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Published on: February 5, 2019
Quantifying the Ponseti method
R B Giesberts1, E E G Hekman1, P G M Maathuis2
1Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
Insights
This study measured forces during the Ponseti method for idiopathic clubfoot treatment. Significant variability exists, suggesting potential for optimizing this standard clubfoot treatment.
Area of Science:
- Orthopedics
- Biomechanics
- Pediatric medicine
Background:
- The Ponseti method is the gold standard for treating idiopathic clubfoot.
- Detailed manipulation techniques exist, but applied forces are not well quantified.
Purpose of the Study:
- To investigate the magnitude and course of forces applied during the Ponseti method.
- To identify potential areas for optimizing clubfoot treatment.
Main Methods:
- An instrumented clubfoot model with force sensors was used.
- Seventeen practitioners applied the Ponseti method to the model.
- Forces were measured during manipulation, casting, and post-casting.
Main Results:
- Forces during manipulation were significantly higher on the talar neck (TN) than during casting.
- No definitive 'correct' force amount was determined.
- Inter-practitioner variability in force application reached 70%.
Conclusions:
- Applied forces during the Ponseti method show high variability among practitioners.
- Cast pressure may exceed local tissue perfusion, indicating a need for optimization.
- Further research can refine force application for improved clubfoot outcomes.
Abstract:
The Ponseti method is the accepted treatment of idiopathic clubfoot. Although the method of manipulating the baby feet is described in great detail, current study aimed to investigate the magnitude and course of the applied forces in order to optimise the treatment of clubfoot. An instrumented clubfoot model was constructed with force sensors on the location of the first metatarsal (FM) and the talar neck (TN) and treated with the Ponseti method by 17 practitioners. Applied forces on FM and TN were measured during manipulation (4.2N; 12N), during casting (3.2N; 3.5N) and after casting (2.9N; 2.2N). The forces during manipulation were significantly higher than during casting on TN (p<0.001) but not on FM (p=0.129). No 'correct' amount of force could be determined and inter-practitioner variability was measured to be 70%. The resulting pressure of the cast on the clubfoot model as measured directly after casting was significantly higher than local tissue perfusion. The results of this study suggest potential for the optimisation of the application of the Ponseti method.
