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Sequential correction of clubfoot deformities with Ponseti casting and tenotomy: Insights from the Dimeglio scoring
Sitanshu Barik1, Anil Agarwal2, Yogesh Patel2
1All India Institute of Medical Sciences, Nagpur, India.
Insights
The Ponseti method rapidly corrects clubfoot deformity within the first few casts. Percutaneous Achilles tenotomy further improves residual equinus and other deformities, aiding in achieving a neutral foot position.
Area of Science:
- Pediatric Orthopedics
- Biomechanical Analysis
- Clinical Trial Methodology
Background:
- Clubfoot is a common congenital lower limb deformity.
- The Ponseti method is a widely used conservative treatment for clubfoot.
- Understanding correction dynamics is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To determine when the foot achieves a neutral position during Ponseti treatment.
- To quantify the impact of percutaneous Achilles tenotomy on clubfoot components.
- To visualize clubfoot correction trends using the Dimeglio scoring system.
Main Methods:
- Infants under six months with idiopathic clubfoot were enrolled.
- Serial casting and percutaneous Achilles tenotomy were performed.
- The Dimeglio score assessed deformity at each visit, analyzing changes throughout treatment.
Main Results:
- A mean of 6.2 casts were used before tenotomy.
- The most significant correction occurred between the first and second casts for all deformity components.
- Tenotomy provided additional correction, particularly for equinus deformity.
Conclusions:
- The Ponseti technique facilitates early and concurrent improvement of major clubfoot elements.
- Correction is most pronounced in the initial casts, with tenotomy offering further benefits.
- Standardized graphical correction profiles could enhance treatment monitoring and comparison.
Background:
This study evaluated the point during Ponseti treatment when the foot reaches a neutral position and quantified how percutaneous Achilles tenotomy influences each component of clubfoot deformity. An additional aim was to provide a visual representation of correction trends using the Dimeglio scoring framework.
Methods:
Infants under six months of age with unilateral idiopathic clubfoot were assessed at each visit with the Dimeglio score. Changes in total and individual deformity parameters were analyzed throughout serial casting and following tenotomy.
Results:
The total number of casts required before tenotomy ranged from 3 to 12 (mean 6.2). The largest drop in total Dimeglio score occurred between the initial and second casts. All the individual components exhibited the steepest reduction between the first and second casts (17.90 - equinus, 19.20 - hindfoot varus, 44.40 - midfoot rotation, and 18.80 - forefoot adduction). All the deformities except equinus approached neutral through the third cast and equinus through the fourth cast. Tenotomy improved (mean) equinus by 140, hindfoot varus by 20, midfoot rotation by 50 and forefoot adduction by 3.20.
Conclusions:
All major deformity elements show concurrent early improvement when managed with the Ponseti technique. Significant change occurs within the first few casts, with tenotomy offering additional correction beyond equinus alone. Larger-scale studies could help standardize the graphical correction profiles observed here.
Level Of Evidence:
IV.
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