Ponseti method in the management of clubfoot under 2 years of age: A systematic review

Abstract

BackgroundCongenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age.Materials and methodsArticles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age.ResultsOf the outcome of 1095 articles from four electronic databases, twelve articles were included in the review. Pirani scoring system, Dimeglio scoring system, measuring the range of motion and rate of relapses were used as outcome measures.ConclusionsIn conclusion, all reviewed, 12 articles reported that Ponseti method is a very effective method to correct the clubfoot deformities. However, we noticed that relapses occur in nine studies, which is due to the non-adherence of bracing regime and other factors such as low income and social economic status.

Congenital clubfoot in Europe: A population‐based study

“…In congenital clubfoot, the foot cannot be moved into a normal position by hand. Treatment of congenital clubfoot includes the Ponseti method with multiple casting or splinting, and/or surgery (Dobbs, Morcuende, Gurnett, & Ponseti, ; Ganesan, Luximon, Al‐Jumaily, Balasankar, & Naik, ). The prevalence of congenital clubfoot has been reported as higher in males compared to females (2.0–2.5 times) (Kancherla, Romitti, Caspers, Puzhankara, & Morcuende, ; Moorthi et al, ).…”

Klumpfußtherapie nach Ponseti – aktueller Standard

“…einer 19-Gauge-Nadel beschrieben worden [12]. [17]. Ebenso konnte die Überlegenheit gegenüber operativen Methoden nachgewiesen werden [18].…”

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

“…Об этом свидетельствуют проведен-ные исследования с высоким уровнем доказа-тельности [2]. продолжение использования неоптимальных методов является негативной практикой.…”

“…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.…”

“…В этой связи, учи-тывая рекомендации исследований столь высо-кого уровня доказательности (довольно редкого в детской ортопедии), применение других ме-тодик лечения врожденной косолапости вместо метода понсети имеет ряд существенных не-достатков. К ним относятся увеличение сроков лечения, более высокая частота рецидивов, боль-шая травматичность, менее прогнозируемый ре-зультат первичной коррекции, негативное вли-яние на состояние нервно-мышечного аппарата даже в том случае, если в результате достигается стойкая коррекция деформации [2].…”