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Pedrotti L, Bertani B, Tuvo G, Mora R, Nasi F, Manzoni F, Marin L, Moro F, De Rosa F. Ultrasonic Evaluation of the Achilles Tendon in Patients Treated for Congenital Clubfoot: Comparison between Patients Treated with Plaster Alone, Achilles Tenotomy, and Z-Plasty Lengthening. CHILDREN (BASEL, SWITZERLAND) 2024; 11:580. [PMID: 38790575 PMCID: PMC11119425 DOI: 10.3390/children11050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Clubfoot is a common congenital deformity. The Ponseti technique, involving early corrective manipulations followed by applying long leg casts and Achilles tenotomy, is widely accepted as the preferred treatment. Rapid tendon healing after surgery has been documented, but the aspect regarding long-term tendon structure and properties is not known. Three cases of Achilles tendon rupture in adolescents previously treated for clubfoot have been described in the literature. As rupture is a rare event in this age group, a possible correlation with previous surgery has been hypothesized. The primary aim of the study was to compare the ultrasound findings of the Achilles tendon in patients treated for clubfoot, between patients treated with casting alone and with patients who underwent surgery (percutaneous tenotomy or Z-plasty lengthening). METHODS There were 22 asymptomatic patients (34 feet) with a median age of 12 years, previously treated for clubfoot, that were recruited for this study; the patients underwent an Achilles tendon ultrasound examination during a follow-up outpatient visit. RESULTS A greater thickness and increased number of structural alterations with the presence of hypoechoic areas of the operated tendons compared with those treated with plaster alone were observed (p-value: 0.0498 and <0.001, respectively). These ultrasound findings were indicative of tendon suffering, as seen in tendinopathies. CONCLUSIONS The presence of ultrasound alterations in asymptomatic patients operated on for clubfoot requires careful control of the extrinsic factors of tendinopathy in order to reduce the risk of subcutaneous rupture.
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Affiliation(s)
- Luisella Pedrotti
- Locomotor System Diseases Unit, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Barbara Bertani
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Gabriella Tuvo
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Redento Mora
- Orthopedic and Traumatology Unit, Città di Pavia Institute, 27100 Pavia, Italy; (B.B.); (G.T.); (R.M.)
| | - Fabrizio Nasi
- Outpatient Ultrasound Service, Città di Pavia Institute, 27100 Pavia, Italy;
| | - Federica Manzoni
- Epidemiology Unit, Health Protection Agency of Pavia (ATS Pavia) Italy, 27100 Pavia, Italy;
| | - Luca Marin
- Laboratory of Adapted Motor Activity, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Francesco Moro
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Federica De Rosa
- Pediatric Orthopedic and Traumatology Unit, Children’s Hospital, AON SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
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Butt MN, Perveen W, Ciongradi CI, Alexe DI, Marryam M, Khalid L, Dobreci DL, Sârbu I. Outcomes of the Ponseti Technique in Different Types of Clubfoot-A Single Center Retrospective Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1340. [PMID: 37628341 PMCID: PMC10453163 DOI: 10.3390/children10081340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Background: Clubfoot is a congenital deformity that can affect one or both of a newborn's lower extremities. The main objective of the study is to evaluate and compare the outcomes of the Ponseti method for the management of different types of clubfoot. Methods: A retrospective analysis of 151 children with 253 clubfeet (idiopathic untreated, idiopathic recurrent, and syndromic) with at least one year of follow-up was conducted in four months after ethical approval. Data were collected with a structured proforma after the consent of the parents. An independent sample t-test was applied to show the comparison between the groups, and a p-value of 0.05 was considered significant. Results: Out of 151 patients, 76% were male and 24% were female. Out of a total of 235 feet, 96 (63%) were idiopathic untreated, 40 (26.5%) were idiopathic recurrent, and 15 (9.5%) were syndromic clubfoot. The average number of casts was higher in syndromic clubfoot (9 casts per foot). There was no significant difference in the baseline Pirani score of the three groups (p-value > 0.05); but after one year of follow-up, there was a significant difference in the Pirani score of idiopathic and syndromic clubfoot (p-value ≤ 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value = 0.01). Conclusions: The aetiology of syndromic clubfoot affects the outcomes of the Ponseti method and leads to relapse. In idiopathic (untreated and recurrent) clubfoot, the Ponseti method does not produce a significant difference in outcome. Poor brace compliance and a lack of tenotomy lead to orthotic (ankle foot orthosis AFO and foot orthosis FO) use in the day time and the recurrence of clubfoot deformity in these three types of clubfoot.
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Affiliation(s)
- Maryum Naseer Butt
- Muzaffarabad Physical Rehabilitation Centre, Muzaffarabad 13100, Pakistan;
| | - Wajida Perveen
- School of Allied Health Sciences, CMH Lahore Medical College & IOD (NUMS Rawalpindi), Lahore 54810, Pakistan
| | - Carmen-Iulia Ciongradi
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania; (D.I.A.); (D.L.D.)
| | | | - Laique Khalid
- Combined Military Hospital, Muzaffarabad 13100, Pakistan;
| | - Daniel Lucian Dobreci
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania; (D.I.A.); (D.L.D.)
| | - Ioan Sârbu
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study. CHILDREN 2022; 9:children9060865. [PMID: 35740802 PMCID: PMC9221593 DOI: 10.3390/children9060865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 02/08/2023]
Abstract
There are few validated predictors of the need for additional surgery in idiopathic clubfeet treated according to the Ponseti method. Our aim was to examine if physical examination (Pirani score) and radiographs at the age of three months (after initial correction of the clubfeet) can predict the future need for additional surgery. In this retrospective cohort study, radiographs of idiopathic clubfeet were made at the age of three months. The Pirani score was determined at the first cast, before tenotomy, and at the age of three months. Follow-up was at least five years. The correlation between the radiograph, Pirani score, and the need for additional surgery was explored with logistic regression analysis. Parent satisfaction was measured with a disease-specific instrument. The study included 72 clubfeet (50 children) treated according to the Ponseti method. Additional surgery was needed on 27 feet (38%). A larger lateral tibiocalcaneal angle (i.e., equinus) and a smaller lateral talocalcaneal angle (i.e., hindfoot varus) at the age of three months were correlated with the need for additional surgery. Higher Pirani scores before tenotomy and at the age of three months also correlated with additional surgery. Parent satisfaction was lower in patients who needed additional surgery. Both the Pirani scores and the lateral radiographs are predictive for future additional surgery.
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Laliotis N, Chrysanthou C, Konstandinidis P, Anastasopoulos N. Anatomical Structures Responsible for CTEV Relapse after Ponseti Treatment. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050581. [PMID: 35626758 PMCID: PMC9139296 DOI: 10.3390/children9050581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/03/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Relapse of deformity after a successful Ponseti treatment remains a problem for the management of clubfoot. An untreated varus heel position and restricted dorsal flexion of the ankle are the main features of recurrences. We analyze the anatomical structures responsible for these recurrences. Materials and methods: During 5 years, 52 children with CTEV (Congenital Talipes Equino Varus) were treated with casts according to the Ponseti method, with a mean number of 7 casts. Closed percutaneous tenotomy was performed in 28 infants. Children were followed monthly and treated with the continuous use of a molded cast. We had 9 children with relapsed clubfeet. During the standing and walking phase, they had a fixed deformity with a varus position of the heel and dorsal flexion of the ankle <10 d. They were surgically treated with the posterolateral approach. Results: In all patients, we found a severe thickening of the paratenon of the Achilles in the medial side, with adhesions with the subcutaneous tissue. The achilles after the previous tenotomy was completely regenerated. The achilles was medially displaced. Conclusions: A severe thickening of the paratenon of the achilles and adhesions with the subcutaneous tissue are anatomical structures in fixed relapsed cases of clubfoot. We treated our patients with an appropriate surgical release.
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Affiliation(s)
- Nikolaos Laliotis
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
- Correspondence:
| | - Chrysanthos Chrysanthou
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
| | - Panagiotis Konstandinidis
- Orthopaedic Department, Inter Balkan Medical Center, Asklipiou 10 Pilea, 57001 Thessaloniki, Greece; (C.C.); (P.K.)
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Pavone V. Bone Development and Disease in Infants. CHILDREN 2022; 9:children9040519. [PMID: 35455563 PMCID: PMC9025282 DOI: 10.3390/children9040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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Hu W, Ke B, Niansu X, Li S, Li C, Lai X, Huang X. Factors associated with the relapse in Ponseti treated congenital clubfoot. BMC Musculoskelet Disord 2022; 23:88. [PMID: 35081931 PMCID: PMC8790874 DOI: 10.1186/s12891-022-05039-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/17/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method. Methods We retrospectively reviewed all children with congenital clubfoot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee. Results In this study, there were 148 cases (164 ft) in total that underwent the Ponseti method, with the follow–up period at least 5 years. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50 ± 2.15 months. The average initial Pirani score was 4.98 ± 1.33, and the average number of casts was 5.71 ± 2.28 times. The mean age of mothers at birth was 25.81 ± 2.38 years old. The walking age of children was at a mean of 14.83 ± 1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 ft (76.4%). The average follow–up period was 7.27 ± 1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group . Conclusion The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.
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Affiliation(s)
- Wei Hu
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China.
| | - Baoyi Ke
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
| | - Xiao Niansu
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
| | - Sen Li
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
| | - Cheng Li
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
| | - Xingming Lai
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
| | - Xinyu Huang
- Department of Spine and Osteopathy Ward, Guilin Peoples' Hospital, No 12 Wenming road, Guilin, 540021, Guangxi, China
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Pavone V, Sapienza M, Vescio A, Caldaci A, McCracken KL, Canavese F, Testa G. Early developmental milestones in patients with idiopathic clubfoot treated by Ponseti method. Front Pediatr 2022; 10:869401. [PMID: 36090581 PMCID: PMC9448959 DOI: 10.3389/fped.2022.869401] [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: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Idiopathic clubfoot, also referred to as congenital talipes equinovarus (CTEV), is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment if untreated. The aims of this study were to (1) assess the developmental milestones in patients with CTEV treated by the Ponseti technique, and to compare them to the unaffected controls; (2) evaluate the possible correlation between developmental milestones, severity of the deformity, and number of casts. MATERIALS AND METHODS Seventy-nine subjects were divided into two groups, CTEV group (43 patients; 72 feet) and control group (36 patients). Age, sex, affected side, attainment of babbles (BAL), independent gait (IG), and combined word (CW) were recorded for all patients. In patients with CTEV, Pirani Score (PRS), number of casts (NC), and clinical outcome were collected according to the Clubfoot Assessment Protocol (CAP), The American Orthopedic Foot and Ankle Score (AOFAS), and Foot and Ankle Disability Index (FADI). RESULTS IG was achieved later later than the unaffected controls by 12/43 patients (27.9%) with CTEV and 3/36 patients in the control group (8.3%) (p = 0.04) and in a mean time of 16.8 ± 3.5 months and 13.2 ± 2.7 months, respectively (p = 0.001). In the CTEV group the mean value of CAP was 98.6 ± 4.7, of AOFAS of 98.4 ± 4.4 and of FADI equal to 99.9 ± 0.44. There were no statistically significant differences for BAL and CW; and no correlation with PRS, NC, or clinical score were identified. CONCLUSION CTEV patients managed by the Ponseti technique achieve independent gait later than the unaffected controls, although they do so within the age limit of developmental. On the other hand, the Ponseti treatment has no impact on attainment of language development.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
| | - Kathryn Louise McCracken
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Lille, France
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, P.O. "Policlinico Gaspare Rodolico", University of Catania, Catania, Italy
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Li SJ, Shi BC, Liu CL, Liu YB. Finite element analysis of the kinematic coupling effect of the joints around talus when Ponseti manipulation. BMC Musculoskelet Disord 2021; 22:682. [PMID: 34384390 PMCID: PMC8361653 DOI: 10.1186/s12891-021-04575-0] [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: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Little information was obtained from the published papers about the kinematic coupling effect between tarsal bones during Ponseti manipulation. The aim was to explore the kinematic coupling effect of the joints around talus, to investigate the kinematic rhythm and coupling relationship of tarsal joints; to clarify the pulling effect on medial ligament of the ankle during the process of Ponseti manipulation. Methods The model of foot and ankle was reconstructed from the Chinese digital human girl No.1 (CDH-G1) image database. Finite element analysis was applied to explore the kinematic coupling effect of the joints around talus. The distal tibia and fibula bone and the head of talus were fixed in all six degrees of freedom; outward pressure was added to the first metatarsal head to simulate the Ponseti manipulation. Kinematic coupling of each tarsal joint was investigated using the method of whole model splitting, and medial ligament pulling of the ankle was studied by designing the model of medial ligament deletion during the Ponseti manipulation. Results All the tarsal joints produced significant displacement in kinematic coupling effect, and the talus itself produced great displacement in the joint of ankle. Quantitative analysis revealed that the maximum displacement was found in the joints of talonavicular (12.01mm), cuneonavicular (10.50mm), calcaneocuboid (7.97mm), and subtalar(6.99mm).The kinematic coupling rhythm between talus and navicular, talus and calcaneus, calcaneus and cuboid, navicular and cuneiform 1 were 1:12, 1:7, 1:2 and 1:1.6. The results of ligaments pulling showed that the maximum displacement was presented in the ligaments of tibionavicular (mean 27.99mm), talonavicular (21.03mm), and calcaneonavicular (19.18 mm). Conclusions All the tarsal joints around talus were involved in the process of Ponseti manipulation, and the strongest kinematic coupling effect was found in the joints of talonavicular, subtalar, calcaneocuboid, and cuneonavicular. The ligaments of tibionavicular, talonavicular, and calcaneonavicular were stretched greatly. It was suggested that the method of Ponseti management was a complex deformity correction processes involved all the tarsal joints. The present study contributed to better understanding the principle of Ponseti manipulation and the pathoanatomy of clubfoot. Also, the importance of cuneonavicular joint should be stressed in clinical practice.
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Affiliation(s)
- Song-Jian Li
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, No.253. Gongye Middle Avenue, Haizhu District, 510280, Guangzhou, Guangdong, China
| | - Ben-Chao Shi
- Orthopedics Center, Department of Spinal Surgery, Zhujiang Hospital, Southern Medical University, No.253. Gongye Middle Avenue, Haizhu District, 510280, Guangzhou, Guangdong, China
| | - Cheng-Long Liu
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, No.253. Gongye Middle Avenue, Haizhu District, 510280, Guangzhou, Guangdong, China
| | - Yu-Bin Liu
- Orthopedics Center, Department of Orthopedics and Traumatology, Zhujiang Hospital, Southern Medical University, No.253. Gongye Middle Avenue, Haizhu District, 510280, Guangzhou, Guangdong, China. .,Orthopedics Center, Department of Spinal Surgery, Zhujiang Hospital, Southern Medical University, No.253. Gongye Middle Avenue, Haizhu District, 510280, Guangzhou, Guangdong, China.
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