Ponseti casting

Abstract

We have modified the Ponseti casting technique by using a below-knee Softcast instead of an above-knee plaster of Paris cast. Treatment was initiated as soon as possible after birth and the Pirani score was recorded at each visit. Following the manipulation techniques of Ponseti, a below-knee Softcast was applied directly over a stockinette for a snug fit and particular attention was paid to creating a deep groove above the heel to prevent slippage. If necessary, a percutaneous Achilles tenotomy was performed and casting continued until the child was fitted with Denis Browne abduction boots.Between April 2003 and May 2007 we treated 51 consecutive babies with 80 idiopathic club feet with a mean age at presentation of 4.5 weeks (4 days to 62 weeks). The initial mean Pirani score was 5.5 (3 to 6). It took a mean of 8.5 weeks (4 to 53) of weekly manipulation and casting to reach the stage of percutaneous Achilles tenotomy. A total of 20 feet (25%) did not require a tenotomy and for the 60 that did, the mean Pirani score at time of operation was 2.5 (0.5 to 3). Denis Browne boots were applied at a mean of 10 weeks (4 to 56) after presentation. The mean time from tenotomy to boots was 3.3 weeks (2 to 10). We experienced one case of cast-slippage during a period of non-attendance, which prolonged the casting process. One case of prolonged casting required repeated tenotomy, and three feet required repeated tenotomy and casting after relapsing while in Denis Browne boots.We believe the use of a below-knee Softcast in conjunction with Ponseti manipulation techniques shows promising initial results which are comparable to those using above-knee plaster of Paris casts.The Ponseti technique 1 is increasingly popular in the treatment of congenital talipes equinovarus. However, his method of serial manipulation and above-knee plaster of Paris casting causes some practical difficulties. Above-knee casts can make perineal hygiene more difficult, especially in bilateral cases and the removal of casts can be distressing for the child and parents.2 The theoretical disadvantages of aboveknee casts include the immobilisation of rapidly growing bones and joints. 3,4

Evaluation of cast creep occurring during simulated clubfoot correction

“…15 In their study though, the authors did not correlate each cast material in regard to their efficacy. Similarly, Brewster et al, 8 using SRF, and Ng et al, 28 using fiberglass material, published their favorable clinical results.…”

“…13 Alternative cast materials used in conjunction with the Ponseti method have been considered. 8, 13-15 Coss and Hennrikus 15 found that parents preferred semi-rigid fiberglass (SRF) over POP due to its ease of removal, durability, and performance.…”

Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast

“… 8 Semirigid fiberglass cast materials can be removed easily with unwinding alone in a few minutes. 10 On the other hand, the major disadvantage of fiberglass material is its high cost.…”

“…Our study revealed different results compared to Pittner et al although we used approximately the same parameters such as complete time, different results could be secondary to the scoring system which was used and low number of the patients. Brewster et al 10 reported the results of clubfoot treatment with softcast. They used below knee soft casts and concluded that using below knee soft cast was comparable to those using above knee POP cast.…”

“…Dennis–Browne splints, as described in the Ponseti method, were applied after the removal of the final cast. 10 A final parent satisfaction score was also obtained. 9 According to this 5-point evaluation system (excellent = 5, very good = 4, good = 3, fair = 2, and poor = 1), cast convenience, cast weight, infant tolerance, durability, material satisfaction, and likelihood of recommending the material scores were noted at the end of the final cast removal.…”