Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  11 (2024)
Volume  10 (2023)
Volume  9 (2022)
Volume  8 (2021)
Volume  7 (2020)
Volume  6 (2019)
Volume  5 (2018)
Volume  4 (2017)
Volume  3 (2016)
Volume  2 (2015)
Volume  1 (2014)
Related articles

VOLUME 8 , ISSUE 3 ( July-September, 2021 ) > List of Articles

Original Article

Clinico-radiological Outcome after Ponseti Technique for Bilateral Idiopathic Congenital Talipes Equinovarus

Ujjwal K Debnath, Gourab Chatterjee

Citation Information : Debnath UK, Chatterjee G. Clinico-radiological Outcome after Ponseti Technique for Bilateral Idiopathic Congenital Talipes Equinovarus. J Foot Ankle Surg Asia-Pacific 2021; 8 (3):145-151.

DOI: 10.5005/jp-journals-10040-1171

License: CC BY-NC 4.0

Published Online: 08-07-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim and objective: Ponseti method is a well-established treatment method for clubfeet. It has been suggested that pooling of data for unilateral and bilateral idiopathic congenital talipes equinovarus (ICTEV) is not appropriate. Therefore, this study aimed to evaluate the clinical and radiological outcome and their correlation in bilateral clubfeet. Materials and methods: Thirty infants (19M:11F) with bilateral ICTEV underwent the Ponseti method of treatment. Pirani scores and X-rays were recorded at the first visit (pre-treatment) and at the end of 12 months (post-treatment). Radiological angles were measured on anteroposterior (AP) and lateral (Lat) views of the foot and ankle. Results: The mean age was 6.7 ± 3.4 weeks (range 1–11 weeks). The mean initial Pirani score was 4.28 ± 1.1 (left) and 4.23 ± 1.09 (right). Successful outcomes were observed in 27/30 (90%) and 28/30 (93%) of the left and right foot, respectively. The mean number of casts required for left and right were (5.3 ± 1.1) and (4.9 ± 1.0), respectively. Achilles tendon (TA) tenotomy was performed in 76% (left) and 73% (right) feet. The postprocedure Pirani scores significantly correlated with talocalcaneal angle on AP (TCAP) and lateral views (TCL) on left (rAP = 0.63, rLat = 0.76) and right feet (rAP = 0.65, rLat = 0.73) (p < 0.01). Talocalcaneal index (TCI) has been significantly correlated with postprocedure Pirani score in left (r = 0.77) and right (r = 0.64) feet (p < 0.01). Tibiocalcaneal lateral angle (TiCL) has been significantly correlated with postprocedure Pirani score in the left feet (p < 0.01). Conclusion: Bilateral ICTEV can be treated successfully by the Ponseti method in infants. There was a good correlation between clinical scores and radiological parameters.

HTML PDF Share
  1. Cummings RJ, Davidson RS, Armstrong PF, et al. Congenital clubfoot. J Bone Joint Surg Am 2002;84-A(2):290–308. DOI: 10.2106/00004623-200202000-00018.
  2. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg Am 1980;62(1):23–31. DOI: 10.2106/00004623-198062010-00004.
  3. Ponseti IV, Campos J. Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res 1972;84:50–60. DOI: 10.1097/00003086-197205000-00011.
  4. Ponseti IV. Current concept review: treatment of congenital clubfoot. J Bone Joint Surg Am 1992;74-A(3):448–454. DOI: 10.2106/00004623-199274030-00021.
  5. Pavone V, Testa G, Costarella L, et al. Congenital idiopathic talipes equinovarus: an evaluation in infants treated by the Ponseti method. Eur Rev Med Pharmacol Sci 2013;17(19):2675–2679.
  6. Diméglio A, Bensahel H, Souchet P, et al. Classification of clubfoot. J Pediatr Orthop 1995;4(2):129–136. DOI: 10.1097/01202412-199504020-00002.
  7. Pirani S, Outerbridge HK, Sawatzky B, et al., (1999) A reliable method of clinically evaluating a virgin clubfoot evaluation. 21st SICOT Congress.
  8. Roye BD, Vitale MG, Gelijns AC, et al. Patient based outcomes after clubfoot surgery. J Pediatr Orthop 2001;21(1):42–49. DOI: 10.1097/01241398-200101000-00010.
  9. Uglow MG, Clarke NMP. The functional outcome of staged surgery for the correction of talipesequinovarus. J Pediatr Orthop 2000;20(4):517–523. DOI: 10.1097/01241398-200007000-00018.
  10. Yamamoto H, Furuya K. One stage postero medial release of congenital clubfoot. J Pediatr Orthop 1988;8(5):590–595. DOI: 10.1097/01241398-198809000-00018.
  11. Herbsthofer B, Eckardt A, Rompe JB, et al. Significance of radiographic angle measurements in evaluation of congenital clubfoot. Arch Orthop Trauma Surg 1998;17(6-7):324–329. DOI: 10.1007/s004020050259.
  12. Smythe T, Kuper H, Macleod D, et al. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health 2017;22(3):269–285. DOI: 10.1111/tmi.12833.
  13. Mittal R, Sekhon A, Singh G, et al. The presence of congenital orthopaedic anomalies in a rural community. Int Orthop 1993;17(1):11–12. DOI: 10.1007/BF00195214.
  14. Ansar A, Rahman AE, Romero L, et al. Systematic review and meta-analysis of global birth prevalence of clubfoot: a study protocol. BMJ Open 2018;8(3):e019246. DOI: 10.1136/bmjopen-2017-019246.
  15. Dobbs MB, Rudzki JR, Purcell DB, et al. Factors predictive of outcome after use of Ponsenti method for treatment of idopathic clubfeet. J Bone Joint Surg Am 2004;86(1):22–27. DOI: 10.2106/00004623-200401000-00005.
  16. Gupta A, Singh S, Patel P, et al. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation. Int Orthop 2008;32(1):75–79. DOI: 10.1007/s00264-006-0284-7.
  17. Saif Ullah M, Ferdous KMN, Md. Shahjahan M, et al. Management of congenital talipes equino varus (CTEV) by Ponseti casting technique in neonates: our experience. J Neonatal Surg 2013;2(2):17. DOI: 10.47338/jns.v2.29.
  18. Pirani S, Hodges D, Sekeramayi F, et al. A reliable and valid method of assessing the amount of deformity in the congenital club foot deformity. J Bone Joint Surg Br 2008;90(Suppl I):53.
  19. Jain P, Mehtani A, Goel M, et al. Correlation of foot bimalleolar angle with Pirani score to assess the severity of congenital talipes equinovarus deformity. J Pediatr Orthop 2012;21B(1):68–72. DOI: 10.1097/BPB.0b013e32834adb56.
  20. Goriainov V, Judd J, Uglow M. Does the Pirani score predict relapse in clubfoot? J Child Orthop 2010;4(5):439–444. DOI: 10.1007/s11832-010-0287-1.
  21. Gray K, Gibbons P, Little D, et al. Bilateral clubfeet are highly correlated: a cautionary tale for researchers. Clin Orthop Relat Res 2014;472(11):3517–3522. DOI: 10.1007/s11999-014-3776-6.
  22. Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year followup. Clin Orthop Relat Res 2009;467(5):1263–1270. DOI: 10.1007/s11999-008-0683-8.
  23. Blakeslee TJ. Comparative radiographic analysis of congenital idiopathic talipes equinovarus (clubfoot) in infancy. A retrospective study. J Foot Surg 1988;27(3):189–205.
  24. Bhatiwal SK, Chopra BL, Khajotia BL, et al. Idiopathic clubfoot treated by Ponseti method: a series of 300 cases. Int J Res Orthop 2018;4(6):954–958. DOI: 10.18203/issn.2455-4510.IntJResOrthop20184383.
  25. Saini MK, Vijay A, Gupta M, et al. Management of clubfoot by Ponseti method: a prospective study. J Orthop Allied Sci 2017;5(1):27–34.
  26. Lehman WB, Ahamed M, Madan S. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop 2003;12B(2):133–140. DOI: 10.1097/00009957-200303000-00011.
  27. Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg Am 1963;45(2):2261–2275. DOI: 10.2106/00004623-196345020-00004.
  28. Morcuende JA, Abbasi D, Dolan LA, et al. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005;25(5):623–626. DOI: 10.1097/01.bpo.0000162015.44865.5e.
  29. Sharma A, Shukla S, Kiran B, et al. Can the Pirani score predict the number of casts and the need for tenotomy in the management of clubfoot by the Ponseti method? Malaysian Orthop J 2018;12(1):26–30.
  30. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot (a study of 67 clubfeet with mean five year follow-up). J Orthop Surg Res 2011;6(3):1–7. DOI: 10.1186/1749-799X-6-3.
  31. Scher DM, Feldman DS, van Bosse HJ, et al. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 2004;24(4):349–352. DOI: 10.1097/01241398-200407000-00001.
  32. Kulambi V, Gaurav M, Naveen DS. Study of factors predicting the need for tenotomy in correction of clubfeet by Ponseti method. J Orthop Trauma Rehab 2017;9(1):38–40. DOI: 10.4103/0975-7341. 207160.
  33. Prasad P, Sen RK, Gill SS, et al. Clinico-radiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release. Int Orthop 2009;33(1):225–229. DOI: 10.1007/s00264-007-0448-0.
  34. Shabtai L, Hemo Y, Yavor A, et al. Radiographic indicators of surgery and functional outcome in Ponseti-treated clubfeet. Foot Ankle Int 2016;37(5):542–547. DOI: 10.1177/1071100715623036.
  35. Zimmerman CC, Nemeth BA, Noonan KJ, et al. Reliability of radiographic measures in infants with clubfoot treated with the Ponseti method. J Child Orthop 2015;9(2):99–104. DOI: 10.1007/s11832-015-0647-y.
  36. O'Halloran CP, Halanski MA, Nemeth BA, et al. Can radiographs predict outcome in patients with idiopathic clubfeet treated with the Ponseti method? J Pediatr Orthop 2015;35(7):734–738. DOI: 10.1097/BPO.0000000000000354.
  37. Lykissas MG, Crawford AH, Eismann EA, et al. Ponseti method compared with soft-tissue release for the management of clubfoot: a meta-analysis study. World J Orthop 2013;4(3):144–153. DOI: 10.5312/wjo.v4.i3.144.
  38. Hutchins PM, Foster BK, Paterson DC, et al. Long-term results of early surgical release in clubfeet. J Bone Joint Surg Br 1985;67(5):791–799. DOI: 10.1302/0301-620X.67B5.4055883.
  39. Khanna M, Kumar M. Radiographic analysis of resistant and neglected clubfoot treated by fixator. J Foot Angle Surg (Asia-Pacific) 2015;2(2):71–73. DOI: 10.5005/jp-journals-10040-1032.
  40. Shankar RK, Kotian P, Annappa R, et al. Radiological assessment of idiopathic club foot treated with Ponseti technique. J Clin Diag Res 2018;12(3):RC10–RC13. DOI: 10.7860/JCDR/2018/31616. 11289.
  41. Radler C, Manner HM, Suda R, et al. Radiographic evaluation of idiopathic club foot undergoing Ponseti treatment. J Bone Joint Surg Am 2007;89(6):1177–1183. DOI: 10.2106/JBJS.F.00438.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.