Advertisement

Accelerated Ponseti technique: efficacy in the management of CTEV

  • Sitanshu Barik
  • Muhammed Nazeer
  • Babloo Thomas Mani
Original Article • FOOT - PAEDIATRICS
  • 4 Downloads

Abstract

The current standard practice of treatment for congenital talipes equinus varus (CTEV) is the Ponseti method of manipulation and casting which requires great compliance by caregivers for casting as well as bracing. There is inconclusive evidence regarding optimal cast change interval. This was a prospective non-randomized study conducted at a tertiary care hospital in South India over a 2-year period with a minimum follow-up of 5 years. The patients were divided into 2 groups, one with cast change interval of 7 days and the other group at 3 days. Children with CTEV with age less than 1 year with no previous intervention were included in the study. Functional score devised by Ponseti was determined at final follow-up. The average number of casts in standard and accelerated group was 5.23 ± 0.59 and 4.72 ± 0.61 (p < 0.01). The average number of days required for correction of feet was 54.38 ± 8.01 and 33.88 ± 9.03 (p < 0.01) respectively, for standard and accelerated groups. The Pirani score showed a faster reduction in the accelerated group. This study is the longest prospective study published yet in literature, comparing standard and accelerated Ponseti protocols. Complication rate noted in our study was comparable to study by Morcuende but higher than other studies comparing the techniques. It increases compliance as well as reducing treatment and travel costs for parents, more so in developing countries. At 5-year follow-up, there is no significant difference in the functional outcome.

Keywords

Congenital talipes equinovarus Standard Ponseti Accelerated Ponseti 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Tachdijan M (1980) Paediatric orthopaedics, 2nd edn. WB Saunders, Philadelphia, p 2428Google Scholar
  2. 2.
    Halanski MA, Davison JE, Huang J-C, Walker CG, Walsh SJ, Crawford HA (2010) Ponseti method compared with surgical treatment of clubfoot: a prospective comparison. JBJS A92:270–278CrossRefGoogle Scholar
  3. 3.
    Ponseti IV, Smoley EN (1963) Congenital club foot: the results of treatment. J Bone Joint Surg Am 45-A:261–344CrossRefGoogle Scholar
  4. 4.
    Laaveg SJ, Ponseti IV (1980) Long term results of treatment of congenital clubfoot. J Bone Joint Surg Am 62-A:23–31CrossRefGoogle Scholar
  5. 5.
    Docker CEJ, Lewthwaite S, Kiely NT (2007) Ponseti treatment in the management of clubfoot deformity—a continuing role for paediatric orthopaedic services in secondary care centers. Ann R Coll Surg Engl 89:510–512CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Boardman A, Jayawardena A, Oprescu F, Cook T, Morcuende JA (2011) The Ponseti method in Latin America: initial impact and barriers to its diffusion and implementation. Iowa Orthop J 31:30–35PubMedPubMedCentralGoogle Scholar
  7. 7.
    Morcuende J, Abbasi D, Dolan L (2005) Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 25:623–625CrossRefPubMedGoogle Scholar
  8. 8.
    Flowers KR, LaStayo P (1994) Effect of total end range time on improving passive range of motion. J Hand Ther 7(3):150–157CrossRefPubMedGoogle Scholar
  9. 9.
    Pohl M, RuÈckriem S, Mehrholz J, Ritschel C, Strik H, Pause MR (2002) Effectiveness of serial casting in patients with severe cerebral spasticity: a comparison study. Arch Phys Med Rehabil 83(6):784–790CrossRefPubMedGoogle Scholar
  10. 10.
    Harshwardhan H, Kumar S (2018) Evaluation of outcome in idiopathic clubfoot managed by accelerated Ponseti method. Int J Orthop Sci 4(2):172–176CrossRefGoogle Scholar
  11. 11.
    Elgohary HSA, Abulsaad M (2014) Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol.  https://doi.org/10.1007/s00590-015-1594-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Harnett PL, Freeman R, Harrison WJ, Brown LC, Beckles V (2011) An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br 93-B:404–408CrossRefGoogle Scholar
  13. 13.
    Gilani SF, Ahmed S, Obaid-Ur-Rehman Bashir MA (2014) Comparison of accelerated VS standard Ponseti method in management of idiopathic clubfoot. J Pak Orthop Assoc 26(1):7–10Google Scholar
  14. 14.
    Ibraheem G, Adegbehingbe O, Babalola O, Agaja S, Ahmed B, Olawepo A et al (2017) Evaluation of an accelerated Ponseti protocol for the treatment of talipes equinovarus in Nigeria. East Cent Afr J Surg 22(1):28–38CrossRefGoogle Scholar
  15. 15.
    Sahu B, Rajavelu R, Tudu B (2015) Management of idiopathic congenital talipes equinovarus by standard versus accelerated Ponseti plaster technique: a prospective study. J Orthop Traumatol Rehabil 8(1):30CrossRefGoogle Scholar
  16. 16.
    Giesberts RB, van der Steen MC, Maathuis PGM, Besselaar AT, Hekman EEG, Verkerke GJ (2018) Influence of cast change interval in the Ponseti method: a systematic review. PLoS ONE 13(6):e0199540.  https://doi.org/10.1371/journal.pone.0199540 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Garg S, Porter K (2009) Improved bracing compliance in children with clubfeet using a dynamic orthosis. J Child Orthop 1:271–276CrossRefGoogle Scholar
  18. 18.
    Boehm S, Sinclair M (2007) Foot abduction brace in the Ponseti method for idiopathic clubfoot deformity: torsional deformities and compliance. J Pediatr Orthop 27:712–716CrossRefPubMedGoogle Scholar
  19. 19.
    Pirani S, Naddumba E, Mathias R, Konde-Lule J, Penny JN, Beyeza T, Mbonye B, Amone J, Franceschi F (2009) Towards effective Ponseti clubfoot care: the Uganda sustainable clubfoot care project. Clin Orthop Rel Res 467:1154–1163CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Sitanshu Barik
    • 1
  • Muhammed Nazeer
    • 2
  • Babloo Thomas Mani
    • 3
  1. 1.Department of OrthopaedicsAll India Institute of Medical SciencesRishikeshIndia
  2. 2.Department of OrthopaedicsKerala Institute of Medical SciencesTrivandrumIndia
  3. 3.Spring Garden ClinicTrivandrumIndia

Personalised recommendations