Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus

Ošťádal, Martin; Chomiak, J; Dungl, P; Frydrychová, M; Burian, Michal

doi:10.1007/s00264-013-2033-z

Cited by 28 publications

(17 citation statements)

References 24 publications

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“…Data on the sex differences in the incidence of clubfoot are not concise. In general, we can find in the literature the ratio between boys and girls of 2:1, in our group of patients (Ošťádal et al 2013) the male to female ratio was 3:1, Morcuende et al (2004) indicated even the ratio of 4:1. Most clubfeet develop in otherwise normal children toward the middle of gravidity.…”

Section: Introductionsupporting

confidence: 48%

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Possible Pathogenetic Mechanisms and New Therapeutic Approaches of Pes Equinovarus

Ošťádal

Lišková²,

Hadraba³

et al. 2017

Physiol Res

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Idiopathic pes equinovarus (clubfoot) is a congenital deformity of the foot and lower leg defined as a fixation of the foot in plantar flexion, adduction, supination and varus. The deformity does not affect only the foot position, which is usually investigated by radiography, CT, micro-CT, MRI or ultrasound but logically influence the whole gait biomechanics. It is supposed, that clubfoot belongs to a group of fibroproliferative disorders whose origin and multi-hierarchical effect remain unknown. It has been suggested that fibroblasts and growth factors may be involved. To gain a more global view, direct analysis of the protein composition of extracellular matrix, a proteomic approach was used. At present two principle methods are mostly used for the treatment of clubfoot: physiotherapy and the Ponseti method. The determination of the general biological and biomechanical parameters for various regions of the clubfoot can potentially help in the understanding of the mechanisms participating on this serious anomaly and thus contribute to the development of the more efficient therapeutic approach. This review summarizes the present knowledge on the possible pathogenetic mechanisms participating in the development of the clubfoot and their possible relation to the new therapeutic approaches.

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Section: Introductionsupporting

confidence: 48%

“…This review summarizes the present knowledge on the possible pathogenetic mechanisms participating in the development of the clubfoot and their possible relation to the new therapeutic approaches, including our own experience (Ošťádal et al 2013, Ošťádal et al 2015.…”

Section: Introductionmentioning

confidence: 99%

Possible Pathogenetic Mechanisms and New Therapeutic Approaches of Pes Equinovarus

Ošťádal

Lišková²,

Hadraba³

et al. 2017

Physiol Res

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“…Congenital clubfoot deformity is a challenging condition to manage, and relapses following initial correction using Ponseti method have been reported as 30 % [19] and a fact intrinsic to the condition per se [27]. That said, better brace use is well documented as being associated with lower relapse rates, which in turn is associated with parents continuing to ensure that the children wear the braces [28, 29].…”

Section: Discussionmentioning

confidence: 99%

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Evans

Chowdhury

Kabir

et al. 2016

Journal of Foot and Ankle Research

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BackgroundCongenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a non-government organisation, Walk For Life (WFL). WFL has provided free treatment for over 17,500 Bangladeshi children with clubfeet since 2009, sustained by local ownership, and international support. This study assesses the 4-year results in children for whom treatment began before the age of 3 years.MethodsA centrally located WFL clinic at Mymensingh Medical College Hospital (MMCH), representative of the larger WFL clinics, which treats >100 cases annually, was reviewed. In 2015, 99 of the 147 eligible subjects who had begun treatment in 2011 were available for follow up. Specific assessment tools enabled evaluation of parent satisfaction, gait function, and relapse cases.ResultsResults for 99/147 cases were returned after four years: 72 males, 27 females. Typical clubfeet comprised 98/99 of cases, and 55/99 were bilateral. The tenotomy rate was 80 %. Brace use after 3 months was 90 %, at 12 months was 65 %, and at 4 years post treatment was 40 %. Functionally, 98/99 of children could walk and run (99 %). Relapsing deformity was found in 13 %. Relapse severity varied: eight were flexible and partial, five were rigid. Half of the children lost to follow were due to changed phone numbers. While parents were very happy with their child’s feet (97 %), a materials cost of 3000 Taka ($US40) was deemed unaffordable by 60 %.ConclusionsThe 4-year outcomes after Ponseti treatment for clubfoot deformity, showed that 99 % of children available for follow up, were walking independently. The relapse rate was low. Parent satisfaction was high, but those whose children required further treatment were less satisfied.

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“…This difference is due to the age of the patient population; the majority is well older than the walking age and have neglected clubfeet, which are more difficult to correct using the Ponseti method [16].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and barriers of treating clubfeet in four countries

Wijck

Oomen²,

Heide

2015

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to elucidate why neglected clubfeet still exists despite the availability of a highly (cost)-effective treatment-the Ponseti treatment. Methods A qualitative and partly quantitative study with semi-structured interviews was conducted in four countries: the Netherlands, South Africa, Argentina and Indonesia with both caregivers, mostly parents, of children with clubfoot and practitioners treating clubfoot. The topics discussed with the caregivers (n=51) were the conceptions of the cause of clubfeet, received information, accessibility, financial aspects, and social stigma. With the practitioners (n=11) the focus of the interviews was the treatment protocol and finance. Results Several barriers towards the start of the treatment were highlighted. At all places treatment was financed by the government, insurance or charity. Nevertheless, the cost of transport and missed working days formed a barrier, although there is a large difference between and within countries. Poverty, long travel duration, and beliefs of supernatural causes for the clubfoot result in delay in the start of treatment. Conclusion These are problems we need to address when making effective treatment available for every child to diminish the burden of neglected clubfoot; especially accessible clinics in rural areas can be a good alternative to highly specialized hospitals in large cities. We as a community should try to find and overcome the barriers to treat these patients, because we have a relatively easy and highly costeffective treatment option which can be given by trained nonphysicians supervised by an interested medical doctor.

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Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus

Cited by 28 publications

References 24 publications

Possible Pathogenetic Mechanisms and New Therapeutic Approaches of Pes Equinovarus

Possible Pathogenetic Mechanisms and New Therapeutic Approaches of Pes Equinovarus

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Feasibility and barriers of treating clubfeet in four countries

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