The Ponseti method of treating club foot has been shown to be effective in children up to two years of age. However, it is not known whether it is successful in older children. We retrospectively reviewed 17 children (24 feet) with congenital idiopathic club foot who presented after walking age and had undergone no previous treatment. All were treated by the method described by Ponseti, with minor modifications. The mean age at presentation was 3.9 years (1.2 to 9.0) and the mean follow-up was for 3.1 years (2.1 to 5.6). The mean time of immobilisation in a cast was 3.9 months (1.5 to 6.0). A painless plantigrade foot was obtained in 16 feet without the need for extensive soft-tissue release and/or bony procedures. Four patients (7 feet) had recurrent equinus which required a second tenotomy. Failure was observed in five patients (8 feet) who required a posterior release for full correction of the equinus deformity. We conclude that the Ponseti method is a safe, effective and low-cost treatment for neglected idiopathic club foot presenting after walking age.

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Objectives To evaluate the accuracy of measurement of the pubofemoral distance (PFD) for the diagnosis of developmental dysplasia of the hip (DDH), using the Graf method as the reference standard. Methods This was a prospective diagnostic accuracy study evaluating 1980 hips in at‐risk neonates. The PFD measurement and the Graf method were performed at the same opportunity, with the hips in the same position (slightly flexed, adducted, and medially rotated). Results In our sample, the prevalence of DDH, defined as Graf type IIb or higher, was 15.6%. The mean PFD for dysplastic hips was 3.5 mm (median, 3.3 mm), whereas it was 3.0 mm (median, 2.9 mm) for nondysplastic hips. In both groups, there was a significant overlap between the PFD measurements and the Graf classifications. The PFD cutoff with the largest area under the receiver operating characteristic curve was 3.0 mm, which was found to have a sensitivity and specificity of 63.6 and 62.2%, respectively, with positive and negative predictive values of 31.2 and 71.4%, respectively, for the diagnosis of DDH. Conclusion Measurement of the PFD shows good overall accuracy for the diagnosis of DDH. However, given its low‐positive predictive value, it should not be considered to be a replacement for the Graf method.

Atualmente, não são encontráveis referências na literatura em saúde sobre critérios objetivos e práticos para a prescrição e adequação de colchões. Objetivo: propor um método quantitativo de avaliação da postura deitada baseado em fotografia digital e validá-lo. Métodos: Foram avaliados 25 voluntários normais. Os voluntários receberam marcadores adesivos, e colocaram-se em decúbito dorsal e lateral sobre 2 colchões de diferentes densidades. Foram feitas fotografias digitais, que foram analisadas em um programa de computador. Dois observadores obtiveram o valor das inclinações dos segmentos corporais, e estes valores foram comparados aos valores fornecidos por um padrão ouro. Resultados: A análise dos dados mostrou que a validade, a reprodutibilidade intra-observador, a reprodutibilidade inter-observadores e a responsividade do método proposto foram estatisticamente significantes, com excelentes valores de concordância (acima de 0,9). Houve duas excessões, em situações específicas, que não invalidam o método como um todo. Conclusão: O método proposto tem caracterísitcas metodológicas adequadas para ser usado clinicamente e em pesquisa. Relevância: O sistema descrito pode ser usado em pesquisas futuras sobre o alinhamento da postura deitada a fim de orientar grupos populacionais sobre qual tipo de colchão lhes é mais adequado.