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The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot

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Abstract

Background

The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized. The purpose of this study was to evaluate the clinical outcomes at the end of the casting period while addressing these issues.

Methods

A retrospective study of 17 patients with 25 complex clubfeet over a period of 2 years was conducted. Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads.

Results

The mean age of patients at diagnosis was 4.41 months (2–7 months). The mean pre-casting Pirani score was 4.8 (4–6) and post casting Pirani score was 0.4 (0–1). A total of 128 casts were applied to correct 25 complex clubfeet. The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4–7). Overall, four incidences of cast slippage occurred.

Conclusion

The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast.

Level of evidence Level 4.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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Funding

The authors received No financial support for the preparation, research, authorship, and/or publication of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India

    Sourabh Kumar Sinha, Varun Garg & Vivek Singh

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  1. Sourabh Kumar Sinha
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  2. Varun Garg
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  3. Vivek Singh
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Correspondence to Vivek Singh.

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Clearance from Institutional Ethical Committee taken with IEC number Letter No. AIIMS/IEC/22/125.

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Supplementary file1 Video demonstrating the Tug test to assess cast molding and cast fit in complex clubfoot (MP4 15183 KB)

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Sinha, S.K., Garg, V. & Singh, V. The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot. JOIO 57, 1147–1152 (2023). https://doi.org/10.1007/s43465-023-00910-w

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  • DOI: https://doi.org/10.1007/s43465-023-00910-w

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