The ultrasonography evaluation of talar dysplasia as a potential prognostic factor for predicting the course and outcomes of clubfoot deformity treatment using Ponseti technique

Retrospective Case Analysis of 104 Cases of Talipes Equinus

A retrospective study of 104 patients (81 male and 23 females, the age range from 2 to 288days) with talipes equinus was conducted to explore the case factors associated with it. We analyzed and discussed the correlation of plaster correction times, age of first visit, gender, and birthplace of patients in the department and understood their correlation and causality. The data were analyzed using frequency analysis, normality test, chi-square goodness-of-fit test, chi-square test, and PLS regression. The findings are set out below. All the distributions of the number of plaster casts in the samples did not have normality. Therefore, we used the nonparametric test and partial least squares regression (PLS regression) and found that the number of plaster casts was more closely related to the age at first visit, gender, and birthplace and had a strong positive correlation. There was a negative correlation between the times of plaster correction and the compliance of braces. The lower the compliance of patients with braces, the more times the plaster correction will be conducted.

Manipulation of a clubfoot prior to a Ponseti method decreases the need for tenotomy!

The combination of the Ponseti method with functional treatment produces better results and may reduce the need for surgery. The objective of this study was to assess the impact of manipulation of a congenital equinovarus clubfoot performed before correction by the Ponseti method. This was a cohort study of children <5 years treated with the Ponseti method followed over a minimum period of 1 year. Each foot was treated according to the Ponseti method. The study parameters were as follows: age, gender, concept of previous treatment, previous treatment with manipulation, the degree of deformation according to the Pirani score, the laterality of the deformation, the number of casts required and the time needed for correction, the evolution of the Pirani score before each correction by plaster, the use or not of tenotomy and the Pirani score at the end of the correction session, the evolution of the Pirani score when wearing an abduction boot. The series comprised a total of 68 feet. The average age of the children was 15.5 months. Regarding the deformity, 29 children presented a severe or very severe deformity. Before the treatment, 16 children received regular handling massage. Feet that had received manipulation prior to correction were the least exposed to tenotomy (P = .009). For the children who did not require a tenotomy, all the feet had a Pirani score of zero after the fourth week of wearing the splint. We noted a rapidly decreasing in the Pirani score of the feet, which did not require an tenotomy compared with other feet (Kolmogorov-Smirnov test: D = 0.61; P = .01). The combination of functional treatment with the Ponseti method reduces the need for tenotomy.

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

Background and purpose - After initial clubfoot correction through Ponseti treatment, recurrence rates range from 26% to 48%. Even though various factors have been associated with increased recurrence risk, systematic assessments of the prognostic capacity of recurrence risk factors and their clinical relevance are lacking. Therefore we assessed clinically relevant prognostic factors for recurrent idiopathic clubfoot deformity after initial correction through Ponseti treatment. Methods - PubMed, Embase, Cinahl, and Web of Science were systematically searched for studies investigating the association between clinically relevant factors and recurrence rates. Prognostic factors were qualitatively assessed and included in the meta-analysis if ≥ 2 studies investigated the same factor and methods were comparable. Results - 34 articles were included in the qualitative synthesis, of which 22 were also included in the meta-analysis. Meta-analysis revealed that poor evertor muscle activity (OR = 255, 95% CI 30-2,190), brace non-compliance (OR = 10, CI 5-21), no additional stretching (OR = 31, CI 10-101), more casts (OR = 3.5, CI 1.6-7.8), lower education level of parents (OR = 1.8, CI 1.2-2.6), non-marital status of parents (OR = 1.8, CI 1.1-3.0), and higher Dimeglio scores (OR = 1.9, CI 1.2-3.3) were associated with higher recurrence rates. Interpretation - Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are therefore important to be closely monitored during clinical follow-up of clubfoot patients. Adding additional stretching during the bracing protocol might be promising in the quest to prevent relapse, but scientific evidence for clear clinical treatment recommendations is still limited.