Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Agarwal, Ankur; Gupta, Sumit; Sud, Alok; Agarwal, Saurabh

doi:10.1016/j.jcot.2019.05.003

Cited by 6 publications

(6 citation statements)

References 25 publications

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“…Early detection of the deformity and modifying the standard protocol, described by Ponseti et al [5], resulted in a high rate of success at final follow-up despite of the outcome tools used [5,9,10,[12][13][14][15][16]. Although the modified Ponseti method has a success reaching to 100%, several studies have proposed different modifications and management plans for complex clubfoot [4,11,27,28]. To our knowledge, no study has compared the different methods; therefore, conclusions cannot be drawn regarding the modified Ponseti protocol in comparison with others.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The number of studies regarding complex and atypical idiopathic clubfoot has increased rapidly since Ponseti modified his technique to treat these subgroups, and most have shown consistent success in initial correction rates [5,[9][10][11][12][13][14][15][16]. However, most of the available literature reports wide variations in relapse and complication rates that are not defined in a consistent fashion, which may limit appropriate treatment decisions [11]. Moreover, in most of the available literature, including the original paper by Ponseti, there seems to be a lack of clear differentiation between the two subgroups which might be the main reason for such discrepancies in recurrence/complications.…”

Section: Introductionmentioning

confidence: 99%

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Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

Al-Mohrej

Alshaalan

Alhussainan

2021

International Orthopaedics (SICOT)

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Purpose In 2006, Ponseti modified the standard technique to treat cases of "atypical" and "complex" clubfoot. To determine the outcomes of Ponseti's modified method to treat complex idiopathic clubfoot patients, we asked the following: (1) What is the deformity correction success rate? (2) What is the relapse rate after the correction? (3) What is the incidence of complications? Materials and methods We performed a systematic review by searching the EMBASE, MEDLINE, Cochrane Library, and Web of Science databases from inception to March 1, 2021. All studies on idiopathic, complex, and atypical clubfoot that assessed Ponseti's modified technique were included. Of 699 identified articles, ten met the inclusion criteria. The mean index for non-randomized studies score for the included studies was 11.8 ± 1.7. Results Early detection of the deformity and modifying the standard protocol, as described by Ponseti, resulted in a high rate of success. Initial correction occurred in all children, with a mean ankle dorsiflexion of 15°. Relapse occurred often ranging between 10.5 and 55%. The incidence of complications associated with the modified Ponseti method ranged from 6 to 30%. Conclusions Studies using the modified Ponseti technique have shown high initial correction rates and a smaller number of relapses. However, studies with prospective designs and long-term follow-up are required to conclude whether these observations are due to properly performing the modified method or if higher rates of relapse increase with further follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

Al-Mohrej

Alshaalan

Alhussainan

2021

International Orthopaedics (SICOT)

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“…Clubfoot is clinically manifested as restricted ankle dorsiflexion ability and foot varus. Flaccidity of foot and foot varus could cause the sole of the foot not to effectively touch the ground, and the body center is unable to move forward effectively, which resulted in walking dysfunction (Agarwal et al, 2020b). Through surgery, the patient's ankle dorsiflexion had been greatly improved.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Multilevel Surgeries in Children With Spastic Cerebral Palsy Based on Surface Electromyography

Luo

Zhang

et al. 2021

Front. Neurosci.

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The root mean square (RMS) of the surface electromyography (sEMG) signal can respond to neuromuscular function, which displays a positive correlation with muscle force and muscle tension under positive and passive conditions, respectively. The purpose of this study was to investigate the changes in muscle force and tension after multilevel surgical treatments, functional selective posterior rhizotomy (FSPR) and tibial anterior muscle transfer surgery, and evaluate their clinical effect in children with spastic cerebral palsy (SCP) during walking. Children with diplegia (n = 13) and hemiplegia (n = 3) with ages from 4 to 18 years participated in this study. They were requested to walk barefoot at a self-selected speed on a 15-m-long lane. The patient's joints' range of motion (ROM) and sEMG signal of six major muscles were assessed before and after the multilevel surgeries. The gait cycle was divided into seven phases, and muscle activation state can be divided into positive and passive conditions during gait cycle. For each phase, the RMS of the sEMG signal amplitude was calculated and also normalized by a linear envelope (10-ms running RMS window). The muscle tension of the gastrocnemius decreased significantly during the loading response, initial swing, and terminal swing (p < 0.05), which helped the knee joint to get the maximum extension when the heel is on the ground and made the heel land smoothly. The muscle force of the gastrocnemius increased significantly (p < 0.05) during the mid-stance, terminal stance, and pre-swing, which could generate the driving force for the human body to move forward. The muscle tension of the biceps femoris and semitendinosus decreased significantly (p < 0.05) during the terminal stance, pre-swing, and initial swing. The decreased muscle tension could relieve the burden of the knee flexion when the knee joint was passively flexed. At the terminal swing, the muscle force of the tibial anterior increased significantly (p < 0.05), which could improve the ankle dorsiflexion ability and prevent foot drop and push forward. Thus, the neuromuscular function of cerebral palsy during walking can be evaluated by the muscle activation state and the RMS of the sEMG signal, which showed that multilevel surgical treatments are feasible and effective to treat SCP.

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“…However, in resistant and difficult cases a modification in standard technique is described to achieve good results. 3 There are thought-provoking articles on cerebral palsy, 6 pediatric hip, 7,8 trauma and tuberculosis. 9 Yadav et al 8 in a case series concluded that the Botulinum injections are safe and effective for spasticity of upper limbs in cerebral palsy and capable of improving function without major side effects.…”

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confidence: 99%

Revisiting Paediatric Orthopaedics

Sud

Vaishya

2020

Journal of Clinical Orthopaedics and Trauma

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The meaning of the term "Orthopaedics" denotes the science of correcting deformities in children. It has since long outgrown its Paediatric boots to encompass a variety of diseases in all age groups pertaining to limbs and trunk disorders. However, its name suggests the importance of Paediatric concerns in Orthopaedics. The influence of growth and development on the musculoskeletal system, make the speciality of Paediatric Orthopaedics both interesting and unique. The interventions performed in a child usually has repercussions in adulthood, which makes a long follow-up necessary. Some clinical problems (physiological pes planus and genu varum) in children are just a variation of normal which may resolve with time. The principle of remodelling can be used judiciously in the management of a variety of traumatic disorders. Growth modulation may be used until a certain age for the correction of limb and trunk deformities.This special issue of the journal presents a vast array of disorders in Paediatric Orthopaedics ranging from scoliosis 1,2 to clubfoot. 3e5 Ahmad 1 in a review article on early onset scoliosis suggested that the cornerstone of its treatment is the facilitation of optimal conditions for lung development, thoracic growth, and spinal movement and the spinal fusion should be postponed as much as possible, at least until alveolar growth and significant chest development is completed close to puberty. Jagger et al. 2 concluded that large thoracic scoliotic curves are associated with poorer lung function but better exercise capacity is likely related to higher levels of physical conditioning.Ponseti's technique of serial plaster correction of club foot is now a well-accepted and successful method for most idiopathic clubfeet. However, in resistant and difficult cases a modification in standard technique is described to achieve good results. 3 There are thought-provoking articles on cerebral palsy, 6 pediatric hip, 7,8 trauma and tuberculosis. 9 Yadav et al. 8 in a case series concluded that the Botulinum injections are safe and effective for spasticity of upper limbs in cerebral palsy and capable of improving function without major side effects. Tuberculosis of bones and joints is still seen in the underdeveloped and developing nations. In a review article, there is an excellent overview of this problem in children, with its management strategies. 9 Besides the original research and review articles, there are several case reports in this issue, that will be of educational interest to general Orthopaedic surgeons as well. In addition to the articles on Paediatric Orthopaedics, there is a review article based on the last five-year audit of this journal, which highlights its growth. This scientometric analysis 10 also points out that a sub-speciality like pediatric Orthopaedics needs more "share in the pie" in the general Orthopaedic journals like the Journal of Clinical Orthopaedics and trauma, as there are only a handful of exclusive Paediatric Orthopaedic journals in the world. This will definitely build m...

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Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Cited by 6 publications

References 25 publications

Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

Evaluation of Multilevel Surgeries in Children With Spastic Cerebral Palsy Based on Surface Electromyography

Revisiting Paediatric Orthopaedics

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