromosome condensation, DNA repair, and transcriptional regulation. It is constituted by SMC1, SMC3, RAD21, STAG1/STAG2 subunits, and several regulatory proteins. Pathogenic variants in these components cause cohesinopathies, with common clinical features including facial dysmorphism, delayed growth, developmental delay, and limb anomalies. Pathogenic variants in the STAG1 contribute to an emerging syndromic developmental disorder with only 21 reported cases in the literature. We describe a 3-year-old girl presenting with congenital bilateral clubfoot and unilateral microphthalmia-clinical manifestations not previously reported in the literature. Whole exome sequencing revealed a novel de novo nonsense variant (c.1183C>T, p.(Arg395*)) in the STAG1, expanding the clinical and molecular spectrum of STAG1-related cohesinopathy. This patient's unique phenotype highlights the clinical diversity within cohesinopathies, emphasizing their relevance in cases of developmental delay and dysmorphic features. Further studies, including genotype-phenotype correlation analyses and functional investigations, are essential for enhancing our understanding of STAG1-related cohesinopathy.

Midterm clinical and radiological outcomes of arthrogryposis-associated clubfoot treated with the Ponseti method: a retrospective observational study and comprehensive literature review.

BACKGROUND: The treatment results of the Ponseti method for arthrogrypotic clubfoot have been described in only a few case series. Further evaluations are necessary. METHODS: Children from two German paediatric orthopaedic hospitals with arthrogryposis-associated clubfoot treated with the Ponseti method between 2004 and 2011 and who were at least five years of age at their last follow-up were retrospectively evaluated. The endpoints were the clinical foot position, necessary surgeries during the follow-up period and radiological constellations. A comprehensive literature review was conducted after a systematic literature search. RESULTS: Seventeen patients (47% with amyoplasia [AP] and 53% with distal arthrogryposis [DA]) met the inclusion criteria. Thirty-one feet were evaluated. The period between the treatment start and the last follow-up examination covered 8.9 ± 2.5 years. After the last cast removal within the initial Ponseti cast series, 74% of the clinical results were good to excellent. However, the clinical outcomes in the patients with AP were significantly worse. Overall, in 23 feet (74%), at least one major surgery at the age of 2.9 ± 2.2 years was necessary during the clinical course. Major surgeries were much more frequent on the feet of the patients with AP than with DA. Lateral X-rays showed normal age-appropriate radiological angles in 4% of the feet, hindfoot equinus in 19%, under-corrected hindfoot in 44%, under-corrected clubfoot in 26% and rocker bottom deformity in 7%. The radiological residual deformities in AP were much more severe than in DA (p = 0.042). Most of the studies reviewed (11 case series, 144 patients) reported high initial clinical correction rates, followed by high recurrence rates and the need for further surgeries. CONCLUSION: About a quarter of the arthrogrypotic patients benefited from the Ponseti therapy without further major surgery. However, the clinically observed high initial correction rate after Ponseti therapy of arthrogrypotic clubfoot was not accompanied by a correction of the bony foot position in the X-rays. The feet of the patients with DA had better outcomes than those of the patients with AP. Therefore, in outcome studies, a clear distinction between patients with AP and those with DA is necessary.

Psychosocial Impacts of Idiopathic Clubfoot on Parents and Children: A Scoping Review Protocol.

BACKGROUND/OBJECTIVES: Idiopathic clubfoot is a complex pediatric foot deformity. The Ponseti technique is widely regarded as the standard for correcting deformities, and treatment compliance is essential for preventing relapse. Examining psychosocial effects on parents and/or children during clubfoot treatment provides valuable insights for improving compliance. This scoping review will map the existing literature on the psychological and social effects experienced by parents and/or children with idiopathic clubfoot. It also aims to examine the assessment tools used to measure these impacts and identify factors influencing treatment compliance. METHODS: This review will adhere to the Joanna Briggs Institute (JBI) guidelines for scoping reviews. The search will include databases such as Scopus, Web of Science, EBSCOhost, MEDLINE, and PsycINFO and focus on studies published in the last 10 years. This review will include quantitative, qualitative, and mixed-method studies that investigate the psychological and social effects experienced by parents or affected children of any age with idiopathic clubfoot. Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension guidelines. The screening and data extraction process will involve two independent reviewers. The analysis will be descriptive and qualitative. RESULTS: The findings will be presented in tables and a narrative summary. CONCLUSION: This review may guide health practitioners in developing evidence-based interventions to improve treatment adherence.

Investigating clubfoot in Saudi Arabia: Prevalence, factors, and future directions.

This editorial discusses the significant findings and implications of the study conducted by Alomran et al. This retrospective study, soon to be published, provides valuable insights into the epidemiology of and risk factors associated with clubfoot in a specific Saudi population. By highlighting the study's key outcomes and discussing its broader implications for public health and clinical practices, this editorial aims to underscore the importance of continued research and targeted interventions in addressing congenital deformities such as clubfoot.

Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance.

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.

The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana.

Purpose: Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. Methods: A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. Results: High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. Conclusion: These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.

Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations - a systematic review.

PURPOSE: Review the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described. METHODS: A systematic review of the literature was performed with the keywords ''clubfoot'', ''Ponseti'' and ''anterior tibial''. Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included. RESULTS: Six studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small. CONCLUSION: Several options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle.

Prevalence and associated factors of clubfoot in the eastern province of Saudi Arabia: A hospital-based study.

BACKGROUND: Clubfoot, or congenital talipes equinovarus, is a widely recognized cause of disability and congenital deformity worldwide, which significantly impacts the quality of life. Effective management of clubfoot requires long-term, multidisciplinary intervention. It is important to understand how common this condition is in order to assess its impact on the population. Unfortunately, few studies have investigated the prevalence of clubfoot in Saudi Arabia. AIM: To determine the prevalence of clubfoot in Saudi Arabia via the patient population at King Fahad University Hospital (KFUH). METHODS: This was a retrospective study conducted at one of the largest hospitals in the country and located in one of the most densely populated of the administrative regions. RESULTS: Of the 7792 births between 2015 to 2023 that were included in the analysis, 42 patients were diagnosed with clubfoot, resulting in a prevalence of 5.3 per 1000 live births at KFUH. CONCLUSION: The observed prevalence of clubfoot was significantly higher than both global and local estimates, indicating a substantial burden in the study population.

The Co-occurrence of Cleft and Clubfoot: A Case Report on a Rare Medical Condition.

Cleft lip and palate (CLP) are complex deformities in craniofacial development that can range from isolated to syndromic presentations. This case presentation emphasizes the identification and early management of syndromic associations in patients with CLP. The report presents a unique case of a one-month-old female patient with complete unilateral CLP and clubfoot. The patient was comprehensively assessed, and a treatment plan was formulated. Presurgical nasoalveolar molding was done for the initial alignment of cartilages and alveolar bone. The treatment modalities for clubfoot are presented in the discussion. The following presentation emphasizes the characteristics of syndromic CLP and the importance of multidisciplinary therapy toward optimum patient care. This report underlines the role of coordinated efforts in managing the multifaceted needs of patients with complex congenital conditions to improve their overall well-being and quality of life.

Neglected Bilateral Clubfoot Clubhand Deformity.

Introduction: Neglected bilateral clubfoot clubhand deformity is a mesomelic type of dysplasia that is characterized by disproportionate shortness of the middle segment of all limbs and is a form of short-limb dwarfism. Affected individuals are clinically of normal stature with particularly short mesomelic segments with nearly symmetric limb abnormalities. Case Report: The patient was a 20-year-old male Indian who came to outpatient department for cosmetic purpose. Upper limb abnormalities include short forearm, and elbow joints which are broad and deformed with limited flexion-extension range of motion and decreased pronosupination of the forearms. The hands are normal in appearance. The foot is also affected and deformed. The fibulae are malformed and long in relation to the tibiae. Both bones, tibia, and fibula are dysplastic. The atypical foot deformity seen in this patient is characterized by a severe equinovarus component. He is able to do his activities of daily living and can do activities such as gripping, holding a pen/cup, opening a door, and writing on paper comfortably. He is able to walk normally without any support. This patient has normal stature, normal systemic examination, and normal chromosomes. Conclusion: The neglected bilateral clubfoot clubhand deformity a type of mesomelic dysplasia was the most likely diagnosis in our patient. Disorders involving Nievergelt syndrome and mesomelic dwarfism were considered but none were likely possibilities. Our patient had the malformed fibulae and tibiae, and the severe equinovarus deformity of the feet. There were triangular shaped ulnae which were deficient distally, and the radii were bowed. Unlike Nievergelt syndrome, our patient did not have a severe deformity of hands and fingers. He is functionally sound and able to do his activities of daily living and can do activities such as gripping, holding a pen/cup, opening a door, and writing on paper comfortably. He is able to walk normally without any support. These features have not been previously described in literature leading to our diagnosis of neglected bilateral clubfoot clubhand deformity.

Prevalence and Associations of Depression in Parents of Children With Congenital Talipes Equinovarus: A Single-Centre Study.

INTRODUCTION: Congenital talipes equinovarus (CTEV) is a congenital deformity that requires weekly visits to the hospital for manipulation and corrective cast application, followed by an intensive bracing regimen requiring multiple visits to the hospital spread over the years. Parents of children with clubfoot are known to undergo a range of negative emotions. The objective of this study was to identify the prevalence of depression and the factors associated with depression in parents of children with idiopathic CTEV. METHODS: This cross-sectional study consecutively enrolled 190 parents of children with idiopathic CTEV undergoing treatment at King George Medical University. Parents with conditions that preclude the assessment of mental status were not included. These conditions include a history of head injury or psychiatric illness, parents with ongoing treatment of psychiatric illness, ongoing chronic illness, chronic neurological disease, and parents with clinically established intellectual disability. Information was recorded on certain parent-related characteristics and certain child-related characteristics. Parent-related information included age and sex of the parent, religion, area of residence, number of children in the family, degree of perceived social support (using the Multidimensional Scale of Perceived Social Support, MSPSS), level of education, socio-economic status, depression subscale score of DASS 21 (Depression, Depression Anxiety, and Stress Scale -21), chronic pain (visual analogue scale, VAS), family history of clubfoot or depression, and level of stress caused by a major life event during the past year using the Presumptive Stressful Life Event Scale (PSLES). Child-related information included the sex of the child, phase of treatment (casting or bracing), limb involvement (unilateral or bilateral), relapse of the deformity, and Pirani score of the deformity. Bivariate analysis and logistic regression were used to identify factors associated with a score ≥10 on the depression subscale of DASS 21. RESULTS: One hundred forty-five subjects were males (76.3%). The mean age of the enrolled parents was 28.47±4.89 years. The mean score on the depression subscale of DASS-21 was 4.87±6.3. Thirty-two parents (16.8%) had a score of ≥10 on the depression subscale of the DASS-21. On bivariate analysis, female sex, being Hindu, having studied up to class 12th, relapse, MSPSS score, and PSLES score were found to be associated with a score ≥10 on the depression subscale of the DASS-21. On logistic regression, female sex, lack of graduate education and above, and MSPSS scores were found to be significantly associated with a score of ≥10 on the depression subscale of the DASS 21 score. CONCLUSION: The prevalence of depression in parents of children with idiopathic clubfoot was 16.8%. Female gender, lack of college education, and the level of perceived social support (MSPSS) are independently associated with a score ≥10 on the depression subscale of DASS 21. We recommend screening parents of children with clubfoot and referring those with abnormal scores to a psychiatrist for a confirmed diagnosis.

Prenatal diagnosis of a de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis and right clubfoot on prenatal ultrasound.

OBJECTIVE: We present prenatal diagnosis of de novo 10p12.1p11.23 microdeletion encompassing the WAC gene in a fetus associated with bilateral hydronephrosis on prenatal ultrasound. CASE REPORT: A 40-year-old, gravida 2, para 1, woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 46,XY. Level II ultrasound at 22 weeks of gestation revealed bilateral hydronephrosis and right clubfoot. At 23 weeks of gestation, repeat amniocentesis revealed the result of arr [GRCh37] 10p12.1p11.23 (26,182,512-29,826,276) × 1 dn with a 3.6-Mb microdeletion of 10p12.1p11.23 encompassing the genes of MYO3A, GAD2, APBB1IP, PDSS1, ABI1, ANKRD26, YME1L1, MASTL, ACBD5, PTCHD3, RAB18, MKX, ODAD2, MPP7, WAC and BAMBI. The pregnancy was subsequently terminated, and a malformed fetus was delivered with facial dysmorphism of low-set ears, broad forehead and flat nasal bridge. Array comparative genomic hybridization (aCGH) analysis of umbilical cord confirmed a 3.6-Mb 10p12.1p11.23 microdeletion encompassing WAC. CONCLUSION: Application of aCGH is useful in the pregnancy with a normal fetal karyotype and abnormal fetal ultrasound.

Management outcome of congenital talipes equinovarus (clubfoot) using Ponseti protocol at Lagos University Teaching Hospital.

Background: Idiopathic clubfoot occurs commonly in children with a prevalence of 1 in 1000. The Pirani scoring system, which consists of a midfoot contracture score and hindfoot contracture score, is traditionally used in assessing the severity of clubfoot deformity. Ponseti protocol is used in the management of clubfoot deformity. The study aimed to evaluate the outcome of the management of clubfoot using the Ponseti protocol and to correlate the outcome with the initial Pirani score. Materials and Methods: Eighty-two children aged 1 week-2 years with 128 idiopathic clubfeet were recruited into the study. The severity of their clubfoot deformities was scored using the Pirani scoring system on recruitment. They were managed with weekly serial manipulation and cast application with or without tendon-Achilles tenotomy according to Ponseti protocol. Results: The average initial Pirani score was 3.6 ± 0.9. The average number of casts used was 5.9 ± 1.3 (range: 4-9 casts). Tenotomy was done in 51.56% of the feet. The group that required tenotomy required more casts and as such longer duration of treatment than the "no tenotomy" group. There was a relapse rate of 2% in the feet of the compliant group, whereas the relapse rate was 69% in the group that was not compliant with the use of foot-abduction brace. The success rate at 6 months follow-up was 84.4%. Conclusions: Ponseti protocol is an excellent method of management of idiopathic clubfoot, and the Pirani scoring system was useful in assessing the initial severity and the outcome. The initial Pirani score correlates with the duration of treatment.

Kite Versus Ponseti Method in the Treatment of Idiopathic Congenital Clubfoot: A Systematic Review and Meta-Analysis.

Kite and Ponseti methods are two popular manipulating methods for correcting the deformity of idiopathic congenital clubfoot. We aimed to compare the efficacy of Kite and Ponseti methods in the treatment of children with idiopathic congenital clubfoot. A search was launched on Medline/PubMed, Cochrane Central Register of Controlled Trials, the Web of Science, ProQuest, and Scopus without limits, from inception to May 1, 2024. The outcomes included the rates of initial correction and relapse (primary) as well as the number of casts and duration of treatment (secondary). Mean difference (MD) and risk ratio (RR) were calculated for numerical and dichotomous outcomes, respectively, with 95% confidence intervals (CIs). Nine studies were included. Meta-analysis showed the Ponseti method is significantly associated with a higher probability of correction (n = 6, RR = 1.23 [95% CI = 1.14, 1.32], p < 0.001) and a lower risk of relapse (n = 5, RR = 0.50 [95% CI = 0.36, 0.71], p < 0.001) compared to the Kite method. The Ponseti method utilized a lower number of casts (MD = -3.0 [95% CI = -5.8, -0.2], p = 0.04) and took a shorter duration (MD = -39.76 [95% CI = -67.22, -12.30], p = 0.02) than the Kite method. Evidence suggests that the Ponseti method results in better outcomes than the Kite method in terms of successful initial correction and lower relapse rates. However, the available studies showed varying degrees of risk of bias, and the length of follow-up was inadequate in some studies.

Parent reported outcomes for idiopathic clubfoot children treated with the Ponseti technique: An analysis of 140 feet followed minimum 5 years.

Objective: The treated clubfoot children are often evaluated clinically during follow-up. However, patient reported outcomes (PROM) are seldom analysed for these children. We investigated 87 idiopathic clubfoot children (140 feet) treated by the Ponseti method and followed minimum 5 years to study their clinical outcomes and PROM. Material and methods: This was a cross-sectional study, based on evaluating treated clubfoot children clinically (Pirani score) and PROM (Oxford Ankle and Foot Questionnaire - Parent Version) and comparing them with the age-matched healthy controls (n = 60). The questionnaire has four main domains related to the child's physical, school and play, emotional and footwear profile. The children having persistent deformity (residual/relapse) were specifically studied for their PROM scores. Results: The mean child age at initial treatment was 2.3 months and the mean follow-up duration was 6.9 years. The PROM score of clubfoot children was statistically lower than the healthy controls (p < 0.001). Of the individual domains, the physical domain was the most affected. On calculating the Pirani scores, 10 out of 140 feet (7 %) had some form of persistent deformity. The children with persistent deformity had lower Oxford scores than healthy children or those with corrected feet. The physical domain followed by the emotional domain scored low when persistent deformity was present. Conclusions: Most children (98 %) had a plantigrade foot following Ponseti treatment at follow-up. However, PROM score of the clubfoot children did not correspond to the clinical outcome. Persistent deformity, even minor, was a cause of parental concern and resulted in a low PROM score.

Prevalence and pattern of congenital clubfoot among less than 5-year-old children in Ethiopia; cross-sectional based study.

BACKGROUND: Clubfoot is one of the most common congenital malformations, but it is also one of the most neglected public health problems among less than five-year-old children, mainly in middle- and low-income countries. Approximately 80% of clubfoot cases are found in low- and middle-income countries. In this study setting, no epidemiological studies have been conducted to assess clubfoot deformity. Due to this gap, the study aimed to assess prevalence, and pattern of congenital club foot among less than 5-year-old children. MATERIALS AND METHODS: An institutional-based cross-sectional study was carried out at Black Lion Specialized Hospital at the pediatric orthopedic clinic. The sample size was 261 to determine the prevalence and pattern of congenital clubfoot. Terms like frequency, percentage, and mean were used for data presentation. RESULT: A total of 36,303 pediatric patients visited Black Lion Specialized Hospital during the study period, and clubfoot prevalence was 7.2 per 1000. The largest subclassification of congenital clubfoot was idiopathic clubfoot, which accounted for 6.2 per 1000, whereas syndromic clubfoot was 0.3 per 1000, and neuropathic clubfoot was shared at 0.36 per 1000. Most of the cases in this study were bilateral clubfoot, with males having more dominance. CONCLUSION: In the area under investigation, a significant prevalence of congenital clubfoot was observed, especially among male children. The majority of cases were bilateral, with idiopathic clubfoot being the dominant form.