Midterm results following revision surgery in clubfeet

Ettl, V.; Kirschner, S.; Krauspe, Rüdiger; Raab, Peter

doi:10.1007/s00264-007-0495-6

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…However, in such cases, surgery is complex and often associated with serious complications and difficulty obtaining satisfactory outcomes [ 3 ]. In addition, surgery does not prevent recurrence, the rate of which is approximately 25%, and reoperation is frequently required, with a consequent increase in complications and limitations in functional outcomes [ 4 , 5 ]. Given this scenario and considering its success among younger children, the Ponseti method was indicated as a therapeutic option for older children with CC, i.e., older than 1 year old, being associated with low complication rates and lower cost [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Ferreira¹,

Stéfani²,

Haje

et al. 2018

PLoS ONE

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BackgroundThe prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children.MethodsA metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.ResultsTwelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82–0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14–0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03–0.15, p = 0.19).ConclusionApplication of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.

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Section: Introductionmentioning

confidence: 99%

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Ferreira¹,

Stéfani²,

Haje

et al. 2018

PLoS ONE

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“…Although surgery has been advocated for patients presenting with clubfeet after walking age, surgery does not prevent recurrence and reoperations are frequently required, with a consequent increase in complications and limitations in functional outcomes (10,11).…”

Section: Discussionmentioning

confidence: 99%

Neglected clubfoot treated by serial casting: a narrative review on how possibility takes over disability

Alves¹,

Batlle²,

Rodríguez

2021

Ann Transl Med

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The Ponseti Method is recognized as the best treatment for congenital idiopathic clubfoot in newborns and its principles became also adopted for treating older children with neglected deformity. This review aims to evaluate the role and effectiveness of serial casting in the treatment of neglected clubfoot, worldwide. Clubfoot is a complex tridimensional congenital foot deformity that can be easily treated after birth by correct manipulation of the foot and serial casting, with a great majority of cases requiring a percutaneous Achilles tenotomy, which can be organized as an ambulatory day procedure, without need for general anesthesia. However, in many low-income countries, treatment is not readily available, and many children grow up with disabling foot deformities. When compared to a newborn's clubfoot, a neglected clubfoot is different and more challenging to treat, as bones become ossified while malaligned and exposed to abnormal forces. Application of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The upper age limit for the use of Ponseti Method in clubfoot treatment is yet to be established. Success of clubfoot treatment is mostly defined as a pain-free, aesthetically acceptable plantigrade foot, with no need for extensive surgical tissue release after casting and tenotomy. The results of the Ponseti method for the treatment of clubfoot in children after the walking age are encouraging, with more than 80% of success in achieving initial correction and 18-62.5% of relapses. If Ponseti casting is not successful, any further interventions should be carefully selected and planned, in order to maintain the length of the foot and avoid intracapsular scarring or bony fusions.

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“…Recurrence requiring revision procedures has been reported in approximately 25% (13% to 50%) of feet. 2,3 Some detailed algorithms for correction of recurrent CTEV have been described, suggesting that further surgery depends on the severity of the deformity and the age of the patient. 3 There are few reports of further soft-tissue release as the main revision procedure in recurrent idiopathic CTEV, 1,3,4,12 and none of the long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

“…1 Post-operative relapse requiring repeat soft-tissue surgery has been reported in 25% of cases. 2,3 A variety of further soft-tissue procedures have been described, 1,3,4 ranging from a limited posterior release to extensive posteromedial surgery. However, these reports are of small series with no long-term results.…”

mentioning

confidence: 99%

Recurrent club-foot deformity following previous soft-tissue release

Mehrafshan

Rampal

Seringe

et al. 2009

The Journal of Bone and Joint Surgery. British volume

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The results of further soft-tissue release of 79 feet in 60 children with recurrent idiopathic congenital talipes equinovarus were evaluated. The mean age of the children at the time of re-operation was 5.8 years (15 months to 14.5 years). Soft-tissue release was performed in all 79 feet and combined with distal calcaneal excision in 52 feet. The mean follow-up was 12 years (4 to 32). At the latest follow-up the result was excellent or good in 61 feet (77%) according to the Ghanem and Seringe scoring system. The results was considered as fair in 14 feet (18%), all of whom had functional problems and eight had anatomical abnormalities. Four feet (5%) were graded as poor on both functional and anatomical grounds. The results were independent of the age at which revision was undertaken.

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Midterm results following revision surgery in clubfeet

Cited by 12 publications

References 28 publications

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

Neglected clubfoot treated by serial casting: a narrative review on how possibility takes over disability

Recurrent club-foot deformity following previous soft-tissue release

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