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Asuquo JE, Okokon EO, Lasebikan OA, Anisi CO, Asuquo BJ, Abang IE, Obaji AE, Chigbundu KC. Assessment of Treatment Outcomes in the Management of Club foot using the Ponseti Technique: A cross-sectional study. Afr J Paediatr Surg 2024; 21:85-89. [PMID: 38546244 PMCID: PMC11003577 DOI: 10.4103/ajps.ajps_115_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Ponseti technique remains the preferred method for club foot treatment. Although measures of treatment outcomes have been well documented, there is no consensus on the determinants of those outcomes. This study aims to assess treatment outcomes and the factors which can influence treatment outcomes. MATERIALS AND METHODS This is a cross-sectional study. A total of 472 children representing 748 feet in total were recruited. Patient characteristics such as age at presentation, gender, tenotomy, walking with or without deformity, parental educational status and occupation were documented. Outcomes of care were assessed using indictors such as parents' satisfaction with the outcome of treatment and the patients' ambulation without deformity. The relationships between the determinant factors and these outcomes were explored using multivariable binary logistic regression. RESULTS Most of the children (69.1%) were aged below 2 years. Brace compliance was very high (89.9%). The pre-treatment average Pirani scores were 3.9 ± 1.8 and 4.3 ± 1.8 for the right and left feet, respectively. Majority (88.3%) of the children achieved ambulation without deformity, whereas most (87%) of the parents were satisfied with the treatment outcomes. In total, parental satisfaction with child's treatment outcomes was lower in parents who were not formally educated odds ratio (OR) = 0.19 (95% confidence interval [CI] 0.08-0.43), but parental satisfaction was lower if the child had higher Pirani score OR = 0.77 (95% CI 0.62-0.96). Children who had more casts applied to the affected foot were more likely to walk without deformity OR = 1.24 (95% CI 1.01-1.52). CONCLUSIONS This study revealed that treatment outcomes in children with club foot can be determined by some sociodemographic and treatment-related factors.
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Affiliation(s)
- Joseph E. Asuquo
- Department of Orthopaedics and Traumatology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Enembe O. Okokon
- Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | | | | | - Best J. Asuquo
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Innocent Egbeji Abang
- Department of Orthopaedics and Traumatology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Akpet E. Obaji
- Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Kingsley C. Chigbundu
- Department of Orthopaedics and Traumatology, University of Calabar Teaching Hospital, Nigeria University of Calabar, Calabar, Cross River State, Nigeria
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Bitew A, Melesse DY, Admass BA. A 5-years results of the Ponseti method in the treatment of congenital clubfoot: a retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1781-1787. [PMID: 35963923 PMCID: PMC10275805 DOI: 10.1007/s00590-022-03353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clubfoot is a common congenital deformity affecting mobility of children. It leads to pain and disability. The Ponseti treatment method is non-surgical method for the correction of clubfoot. There is variation from country to country in how the result of clubfoot management is measured and reported. This study aimed to assess the 5-years results of the Ponseti method in the treatment of congenital clubfoot which was performed for children aged under 2 years in western Amhara, Ethiopia. OBJECTIVES The objective of this study was to assess a 5-years results of the Ponseti method in the treatment of congenital clubfoot among under 2-years old children in Felege Hiwot Referral Hospital, Bahir-Dar, Ethiopia, from 2015 to 2019 G.C. METHODS A facility-based retrospective cross-sectional study was conducted. After receiving letter of ethical clearance from the University, IRB board, the data were collected from medical record/charts of patients' who received Ponseti treatment, and the collected data were entered and analyzed with Statistical Package for Social Sciences version 21. The results were presented with texts and tables. RESULTS A total of 200 children with 256 congenital clubfeet involved in the study. Among the total study subjects, 143 (71.5%) had unilateral clubfeet. The 5-years results of the Ponseti method in the treatment of congenital clubfoot conducted in 200 children with clubfeet were 187 (93.5%) with 95% (CI 90-99.5). Among the study participants, males were 66.5% (almost two times from females). CONCLUSIONS AND RECOMMENDATIONS According to the results from a 5-years data showed that the Ponseti method in the treatment of congenital clubfoot was successful with a success rate of 93.5%. We recommend that children with congenital clubfeet should be managed with Ponseti treatment method timely.
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Affiliation(s)
- Almaw Bitew
- Department of Orthopaedic Surgery, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Debas Yaregal Melesse
- Department of Anaesthesia, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anaesthesia, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Common Errors in the Management of Idiopathic Clubfeet Using the Ponseti Method: A Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010152. [PMID: 36670703 PMCID: PMC9856779 DOI: 10.3390/children10010152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: "Idiopathic Clubfoot" (All Fields) AND "Management" OR "Outcomes" (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0-12 months). A full-text review of these articles was then performed looking for "complications" or "errors" reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients.
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Vahidi K, Shamabadi A, Nabian MH, Vosoughi F, Panjavi B, Zargarbashi R. Clinical, radiological, pedobarographic, and quality of life outcomes of the Ponseti treatment for clubfoot: a prospective study. Foot (Edinb) 2022; 52:101921. [PMID: 36037761 DOI: 10.1016/j.foot.2022.101921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/28/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Talipes equinovarus, also known as clubfoot, is a congenital anomaly that affects one newborn per 1000 live births. Its standard treatment strategy is Ponseti casting management. This study aims to report the long-term outcomes of the Ponseti treatment in Iran. METHODS A prospective cohort study was enrolled to evaluate clinical outcomes, radiological results, pedobarographic measurements, and quality of life after the Ponseti treatment in patients with clubfoot who were followed for at least five years. RESULTS In this study, 25 clubfeet of 18 patients were included. Significant reductions in Pirani, Dimeglio, and CAP scores, improved ankle dorsiflexion, and acceptable pedobarographic indices were observed in this study. From the radiological evaluation indices, the calcaneal pitch and lateral talus-first metatarsal angles were significantly reduced. After five years of treatment, patients' quality of life was favorable, which was better in females. This study showed that the results of the Ponseti treatment remained acceptable after five years. CONCLUSIONS The Ponseti management for clubfoot in the long term appears to maintain significant improvements. However, the recurrence rate - albeit without disruption to daily activities - cannot be ignored.
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Affiliation(s)
- Kamyar Vahidi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Shamabadi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Surgery and Orthopedics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Panjavi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Surgery and Orthopedics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ramin Zargarbashi
- Department of Orthopedics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Surgery and Orthopedics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Pigeolet M, Vital A, Daoud HA, Mita C, Corlew DS, Alkire BC. The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review. EClinicalMedicine 2022; 48:101448. [PMID: 35706498 PMCID: PMC9112092 DOI: 10.1016/j.eclinm.2022.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Ponseti treatment is considered the gold standard for clubfoot globally, but requires strong engagement from parents. The aim of this review is to assess the impact of socio-economic factors on the presence of drop-out, relapse or non-compliance during Ponseti treatment in low and middle-income countries (LMICs). METHODS This scoping review includes all articles available from inception until 4.4.2022. All articles describing an association between one or more socio-economic factors and one or more adverse outcomes during the Ponseti treatment in an LMICs were considered for inclusion. Studies were identified by searching Medline/PubMed, Embase, Global Health and Global Index Medicus. Data extraction was done using Covidence extraction 2.0 by two independent reviewers. FINDINGS A total of 281 unique references were retrieved from the database searches, 59 abstracts were retained for full-text review, of which 19 studies were included in the final review. We grouped the identified socio-economic factors into 4 larger themes: poverty and physical accessibility of clubfoot clinics, presence of support systems, educational level of the parents, and household-level factors and cultural norms. Reduced access to care for girls was considered an important risk factor in South Asia and the Caribbean. Lack of family and community support was an issue raised more often in studies from Eastern Africa. The extreme heterogeneity among collected variables within a small sample of papers made it not possible to perform a meta-analysis. INTERPRETATION The identified factors are very similar to the socio-economic factors identified in studies looking at the barriers parents and children face when seeking care initially. Poverty was identified as a cross-cutting risk factor in all 4 domains and the most important socio-economic risk factor based on this review, reconfirming poverty eradication as the challenge for the 21st century. FUNDING None.
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Affiliation(s)
- Manon Pigeolet
- The Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, United States
- Université Libre de Bruxelles, Faculty of Medicine, Avenue de Lennik 808, 1070 Brussels, Belgium
- Corresponding author.
| | - Anchelo Vital
- The Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, United States
- State University of Haiti, Faculte de Medecine et de Pharmacie, 10 Imp. Ambroise, Port-au-Prince, Haïti
| | - Hassan Ali Daoud
- The Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, United States
- Amoud University, Somaliland Amoud University College of Health Sciences, Borama, Somalia
| | - Carol Mita
- Countway Library, Harvard Medical School, Harvard University Libraries, 10 Shattuck St, Boston, MA 02115, United States
| | - Daniel Scott Corlew
- The Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, United States
| | - Blake Christian Alkire
- The Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, United States
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Sheta RA, El-Sayed M, Abdel-Ghani H, Saber S, Mohammed ASE, Hassan TGT. A modification of the Ponseti method for clubfoot management: a prospective comparative study. J Child Orthop 2021; 15:433-442. [PMID: 34858529 PMCID: PMC8582604 DOI: 10.1302/1863-2548.15.210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/11/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We aimed to compare our parent-based exercise programem's efficacy with the foot abduction brace (FAB) Ponseti manipulation as a retention programme. METHODS We conducted this prospective multicentre cohort study between August 2009 and November 2019. The included children were allocated into one of two groups according to the retention protocol. The Pirani and Laaveg-Ponseti scores were used to assess the feet clinically and functionally. Radiological assessment was performed using standing anteroposterior and lateral radiographs of the feet. We assessed the parents' satisfaction and adherence to the retention method. SPSS version 25 was used for the statistical analysis. RESULTS A total of 1265 feet in 973 children were included. Group A included 637 feet managed with FAB, while group B included 628 feet managed with our retention programme. All patients were followed up to the age of four years. At the final follow-up, Pirani scores in group A participants were excellent, good and poor in 515, 90, and 32 feet, respectivel, while in group B the scores were excellent, good and poor in 471, 110 and 44 feet, respectively. The mean total score of Laaveg-Ponseti was 87.81 (sd 19.82) in group A and 90.55 (sd 20.71) in group B (p = 0.02). Group B participants showed higher satisfaction with the treatment method (p = 0.011) and more adherence to the treatment (p = 0.013). CONCLUSION The deformity's recurrence related to the brace's non-compliance in the Ponseti method might be reduced by substituting the brace with our home-based daily stretching exercises. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Reda Ali Sheta
- Professor of Orthopaedics, Al-Ahrar Specialist Hospital, Zagazig, Al-Sharkia, Egypt
| | - Mohamed El-Sayed
- Professor of Pediatric Orthopedics & Limb Reconstructive Surgeries, Tanta University, Egypt
| | - Hisham Abdel-Ghani
- Professor of Pediatric Orthopedics; Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sameh Saber
- Assistant Professor of Radiology, Faculty of Medicine, Zagazig University, Al-Sharkia, Egypt
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Sheta RA, El-Sayed M. Is the Denis Browne Splint a Myth? A Long-Term Prospective Cohort Study in Clubfoot Management using Denis Browne Splint Versus Daily Exercise Protocol. J Foot Ankle Surg 2021; 59:314-322. [PMID: 32130997 DOI: 10.1053/j.jfas.2019.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 02/03/2023]
Abstract
The Ponseti technique is successful in idiopathic clubfoot management. However, the leading cause of relapse and recurrence is nonadherence to the Denis Brown bracing protocol. This necessitates more extensive soft tissue surgeries. Based on a detailed up-to-date search, we have found that no other studies provide such a modified Ponseti technique. This study is unique, as it depends on using specific stretching exercises instead of bracing during management. Between August 2009 and June 2019, a consecutive series of 194 isolated idiopathic clubfoot patients (251 feet) were included in this study. The mean follow-up was 93 months (range 72 to 146), mean 91.8 months. All patients underwent a clinical and functional assessment using the Laaveg-Ponseti score and radiological assessments. There were 132 boys (68.1%) and 62 girls (31.9%), a male-to-female ratio of 2:1. The mean age at initiation of treatment was 14.9 days. According to the Laaveg-Ponseti score, 51.7% yielded excellent results, 35.3% yielded good results, 11.55% yielded fair results, and 1.59% yielded poor results. Bracing noncompliance has been identified as a major cause for treatment failure. This presented exercise protocol not only eliminates the need for bracing and reduces the cost for the affected individuals but also provides excellent clinical and radiographic end results, comparable to the original treatment protocol using the Denis Brown brace.
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Affiliation(s)
- Reda Ali Sheta
- Orthopedic Consultant, Al Ahrar Specialist Hospital, Zagazig, Egypt.
| | - Mohamed El-Sayed
- Professor, Pediatric Orthopedics & Limb Reconstructive Surgeries, Tanta University, Tanta, Egypt
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