The purpose of this study was to compare the results of traditional and accelerated Ponseti techniques to clarify whether this technique can be done safely in reduced time with complete correction of the deformity and without complications. A total of 66 feet in 41 children with idiopathic club foot and with Pirani score no <4 were included; of these, 34 feet in 20 children were managed with the traditional Ponseti method with one cast a week, in the other 32 feet in 21 children, an accelerated technique was used with casting twice a week, and the Pirani score was used for initial assessment and for follow-up. The results were comparable for both groups; the mean number of casts for full correction was 4.88 ± 0.88 in the traditional group and 5.16 ± 0.72 in the accelerated group. Initial correction was obtained in all cases in both groups, and relapses were observed in 14.7 % in the traditional group and in 15.6 % in the accelerated group. Deformities required from four to seven casts for correction in both groups. There was a statistically significant reduction in the mean time required for correction from onset of manipulation till tenotomy or correction of equines without tenotomy which was 33.36 ± 6.69 days (21-42 days) in the traditional Ponseti group and 18.13 ± 3.02 days (11-22 days) in accelerated Ponseti (P = 0.001). Accelerated Ponseti technique significantly reduces the correction time without affecting the final results; it is quite as safe and effective as the traditional Ponseti.

Level IV, case series.

We present the results of intramedullary rodding of long bones of the lower limbs in children with osteogenesis imperfecta using a modified Sofield-Millar operation. Fourteen patients (mean age at primary operation was 5 years 11 months) were treated with a modified Sofield-Millar operation which allows minimal bone exposure, preservation of the periosteum and keeping the number of osteotomies to the minimum. Union was achieved in all cases within 7 weeks. Of the 14 patients (29 bones) treated with nonelongating rods, rod revisions were needed in 13 patients (26 bones). We found no statistically significant difference between the width of the bone immediately postoperatively and at the final follow-up. The walking ability was improved in four patients. Advantages of less invasive surgery in osteogenesis imperfecta are rapid bone union, no bone atrophy or nonunion, better postoperative mobility and small scars.

The use of free nonvascularised fibular graft in the induced membrane technique reduces the time of healing and improves the final outcome.

PurposeThe “bean-shaped foot” exhibits forefoot adduction and midfoot supination, which interfere with function because of poor foot placement. The purpose of the study is a retrospective evaluation of patients who underwent a combined double tarsal wedge osteotomy and transcuneiform osteotomy to correct such a deformity.MethodsTwenty-seven children with 35 idiopathic clubfeet were treated surgically by combined double tarsal wedge osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) and transcuneiform osteotomy between 2008 and 2012. The age of children at surgery ranged from 4 to 9 years. There were 19 boys and 8 girls. Pre- and postoperative X-rays were used, considering: on the AP radiograph, the calcaneo-fifth metatarsal angle and the talo-first metatarsal angle (indicators of forefoot adduction); on the lateral radiograph, the talo-first metatarsal angle (an indication of supination deformity) and calcaneo-first metatarsal angles (an indication of cavus deformity). These radiological parameters were compared with the clinical results.ResultsFollow-up was conducted for 24–79 months following surgery. Clinical and radiographic improvements in forefoot position were achieved in all cases. An average improvement in the anteroposterior talo-first metatarsal angle of 21°, calcaneo-fifth metatarsal angle of 14°, lateral talo-first metatarsal angle of 10°, and lateral calcaneo-first metatarsal of 12° confirmed the clinically satisfactory correction in all feet. One patient had a wound infection postoperatively, which resolved with removal of the wires and administration of oral antibiotics. Eight patients followed up for more than 5 years had no deterioration of results.ConclusionsCombined double tarsal wedge osteotomy as well as transcuneiform osteotomy is an effective and safe procedure for lasting correction of the bean-shaped foot.