Interventions for congenital talipes equinovarus (clubfoot)

Gray, Kelly; Pacey, Verity; Gibbons, Paul; Little, David; Frost, Chris; Burns, Joshua

doi:10.1002/14651858.cd008602.pub2

Cited by 30 publications

(30 citation statements)

References 60 publications

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“…In clinical trials, data from each limb are commonly treated as independent [10,13]. However the results of our study show that patients with bilateral clubfeet have a high correlation between right and left feet for baseline severity, response to intervention including number of Ponseti plaster casts and Achilles tenotomies, relapse of right and left feet, and intervention required to correct bilateral relapse.…”

Section: Discussionmentioning

confidence: 70%

“…Without accounting for correlations an over or under estimation of findings can occur. Simple (eg, excluding data from one limb) and sophisticated statistical models (eg, boot strap or generalized estimating equations) are able to account for known and unknown correlations, improving precision of findings [10,11,20].…”

Section: Discussionmentioning

confidence: 99%

“…Orthopaedic research commonly involves analysis of populations of patients with bilateral presentations. Often bilateral presentations (eg, two feet) are pooled as though they are independent observations [10]. Trials commonly report outcomes for y feet from x patients (eg, 31 feet from 20 patients).…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Congenital talipes equinovarus, or clubfoot, is a common pediatric orthopaedic condition of unknown origin. In many clubfoot clinical trials, interventions are assigned to a patient, but response to treatment is assessed separately in each foot. Trials commonly report x patients with y feet where y is greater than x (eg, 35 patients with 56 feet). However, common statistical tests assume that each data point is independent. Although data from unilateral cases of clubfoot are independent, it is unknown if each foot of patients with bilateral clubfeet are correlated. Questions/purposes The purpose of this study was to assess the correlation in the feet of patients with bilateral clubfeet by (1) evaluating the degree of severity between lower limbs of each patient with bilateral clubfeet at baseline; (2) determining if right and left feet of each patient responded to intervention in the same way; (3) determining the proportion of bilateral relapse; and (4) determining the proportion of right and left feet which required the same intervention to correct bilateral relapse. Methods We performed a chart review of the records of 33 patients with bilateral clubfeet (66 feet). Baseline severity was assessed using the Pirani score. The number of Ponseti serial casts to correct the deformity, the proportion of patients who underwent bilateral Achilles tenotomy, the proportion of bilateral relapse, and the treatment to correct bilateral relapse were examined. Results The degree of severity between right (Pirani score mean, 5.2; SD, 0.8) and left (Pirani score mean, 5.2; SD, 0.5) feet for each patient at baseline was highly correlated (r = 0.76, p \ 0.001). Response to intervention between lower limbs was highly correlated for the number of Ponseti casts required for initial correction (right mean, 5.2, SD, 1.1; left mean, 5.2, SD, 1.3) (r = 0.89, p \ 0.001) and the proportion of patients who underwent bilateral Achilles tenotomy (right, 17/18; left, 16/18) (r = 0.94, p \ 0.001). In the nine patients who experienced relapse, eight experienced bilateral involvement. In all cases of bilateral relapse, the right and left foot of each patient required the same intervention to correct the relapse. Conclusions In patients with bilateral clubfeet, baseline severity, response to initial Ponseti treatment, Achilles tenotomy, and relapse outcomes were highly correlated in

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Bilateral Clubfeet Are Highly Correlated: A Cautionary Tale for Researchers

Gray

Gibbons

Little

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Данные опроса представлены в таблице 3. обсуждение за столетие развития современной детской ортопедии методы лечения врожденной косо-лапости претерпели существенную эволюцию. Разнообразие методик и подходов в настоящее время в значительной степени имеет истори-ческое значение благодаря внедрению метода понсети: большинство ортопедов мира призна-ют его «золотым стандартом» лечения врож-денной косолапости у детей [1]. Не подвергая принципиальному сомнению возможности других методик, сравнительный анализ эффек-тивности метода понсети по отношению как к иным методам консервативного лечения [9,10], так и к хирургическому лечению [11,12] по-зволяют считать его оптимальным, а остальные методики, даже учитывая их относительную эффективность, на сегодняшний день относить к неоптимальным.…”

Section: таблица 1/unclassified

“…Многочисленные публикации, свидетельствую-щие об этом, а также суммирующие их два неза-висимых метаанализа, включая Кохрейновский обзор [1,2], являются убедительным доказатель-ством этого факта. Метод понсети рекоменду-ется как международными [3], так и националь-ными сообществами детских ортопедов [4,5] в качестве оптимального метода лечения врож-денной косолапости у детей.…”

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Causes of Non-Optimal Conservative Treatment of Congenital Clubfoot in Children

Kenis

Степанова

2017

Traumatology and Orthopedics of Russia

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Introduction. Ponseti method commonly accepted as the optimal approach to management of congenital clubfoot. Continuing with alternative methods should considered as malpractice. Aim: to assess causes of non-optimal treatment of congenital clubfoot in children.Materials and methods: Assessment group included 60 patients treated earlier in other clinics with non-optimal results. Control group included 60 patients treated in our clinic by Ponseti method. We used case history analysis and parents’ interviewing.Results. Family history of clubfoot and prenatal diagnosis positively influenced on the choice of Ponseti method. Primary consultancy of orthopedist and Internet search were main factors for choosing Ponseti method after birth. In contrast, the methods lead to non-optimal results chosen after maternity home and pediatricians.Conclusion. Main cause of non-optimal results of congenital clubfoot treatment is the lack of information regarding current approaches among non-orthopedic physicians, which emphasizes necessity of adequate informational support.

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