Our Treatment Results of Congenital Clubfoot with the Ponseti Method

Year 2008, Volume: 13 Issue: 2, 116 - 119, 01.04.2008

Tahir Varol Lokman Karakurt Oktay Belhan H. Bayram Tosun

Abstract

Objectives: We evaluated results of the Ponseti method in patients with congenital clubfoot deformity. Material and Methods: The study included 18 feet of 12 patients (8 boys, 4 girls; mean age was 5 days) with idiopathic clubfoot deformities. According to the Dimeglio classification, 10 feet (55.5%) were type 2, 8 feet (44.5%) were type 3. We did manipulation and casting with the Ponseti technique in all the patients. All of the patients underwent a percutaneous Achilles tenotomy for equinus deformity. Foot abduction brace was prescribed for maintenance of reduction. The mean follow-up period was 21 months (range 6-48 months). Results: At latest follow-up, 17 feet (94.4%) were Dimeglio type 1, 1 foot (5.6%) was Dimeglio type 2. We determined relapses in 13 feet of 10 patients. Seven of the 10 patients that we determined relapses had problems of using the abduction brace. Our revision rate was 11.1%; a foot required posteromedial release and another foot required complet subtalar release. These two patients were noncompliant with foot abduction brace. Conclusion: The Ponseti method is an effective method of treating congenital idiopathic clubfoot. The technique must be applied completely to obtain successful result and families must be educated to enhance the compliance to foot abduction brace.©2008, Firat University, Medical Faculty.

Keywords

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Doğuştan Çarpık Ayaklı Olgularda Ponseti Yöntemi ile Tedavi Sonuçlarımız

Abstract

Amaç: Ponseti yöntemi ile tedavi ettiğimiz doğuştan çarpık ayaklı (DÇA) olguların sonuçlarını değerlendirmek. Gereç ve Yöntem: Çalışmada, DÇA'lı 12 hastanın 18 ayağı değerlendirildi (8 erkek, 4 kız; ortalama yaş 5 gün). Dimeglio sınıflamasına göre, 10 ayak (%55.5) tip 2, 8 ayak (%44.5) tip 3 idi. Olgulara Ponseti yöntemi ile manipülasyon ve alçılama yapıldı. Ekin deformitesi için tüm olgulara perkütan Aşil tenotomisi yapıldı. Redüksiyonun korunması için ayak abdüksiyon cihazı kullanıldı. Ortalama takip süresi 21 ay (6-48 ay) idi. Bulgular: Son kontrolde 17 ayak (%94.4) Dimeglio tip 1, 1 ayak (%5.6) Dimeglio tip 2 idi. On hastanın 13 ayağında nüks görüldü. Nüks saptanan bu 10 hastanın 7'sinin ayak abdüksiyon ortezini düzenli kullanmadığı, hatta bir süre sonra kullanmayı bıraktıkları öğrenildi. Revizyon oranımız %11.1 idi ve bir ayağa komplet subtalar gevşetme, diğerine posteromedial gevşetme yapıldı. Bu iki hasta da ortezini düzenli kullanmamıştı. Sonuç: Ponseti yöntemi, idiyopatik tip DÇA deformitesini düzeltmede oldukça etkili bir yöntemdir. Başarılı sonuç alabilmek için yöntem tam olarak uygulanmalı ve ayak abdüksiyon ortezinin uygun şekil ve süre kullanılması amacı ile aileler eğitilmelidir. ©2008, Fırat Üniversitesi, Tıp Fakültesi

Keywords

Doğuştan çarpık ayak, Ponseti, tedavi

References

• Herring JA (editor). Disorders of the foot. Tachdjian’s Pediatric Orthopaedics. Vol. 2, 3rd ed., Philadelphia: WB Saunders, 2002.
• Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg [Am] 1992; 74: 448-454.
• Ponseti IV. Clubfoot management. J Pediatr Orthop 2000; 20: 699- 700.
• Nimityongskul P, Anderson LD, Herbert DE. Surgical treatment of clubfoot: a comparison of two techniques. Foot Ankle 1992; 13: 116-124.
• Uglow MG, Clarke NMP. The functional outcome of staged surgery for the correction of talipes equinovarus. J Pediatr Orthop 2000; 20: 517-523.
• Cummings RJ, Lovell WW. Operative treatment of congenital idiopathic club foot. J Bone Joint Surg [Am] 1988; 70: 1108-1112.
• Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 2002; 22: 517-521.
• Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg Am 1980; 62: 23-31.
• Göksan SB. Treatment of congenital clubfoot with Ponseti method. Acta Orthop Traumatol Turc 2002; 36: 281-287.
• Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B 1995; 4: 129-136.
• Main BJ, Crider RJ, Polk M, et al. The results of early operation in talipes equinovarus: a preliminary report. J Bone Joint Surg Br 1977; 59: 337-341. 12. 12.
• Reimann I, Becker-Andersen H. Early surgical treatment of
• congenital clubfoot. Clin Orthop 1974; 102: 200-206. 13. 13.
• Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term
• comparative results in patients with congenital clubfoot treated
• with two different protocols. J Bone Joint Surg Am 2003; 85: 1286-1294.
• Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990; 10: 109-119.
• Hutchins PM; Foster BK, Paterson DC, Cole EA. Long-term results of early surgical release in club feet. J Bone Joint Surg Br 1985; 67: 791-799.
• Ponseti IV, Smoley EN. Congenital Clubfoot: The results of treatment. J Bone Joint Surg Am 1963; 45: 261-275.
• Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004; 113: 376-380.
• Tindall AJ, Steinlechner CW, Lavy CB, Mannion S, Mkandawire N. results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world? J Pediatr Orthop 2005; 25: 627-629.
• Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg 2003; 42: 259-267.
• Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty- year follow-up. J Bone Joint Surg Am 1995; 77: 1477-1489.
• Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 2001; 21: 719-726.
• Dobbs MB, Rudzki JR; Purcell DB, et al. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 2004; 86: 22-27.
• Thacker MM, Scher DM, Sala DA, et al. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005; 25: 225-228.
• Abdelgawad AA, Lehman WB, van Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B 2007; 16: 98-105.
• Kabul Tarihi:10.08.2007