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Ponseti Method for Untreated Idiopathic Clubfeet in Nepalese Patients From 1 to 6 Years of Age

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release (n = 205 [79%]), open tendo-Achilles lengthening (n = 8 [3%]), posterior release (n = 21 [8%]), and extensive soft tissue release (posteromedial release, n = 16 [6%]). The mean dorsiflexion after removal of the last cast was 12.5° for the entire group and was greater in 1 year olds compared with 3 year olds. Although all patients achieved a plantigrade foot, the importance of the mild loss of passive dorsiflexion remains to be determined. An extensive soft tissue release was avoided in 94% of patients using the Ponseti method. We intend a followup study to ascertain whether the correction is maintained.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Seema Sonnad and Meredith Bergey for their help in performing the statistical analysis.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    David A. Spiegel MD

  2. Hospital and Rehabilitation Centre for Disabled Children, Janagal, Banepa, Kavre, Nepal

    David A. Spiegel MD, Om P. Shrestha MS, Prakash Sitoula MS, Tarun Rajbhandary MS, Binod Bijukachhe MS & Ashok K. Banskota MD, FACS

Authors
  1. David A. Spiegel MD
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  2. Om P. Shrestha MS
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  3. Prakash Sitoula MS
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  4. Tarun Rajbhandary MS
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  5. Binod Bijukachhe MS
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  6. Ashok K. Banskota MD, FACS
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Correspondence to David A. Spiegel MD.

Additional information

Study conducted at the Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Spiegel, D.A., Shrestha, O.P., Sitoula, P. et al. Ponseti Method for Untreated Idiopathic Clubfeet in Nepalese Patients From 1 to 6 Years of Age. Clin Orthop Relat Res 467, 1164–1170 (2009). https://doi.org/10.1007/s11999-008-0600-1

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  • DOI: https://doi.org/10.1007/s11999-008-0600-1

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