Effectiveness of modified ankle foot orthosis of low-temperature thermoplastics in idiopathic congenital talipes equino varus

Abstract

The aim of this study was to study the effectiveness of modified ankle foot orthosis fabricated from low-temperature thermoplastics, as an alternative orthosis for the maintenance of correction in idiopathic congenital talipes equino varus (CTEV) deformity. The study was conducted in infants after the completion of the Ponseti serial manipulation and cast treatment, with or without, percutaneous Achilles tenotomy. Both male and female infants with unilateral or bilateral CTEV deformity were included in our study. A custom-made modified ankle foot orthosis was fabricated on the day of the removal of the last plaster of Paris cast. Initial clinical assessment, including medical history, Pirani score, modified Dimeglio score, clinical method of evaluating tibial torsion, ankle and foot range of motion were carried out on the day of the fabrication of the orthosis. Follow-up assessments were carried out at regular intervals for a duration of 6 months. All infants were provided with a set of exercises in the outpatient department three to five times per week, and other sessions were carried out by the caregivers in the form of home exercise programmes, daily every 2 h. In our study, we had 40 infants. Of these, 12 were lost to follow-up. The remaining 28 infants (22 males and six females) were included in the study. Of the 28 infants, six were left sided, seven were right sided and 15 were bilateral cases. The age at which cast treatment was initiated ranged from 1 week to 8 months, and the age at which modified ankle foot orthosis was given ranged from 1 month 1 week to 15 months. The average number of plaster of Paris casts given was six. Sixteen infants required tenotomy. We found that there was a significant reduction in the Pirani and modified Dimeglio scores from baseline to the third and to the sixth months, that is, improvement and/or maintenance of the baseline scores of Pirani and modified Dimeglio was observed (P<0.05). The difference in the Pirani and modified Dimeglio scores was not significant in the posttreatment results in cases with and without Achilles tenotomy (P>0.05). The difference was independent of the side (left or right) (P>0.05). The mean tibial internal torsion in left foot cases was 14 degrees and in right foot cases was 15.13 degrees . Improvement was observed in the range of motion of both the left and right ankle and foot movements, specifically ankle dorsiflexion. In conclusion, a modified ankle foot orthosis of low-temperature thermoplastics, designed at our centre, is an effective alternative orthosis to maintain the correction of both unilateral and bilateral idiopathic CTEV deformity after the Ponseti cast treatment.

A polyaxial fixation brace for the treatment of idiopathic congenital talipes equinovarus in newborns

“…It is plausible that the brace could be used at night until preschool, which occurs at approximately 7 years old [8]. A foot abduction brace is a crucial part of the Ponseti treatment, and it is considered mandatory to prevent relapse [19, 20]. There were 3 patients (5 ft) in the E-group and 11 patients (14 ft) in the C-group who experienced relapse 3–5 months later.…”

Unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with Ponseti technique: a systematic review

“…For some families, children would not tolerate the device, especially as they become older and more mobile [11,14]. Further, the bilateral orthoses imposed restrictions on the unaffected feet or these may not be ideal for unilateral clubfoot cases [8,11]. The cost of treating a possible recurrence following nonadherence with bilateral orthosis was also added to the benefits of using unilateral orthosis [11].…”

“…This orthosis was unable to provide abduction of the foot required to stretch the medial soft tissues. The device used by Solanki et al was a moldable AFO with emphasis on subtalar joint abduction to mechanically stretch the shortened tissues on the medial aspect of the foot [8]. Chen described two orthoses: Daytime orthopaedic shoes (OS) were custom-made shoes with inserts molded to the shape of hindfoot [10].…”

“…For other series, the prescription was modified. Solanki et al used orthosis during the first year of life, before the child learned to walk, during the daytime initially and later as a night splint [8]. Janicki's prescription was a full-time AFO use for 5 years [12].…”

Developing a Three-Dimensional (3D) Assessment Method for Clubfoot—A Study Protocol

“…Congenital talipes equinovarus (CTEV) or clubfoot is a common pediatric congenital foot deformity that occurs about 1 in 1,000 live births (Wynne-Davies, 1964 ; Shiels et al, 2007 ; Hussain et al, 2014 ; Meena et al, 2014 ; Smith et al, 2014 ), and this deformity is characterized by four components such as hindfoot equinus, midfoot cavus, forefoot adductus, and hindfoot varus (Solanki et al, 2010 ; Meena et al, 2014 ; Shabtai et al, 2014 ). In recent years, the “Ponseti method” (conservative treatment method) has been widely accepted worldwide to correct the clubfoot deformity.…”