The infant with a clubfoot and amniotic bands: a comprehensive understanding and the role of the Ponseti method.

Amniotic band syndrome (ABS) and clubfoot are distinct congenital musculoskeletal conditions that can occasionally co-occur, creating unique challenges in their management. This paper summarizes the comprehensive discussion on the management of amniotic band syndrome (ABS) and clubfoot, emphasizing the critical role of the Ponseti method and the challenges faced in treatment, thereby providing a basis for further research and improved patient care.

El síndrome de banda amniótica (ABS) y el pie zambo son afecciones musculoesqueléticas congénitas distintas que ocasionalmente pueden coexistir, creando desafíos únicos en su manejo. Este artículo resume la discusión exhaustiva sobre el tratamiento del síndrome de bandas amnióticas (ABS) y el pie zambo, enfatizando el papel fundamental del método Ponseti y los desafíos que enfrenta el tratamiento, proporcionando así una base para futuras investigaciones y una mejor atención al paciente.

Multiple Serial Casting for Recurrent Clubfoot in Arthrogryposis Corrects Deformity With Diminishing Returns.

PURPOSE: Arthrogryposis multiplex congenita (AMC) consists of more than 400 conditions involving severe joint contractures of at least two or more body regions. Management of clubfoot in patients with AMC is notoriously challenging, with a higher likelihood of recurrence than idiopathic clubfoot, which can be treated using the Ponseti technique to avoid or delay more invasive procedures. The purpose of this study is to determine the utility of multiple serial casting as a treatment of clubfoot in AMC using Pirani scores as an objective measure of deformity. METHODS: Pirani scores were retrospectively collected from 17 AMC patients with a total of 30 clubfeet and two years follow-up from initiation of treatment. Patients with a minimum of three casting series were included. Pre-treatment and post-treatment deformity scores were examined across casting series using analysis of variance (ANOVA) statistical analysis. RESULTS: The first series pre-treatment Pirani score improved from 4.80±1.54 to 1.68±1.48 (p<0.001). The second series improved from 4.23±1.03 to 2.72±0.916 (p<0.001). The third series had the smallest improvement from 3.87±1.07 to 2.82±1.02 (p<0.001). Change in Pirani scores showed a significant decrease from the first series to the second (p=0.001) and third (p<0.001). In addition, the number of casting days was found to significantly affect the change in scores during the third series (p=0.038). CONCLUSIONS: The Ponseti technique can improve clubfoot in AMC as measured by the Pirani score. Data shows that early intervention yields better results, with a diminished yet effective ability to elicit change over time.

Can the Achilles tendon regenerate completely following percutaneous tenotomy in older children with clubfoot?

PURPOSE: The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. METHODS: A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. RESULTS: Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1-10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0-25°) and mean plantarflexion range of 37.95° (10-40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17-30) and mean height of heel rise of 6.29 cm (range 4-10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3-16 mm) and thickness of 5.1 mm (1.8-15 mm), comparable with unaffected feet. CONCLUSIONS: Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles.

Radiographic Impact on the Clinical Decision Making of Achilles Tenotomy in Clubfoot: In Search of an Objective Cut-Off Value.

BACKGROUND: We tried to determine whether the indication of Achilles tenotomy (AT) in clubfoot patients based on clinical evaluation could be confirmed radiographically, and to find an objective radiographic cut-off value for its indication. METHODS: Eighty-six clubfeet from 60 patients, (26 bilateral and 34 unilateral) were included. A standard Ponseti treatment regimen was applied. Group 1 comprised patients who underwent AT immediately after serial plaster casting (26 feet). Group 2 comprised patients who underwent AT during the follow-up period (48 feet). Group 3 comprised patients who were assumed to have a corrected foot and did not undergo AT (12 feet). Group 4 comprised the healthy sides of the unilateral cases (34 feet). RESULTS: Both Group 1 and Group 2 showed significant improvement after tenotomy (p = 0.002). In order to differentiate between the normal and AT groups according to the pre-tenotomy angle, we obtained an optimal cut-off value of >85° according to the Youden index, a sensitivity of 96%, a specificity of 91.2%, a positive predictive value of 95.9%, a negative predictive value of 91.2%, and an accuracy rate of 94.4% (AUC: 0.983; p < 0.001). CONCLUSIONS: Feet with a lateral tibio-calcaneal angle > 85° can be considered pathologic and accepted as candidates for AT.

The Efficacy of the Ponseti Method in the Management of Clubfoot: A Systematic Review.

Clubfoot is a congenital abnormality of the lower extremities, and it may be unilateral or bilateral. Left untreated, it may lead to issues with walking. Additionally, inappropriate treatment or the lack of treatment can result in functional damage. The goal of clubfoot treatment is to correct the deformities of the involved components. The Ponseti method has been regarded as the gold standard for the treatment of clubfoot as it is safe and effective. In this review, we aimed to assess the success of the Ponseti method in the treatment of clubfoot by reviewing the previous studies on this subject. We searched electronic databases, including PubMed, Scopus, Science Direct, and Google Scholar, for relevant articles spanning the period from 2018 to 2023. The keywords used in the search were "Ponseti method, Treatment, Outcomes, Success, Relapse, Failure, and Rates." The inclusion criteria were original articles in English on clubfoot patients treated with the Ponseti method. While our search yielded a total of 1,037 articles, only nine were deemed eligible for analysis based on the inclusion criteria. The articles involved a total of 537 feet of 358 patients and the age of the patients ranged from one day to five years. The success rate ranged between 55% and 100%, and the relapse rate ranged between 3.2% and 34.2%. Based on our findings, the Ponseti method has a high success rate in the treatment of idiopathic clubfoot, and hence it is an excellent conservative method of treatment. However, there are additional factors that may affect the treatment outcomes, which need to be taken into account.

Application of pedobarographic analysis in neglected congenital clubfoot patients following Ponseti treatment for recurrence prediction.

Background: Neglected congenital clubfoot (NCCF) is a birth deformity that remains untreated until the child begins to walk. Irrespective of the treatment protocols employed, children with NCCF face an elevated risk of recurrence following the initial correction. Predicting this recurrence could enable early intervention for high-risk children, ultimately diminishing the likelihood of invasive surgery. Methods: From January 2006 to January 2022, a total of 33 unilateral NCCF patients were enrolled in this study at Xijing Hospital. Pedobarographic tests were performed at three distinct time points: after the initial Ponseti treatment, before recurrence treatment, and after recurrence treatment. Four derivative parameters were developed for predicting recurrence, namely the difference of the contact time% (DCT%), difference of the contact area% (DCA%), difference of the peak pressure (DPP), and difference of the pressure-time integral (DPTI) between the two feet. ROC curves, Kaplan-Meier survival analysis, and Cox regression were employed to identify potential prognostic factors. Results: Out of the 33 unilateral NCCF patients, recurrence occurred in 8 individuals, with an average follow-up period of 109.8 months. The predictive parameter for recurrence is the midfoot (MF) zone's DCT% (MF-DCT%). When the contact time (CT)% of the affected side was 20.69% higher than that of the unaffected side, the hazard ratio (HR) of recurrence increased by 7.404 times. Another predictive plantar pressure parameter is the DPP in the MF zone (MF-DPP). If the PP of the affected side was 159% higher than that of the unaffected side, the HR of recurrence increased by 9.229 times. The MF-DCT% and MF-DPP of recurrence patients were assessed at three time points for comparisons, further validating their predictive ability for recurrence. Conclusion: Although satisfactory clinical outcomes were achieved in patients with unilateral NCCF after the initial Ponseti treatment, the plantar pressure distribution does not return to normal levels, which may indicate future recurrence. DCT% and DPP in the MF zone can be used as plantar pressure predictors of recurrence in patients with NCCF.

Investigating the association between vitamin D dietary intake during pregnancy and incidence of clubfoot in neonates.

AIMS: Talipes equinovarus (clubfoot) is a congenital lower foot deformity that results from a neuromuscular deficiency, but the precise etiology remains elusive. Vitamin D is important for fetal neuromuscular development. In this study, we investigated the association between dietary vitamin D intake during pregnancy and incidence of clubfoot in neonates, since such a question has thus far been overlooked. METHODS: We conducted a secondary analysis of data collected in the United States, between 2007 and 2011 for a case-control study of children born with clubfoot. Participating mothers were interviewed by telephone about dietary and other health and life-style indicators. Exposure to vitamin D was recorded as the average daily intake of dietary vitamin D over a period of 6 months before pregnancy began. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. RESULTS: The dataset included 2667 study participants, of which 663 were cases. Logistic regression showed no significant association between dietary vitamin D or log10 (Vitamin D) intake during pregnancy and incidence of clubfoot in neonates (OR = 1.00, CI = 1.00-1.00, OR = 1.51, CI = 0.83-2.82, respectively). No interaction in the regression model was found between vitamin D and other predictor variables. Results were not confounded by supplement intake of vitamin D during pregnancy. CONCLUSIONS: Results show no evidence of an association between dietary vitamin D intake and incidence of clubfoot in neonates. The lack of association is not confounded by consumption of vitamin D supplements during pregnancy.

A single-center, single-blinded, randomized, parallel-group, non-inferiority trial to compare the efficacy of a 22-gauge needle versus a 15 blade to perform an Achilles tendon tenotomy in 244 clubfeet-study protocol.

BACKGROUND: Achilles tendon tenotomy is an integral part of the Ponseti method, aimed at correcting residual equinus and lack of dorsiflexion after correction of the adductus deformity in clubfoot. Percutaneous tenotomy using a number 15 scalpel blade is considered the gold standard, resulting in excellent results with minimal complications. The use of a large-bore needle to perform Achilles tendon tenotomies has been described in literature, but a large-scale randomized controlled trial is currently lacking. In this trial, we aim to show the non-inferiority of the needle tenotomy technique compared to the gold standard blade tenotomy technique. METHODS: We will randomize 244 feet into group A: needle tenotomy or group B: blade tenotomy. Randomization will be done using a block randomization with random block sizes and applying a 1:1 allocation to achieve an intervention and control group of the exact same size. Children will be evaluated at 3 weeks and 3 months post-tenotomy for primary and secondary clinical outcomes. The primary clinical outcome will be the range of dorsiflexion obtained the secondary clinical outcomes will be frequency of minor and major complications and Pirani score. The non-inferiority margin was set at 4°, and thus, the null hypothesis of inferiority of the needle technique will be rejected if the mean difference between both techniques is less than 4°. The statistical analysis will use a multi-level mixed effects linear regression model for the primary outcomes and a multi-level mixed effects logistic regression model for the secondary clinical outcomes. The physician performing the evaluations post-tenotomy will be the only one blinded to group allocation. TRIAL REGISTRATION: This trial was registered prospectively with ClinicalTrials.gov registration number: NCT04897100 on 21 May 2021.

Assess perception, practice and lived experiences on use of corrective braces among parents of children diagnosed with clubfoot: A mixed method study.

BACKGROUND: Congenital talipes equinovarus (CTEV) is a congenital musculoskeletal deformity, which further leads to abnormal alignment of the feet in children. The aim of the present study is to assess perception and practice and explore lived experiences on the use of corrective braces among parents of children diagnosed with clubfoot. MATERIAL AND METHODOLOGY: A mixed method study approach with convergent parallel research design was used on 100 parents of children with clubfoot. For the quantitative strand, a total enumerative sampling technique was used to collect the data using self-structured tools-a 5-point Likert scale on perception and a checklist on practice at the clubfoot clinic of a selected tertiary care hospital, Rishikesh. For the qualitative strand, a purposive sampling technique was used to conduct the in-depth interview until data saturation from 17 participants using a semi-structured questionnaire. Analysis was done using the SPSS 23.0 software, descriptive statistics with the use of frequency %, whereas for correlation, Pearson's correlation coefficient was used. RESULTS: The mean age of participants was 31 years with a mean score of 30.54 ± 4.97. Among parents, 93% showed positive perception with a mean score of 67.16 ± 6.23 and 64% followed appropriate practice with a mean score of 12.44 ± 1.45. Coefficient correlation showed a statistically weak positive correlation between perception and practice (P < 0.001). The lived experiences of parents were reflected under six main themes, i.e., "personal experiences with wearing braces for correction," "encounters and barriers," "effects on one's social and personal life," "perceived answers," "any other previous practice," and "awareness about clubfoot." CONCLUSION: Present study concluded that parents had a positive perception and appropriate practice on the use of corrective braces, but there were a few issues such as relapse due to non-adherence, financial burden, and traveling distance, and noticeably more, which need to be addressed. Parental information is a very essential component that should be addressed by all treating physicians and nursing officers before starting treatment for clubfoot.

Neglected Clubfoot- a Community Health Challenge in Rural Odisha, India.

Introduction: Neglected clubfoot deformities are very rigid & stiff that need surgical correction. Unlike countries like china, Uganda, and Malawi, no dedicated National program has been implemented for clubfoot management in India. The burden of disability from untreated or partly treated clubfoot is relatively high. With the existing issues, it has been observed that untreated clubfoot is a public health problem in most low and middle-income countries. Objective: To conduct an observational analysis of the community approach to the correction of neglected clubfoot by corrective rehabilitation surgery camps. Methods: The study included the retrospective data of all the neglected clubfoot children who had undergone clubfoot corrective surgery in 13 different remote districts of Odisha, held every year between February 2014 to October 2022 except during covid 19 pandemic period (2020 and 2021). A total of 993 clubfeet of 731 children were corrected through community approach-based corrective camp surgery. Follow-up was done for all the operated children with post-op plaster and orthosis till they returned back to the community. Results: About 46.78% of study participants were within the age group of 5 years. Male presentation [454 males (62.10%)] was reportedly found 1.6 times higher than the female [277 females (37.89%)]. Most of them belonged to minor communities, socially and economically backward classes from various rural districts of eastern India. The Association of different socially backward categories of clubfoot children with the district they belonged to, was found significant statistically (p value < 0.001). When gender distribution was compared among the district where surgical camps were conducted, the association was statistically not significant (p value = 0.676). Conclusion: Neglected clubfoot in rural areas can be managed by camp approach. The establishment of a robust standard operating procedure for the conduction of community-based surgical camps may be required to reduce the morbidity level in children with neglected clubfoot.

Treating Older Children with Clubfoot: Results of a Cross-Sectional Survey of Expert Practitioners.

Treating clubfoot in walking-age children is debated, despite studies showing that using the Ponseti casting principles can correct the midfoot effectively. We aimed to explore techniques and approaches for the management of older children with clubfoot and identify consensus areas. A mixed-methods cross-sectional electronic survey on delayed-presenting clubfoot (DPC) was sent to 88 clubfoot practitioners (response rate 56.8%). We collected data on decision-making, casting, imaging, orthotics, surgery, recurrence, rehabilitation, multidisciplinary care, and contextual factors. The quantitative data were analysed using descriptive statistics. The qualitative data were analysed using conventional content analysis. Many respondents reported using the Pirani score and some used the PAVER score to aid deformity severity assessment and correctability. Respondents consistently applied the Ponseti casting principles with a stepwise approach. Respondents reported economic, social, and other contextual factors that influenced the timing of the treatment, the decision to treat a bilateral deformity simultaneously, and casting intervals. Differences were seen around orthotic usage and surgical approaches, such as the use of tibialis anterior tendon transfer following full correction. In summary, the survey identified consensus areas in the overall principles of management for older children with clubfoot and the implementation of the Ponseti principles. The results indicate these principles are well recognised as a multidisciplinary approach for older children with clubfoot and can be adapted well for different geographical and healthcare contexts.

Conventional Versus Accelerated Ponseti in the Management of Cases of Idiopathic Clubfoot: A Systematic Review and Meta-Analysis.

This study aimed to compare the outcomes of the accelerated and standard Ponseti method for clubfoot pathology by constructing a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted to identify the relevant studies through PubMed, Google Scholar, and Cochrane depending on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keywords used included "accelerated" AND "standard" AND "Ponseti" AND "clubfoot" AND "Congenital Talipes Equinovarus" AND "CTEV" AND "prospective comparative design" AND "randomized trial." We conducted this analysis among 13 studies that met the criteria adopted in this review where eight studies were prospective comparative studies, and five studies were randomized prospective comparative studies which were published in the period between 2015 and 2022. Statistically, accelerated Ponseti showed superior impact over standard Ponseti considering the duration of treatment (22.53 days vs. 40.61 days, p<0.001). No significant difference was reported between the two methods considering final Pirani score (0.64 vs. 0.56, p=0.194), number of casts (5.23 vs. 5.25, p=0.425), rate of tenotomy (66.2% vs. 63.1%, OR=1.246, 95% CI: 0.86-1.80, p=0.245), relapse rate (9.51% vs. 8.54%, OR=1.126, 95% CI: 0.68-1.86, p=0.642) and complication rate (14.4% vs. 13.1%, OR=1.130, 95% CI: 0.58-2.19, p=0.717). We concluded that the accelerated Ponseti method could achieve comparable efficacy to the standard method in terms of post-procedure Pirani score, tenotomy rate, relapse rate, complications rate, and number of casts needed by the patients with advantage of requiring shorter duration of treatment which is associated with more patient's compliance.

Factors Related to Relapse of Congenital Talipes Equinovarus (CTEV) After the Ponseti Method.

BACKGROUND: Congenital talipes equinovarus (CTEV) is one of the common congenital disorders in pediatric orthopedic practice that affects a large group of children.It is a combination of four parts of deformity that affect either a single foot or both feet. Our aim in this study is to estimate the prevalence and incidence of CTEV and to evaluate the risk factors that lead to relapse in some children to avoid relapse in future and complex surgical interventions, as well as to improve the final outcome. MATERIALS AND METHODS: A retrospective cohort study for the cases of CTEV was conducted to estimate the prevalence of relapse in children with CTEV after management by the Ponseti method and to evaluate the risk factors that lead to recurrence. RESULT: The study includes 103 patients with CTEV, and only 22 patients had relapse. The prevalence rate of relapsed cases was 20.4%, and the incidence was 42 per thousand. The average number of casts applied was 4.05 ± 1.37. The average severity of the deformity that was measured by the Pirani score was 4.97 ± 1.21. The most common atypical presentation of CTEV was associated with developmental dysplasia of the hip (DDH), followed by myelomeningocele (MMC). CONCLUSION: The only significant factors in the study were the Pirani score and non-compliance of the brace with p < 0.05. There was not any significance in the correction of the deformity by Ponseti between idiopathic and non-idiopathic CTEV based on the number of casts and the Pirani score. The dynamic foot brace can be the solution for the high recurrence rate, yet more studies are needed in the future.

Congenital Talipes Equinovarus Management and Outcomes: The Experiences of Pediatric Tertiary Centers in Abha, Saudi Arabia.

BACKGROUND: Congenital talipes equinovarus (CTEV), also known as clubfoot, describes a range of foot abnormalities usually present at birth (congenital) in which a baby's foot is twisted out of shape or position. In clubfoot, tendons are shorter than usual. Clubfoot is a fairly common birth defect and is usually an isolated problem for an otherwise healthy newborn. AIM: This study aimed to investigate the experiences of pediatric tertiary centers in Abha, Saudi Arabia, regarding the management, frequency, treatment options, and outcomes of CTEV. METHODS: A retrospective chart review of pediatric patients with clubfoot was conducted to evaluate the number of cases, treatment options, and outcomes at Abha Maternity and Children Hospital and Khamis Mushait Maternity and Children Hospital. Data were extracted independently using prestructured data extraction forms. The collected data included demographic and medical information, family history, clinico-epidemiological information, risk factors, management options, and complications of clubfoot. RESULTS: The study included 89 children with CTEV from the target hospitals. Their ages ranged from 20 days to six years, with a mean age of 10.5 ± 14.5 months. Of these, 57 (64%) were male. CTEV was unilateral in 53 (59.5%) cases and bilateral in 36 (40.5%) cases. The majority of the cases had isolated CTEV. Nearly all cases had Ponseti casting with a tendo-Achilles tenotomy (TAT) surgical procedure. Patient follow-up ranged from one week to three years, with an average follow-up of 3.1 months. Only three (3.4%) cases experienced recurrence of deformity after management. CONCLUSION: Ponseti casting with the tendo-Achilles tenotomy approach emerged as the most commonly employed management option, demonstrating a low rate of recurrence.

Parental Concerns Regarding Bracing Compliance for Children With Clubfoot: Seeking Support on Facebook.

Background Clubfoot treatment requires a period of bracing until early childhood to maintain the initial correction achieved by Ponseti casting and serial manipulations. During this period, bracing compliance is the most important factor in preventing the relapse of clubfoot deformity. This period can be challenging for parents, given several factors that affect treatment adherence. In recent years, social media has opened up new ways to seek guidance from an online community, including health-focused areas such as congenital clubfoot. This study examines bracing-related concerns that arise during clubfoot treatment that lead caregivers to seek support from online forums like Facebook. Methodology Six Facebook clubfoot support groups with the highest number of clubfoot posts were evaluated to identify the relative proportion and content of posts related to bracing compliance during December 2021. Bracing-related concerns across all identified posts were then organized into the following six domains that may affect the child's bracing adherence: physical, psychological, commercial, social, bracing device-related, and parental. Results In December 2021, there were 442 total posts across the six clubfoot-focused Facebook groups analyzed. Of these, 23.1% of posts were directly related to bracing compliance. Approximately 22% of these posts had responses where at least one fellow parent suggested seeking advice from a healthcare professional. When these root concerns were organized into six domains that can affect the child's bracing compliance, we found 49 physical, 26 psychological, 5 commercial, 0 social, 14 bracing device-related, and 8 parental factors. Conclusions In this study, 23.1% of all analyzed Facebook posts involved discussion about brace-related concerns, making this a significant topic of discussion on online parental forums. Facebook groups create a community and provide emotional support to parents that support bracing compliance. Clubfoot physicians should be aware of key parental concerns related to bracing compliance, and physicians can provide education on bracing that provides accurate information and anticipatory counseling during regular check-ups with patients and their families.

Outcomes of the Ponseti Technique in Different Types of Clubfoot-A Single Center Retrospective Analysis.

Background: Clubfoot is a congenital deformity that can affect one or both of a newborn's lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.

Exploring Bracing Adherence in Ponseti Treatment of Clubfoot: A Comparative Study of Factors and Outcomes in Uganda.

The Ponseti method of clubfoot treatment involves two phases: initial correction, usually including tenotomy; and bracing, to maintain correction and prevent relapse. Bracing should last up to four years, but in Uganda, approximately 21% of patients drop from clinical oversight within the first two years of using the brace. Our study compared 97 adherent and 66 non-adherent cases to assess the influential factors and effects on functional outcomes. We analyzed qualitative and quantitative data from clinical records, in-person caregiver interviews, and assessments of foot correction and functionality. Children who underwent tenotomy had 74% higher odds of adherence to bracing compared to those who did not undergo tenotomy. Conversely, children from rural households whose caregivers reported longer travel times to the clinic were more likely to be non-adherent to bracing (AOR 1.60 (95% CI: 1.11-2.30)) compared to those without these factors. Adhering to bracing for a minimum of two years was associated with improved outcomes, as non-adherent patients experienced 2.6 times the odds of deformity recurrence compared to adherent patients. Respondents reported transportation/cost issues, family disruptions, and lack of understanding about the treatment method or importance of bracing. These findings highlight the need to address barriers to adherence, including reducing travel/waiting time, providing ongoing education for caregivers on bracing protocol, and additional support targeting transportation barriers and household complexities.

An Insight on Current Clubfoot Management: A Reported Data From Lebanon.

BACKGROUND/AIM: Clubfoot, which has been reported in the literature since the time of Hippocrates in 400 BC, is regarded as one of the most difficult congenital orthopedic anomalies, with a high relapse incidence of 16.87 infants per 10,000 births. The Lebanese region holds limited data concerning the evolution of clubfoot management. Herein, we aim to present novel findings in the treatment of clubfoot without surgical intervention. MATERIALS AND METHODS: This single-center, cross-sectional research included 300 patients with virgin idiopathic clubfoot treated at our facility from 2015 to 2020. The Pirani and DiMeglio Scores were used to determine the severity of the illness prior to treatment, and the DiMeglio Score was used to determine the severity of the disease after treatment. For data analysis, the Statistical Package for Social Sciences (SPSS, IBM-Version 26; IBM Corp., Armonk, NY) was used and results with p-value < 0.05 were considered statistically significant. RESULTS: Our study included 300 patients, with 188 boys (62.7%) and 112 girls (37.3%). The mean age of the patients' onset was 32 days. We recorded an average initial Pirani score of 4.27 ± 0.65 and an average initial DiMeglio score of 11.58 ± 2.56 (62 out of 300) while the average final DiMeglio score was 2.17 ± 1.82. The mean number of casts was 5 ± 0.8, with a minimum of four and a maximum of six casts. The prevalence of relapse was 20.7%. CONCLUSIONS: Clubfoot remains a challenging deformity with a high rate of treatment failure and recurrence. While the superiority of Ponseti's technique in terms of success rate could not be disputed, tailored therapy based on the patient's socioeconomic status is considered critical for compliance and treatment success.

Unilateral Abduction Dorsiflexion Mechanism Brace as an Attractive Alternative of Congenital Talipes Equino-Varus Treatment - a Preliminary Report.

Ponseti method of CTEV treatment includes use of a foot orthosis, compliance with this can be a challenge. A new brace- Abduction Dorsiflexion Mechanism brace (ADM, C-Prodirect) was introduced to address this. The aim of the study was to assess whether the new ADM brace improves compliance and prevents relapse in children with corrected clubfoot. Eight children with unilateral CTEV who did not tolerate the standard brace were included in the study. All children had been previously treated with Ponseti casting, Achilles tenotomy and Ponseti AFO Abduction Brace (C-Prodirect®). The mean age of children included was 27 months. Parents' satisfaction with the brace was assessed using Client Satisfaction with Device (CSD) questionnaire. Parents reported better tolerance of the brace by the child in six out of eight cases. ADM brace is viable alternative in maintaining correction of unilateral idiopathic CTEV when compliance to standard AFO abduction brace is poorly tolerated.

The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot.

Background: The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized. The purpose of this study was to evaluate the clinical outcomes at the end of the casting period while addressing these issues. Methods: A retrospective study of 17 patients with 25 complex clubfeet over a period of 2 years was conducted. Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads. Results: The mean age of patients at diagnosis was 4.41 months (2-7 months). The mean pre-casting Pirani score was 4.8 (4-6) and post casting Pirani score was 0.4 (0-1). A total of 128 casts were applied to correct 25 complex clubfeet. The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4-7). Overall, four incidences of cast slippage occurred. Conclusion: The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast.Level of evidence Level 4. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00910-w.