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Application of Ponseti method in patients older than 6 months with congenital talipes equinovarus
Yan-zhou Wang1, Xiao-wen Wang, Peng Zhang
1Department of Pediatric Orthopaedics, Provencial Hospital affiliated to Shandong University, Jinan 250021, China. yanzhouwang@gmail.com
Insights
The Ponseti method effectively treats congenital talipes equinovarus (CTE) in children over six months, achieving excellent results. This treatment approach, involving casting and sometimes tenotomy, shows high success rates across various age and deformity severity groups.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Developmental Pediatrics
Background:
- Congenital talipes equinovarus (CTE) is a common birth defect affecting foot and ankle alignment.
- Early intervention is crucial for optimal outcomes in CTE treatment.
- The Ponseti method is a widely recognized non-surgical approach for CTE.
Purpose of the Study:
- To assess the efficacy of the Ponseti method in treating CTE in children older than six months.
- To compare treatment outcomes based on patient age and deformity severity.
- To evaluate key treatment metrics including casting, tenotomy rates, and relapse rates.
Main Methods:
- A cohort of 157 cases (227 feet) with CTE in children over six months were treated using the Ponseti method.
- Patients were categorized into age groups (6-12 months, 1-3 years, >3 years) and deformity severity groups (mild, moderate, severe) using the Pirani scoring system.
- Outcomes measured included the number of casts, Pirani scores for excellent results, percutaneous achillotenotomy rates, and follow-up duration (average 3 years, 11 months).
Main Results:
- An overall excellent result rate of 96.92% was achieved.
- Excellent results were comparable between younger age groups but lower in children over three years old (P > 0.01).
- The severe deformity group had the lowest excellent result rate (P < 0.05), with no significant difference between mild and moderate groups. Relapse rates were not statistically different across groups.
Conclusions:
- The Ponseti method demonstrates high effectiveness in treating congenital talipes equinovarus in children over six months of age.
- Treatment outcomes are influenced by age and severity of deformity, with younger children and less severe deformities yielding better results.
- The study supports the Ponseti method as a successful treatment for CTE, with low relapse rates observed over long-term follow-up.
Objective:
To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months.
Methods:
Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was: (1) I Group (6 months to 12 months), 113 feet in 81 cases; (2) II Group (1 to 3 years old), 78 feet in 52 cases; (3) III Group (> 3 years old), 36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree: (1) Mild Group (scoring 1-2.5), 85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5), 104 feet in 71 cases; (3) Severe Group (scoring 5-6), 38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group, we evaluated the number of casts used, the percentage of excellent result according to the Pirani score, and the percentage of percutaneous achillotenotomy. The result was compared among different groups.
Results:
The overall percentage of excellent result among all cases was 96.92%. Among the age groups, the percentage of excellence was not statistically different between I Group and II Group (P > 0.05). The percentage of excellence was lower in the III group than the other groups (P > 0.01). Among the groups classified by deformity degree, the percentage of excellence was the lowest in severe group (P < 0.05), and the difference between the mild group and moderate group was not statistically different (P > 0.05). The number of casts used among different groups were different (P < 0.01). Among different groups, the percentages of percutaneous achillotenotomy were significantly different (P < 0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P > 0.05).
Conclusion:
Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.