Clubfoot Library

The Effect of the Internet in the Treatment of Congenital Idiopathic Clubfoot

Abstract

Parents have traditionally relied on health care professionals for advice and treatment for most orthopaedic conditions, including clubfoot. However, the unprecedented access to health care information offered by the Internet is changing how parents gather information and make treatment choices. This study was designed to evaluate the effect of the Internet in the treatment of clubfoot. We performed a retrospective review of the clinical census, statistics of the Virtual Hospital web pages on clubfoot, web sites, and web based support-groups related to clubfoot from 1995 to 2002. There were 157 patients that came to our clinic for treatment, a dramatic increase compared to previous years. There were a total of 790,084 hits to the Virtual Hospital web pages, with information requested from all states and 72 countries. Interestingly, the referrals also changed with patients coming from 30 states and 8 different countries, compared to previous years when the majority came from our own state. In addition, 75% of the patients were self-referred, many of them while on treatment at outside institutions. There were 160 web sites providing information on clubfoot and 5 large support groups. There were approximately 30,000 messages (average 1000 messages/month) posted into the support clubfoot websites. After visiting Internet support groups, 125 parents transferred or initiated the care of their children to a doctor practicing the Ponseti method. In conclusion, the Internet provides a mean for parents to obtain disease-specific information in a timely manner. Parents used the support-groups to find and proffer information, share experiences and opinions, and provide encouragement. This sharing of information is affecting how parents make their treatment choices and also has the potential to induce unexpected changes in clinical orthopaedic practice.

Ponseti method compared to previous treatment of clubfoot in Norway

Abstract

Despite few studies comparing Ponseti treatment and traditional treatment of clubfoot (talipes equinovarus), the Ponseti method is now accepted as standard treatment for this deformity. The Ponseti method was introduced in Norway in 2003 and the purpose of this multicenter-study was to compare the results of Ponseti treatment with the results of the previous treatment for clubfoot in Norway.

90 children (134 clubfeet) treated with previous treatment (pre-Ponseti group), were compared to 115 Ponseti treated children (160 clubfeet) (Ponseti group). The previous treatment consisted of casting and surgery if needed. At 8–11 years of age, all children were examined by the same orthopaedic surgeon, the parents answered a questionnaire, all feet were X-rayed and information about surgical procedures was obtained from the patient records.

Ponseti method in the management of clubfoot under 2 years of age

Abstract

Congenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age.

Articles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age.

Design and descriptive data of the randomized Clubfoot Foot Abduction Brace Length of Treatment Study

Abstract

The aim of this study was to describe the design and baseline characteristics of participants enrolled in the prospective randomized-controlled Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Foot abduction bracing is currently the standard of care for preventing clubfoot relapse. Current recommendations include full-time bracing for the first 3 months and then 8-12 h a day for 4 years; however, the optimal length of bracing is not known. The FAB24 trial is a clinical randomized study to determine the effectiveness of 2- versus 4-year foot abduction bracing. Participant enrollment for FAB24 was conducted at eight sites in North America and included enrollment and randomization of 139 participants with isolated clubfoot. This clinical trial will generate evidence-based data that will inform and improve patient care

Long-Term Comparative Results in Patients with Congenital Clubfoot Treated with Two Different Protocols

Background

Long-term follow-up studies of adults who had been treated for congenital clubfoot as infants are rare. The purpose of this study was to review and compare the long-term results in two groups of patients with congenital clubfoot treated with two different techniques. In both groups, treatment was started within the first three weeks of life by manipulation and application of toe-to-groin plaster casts,  with a different technique in each group. At the end of the manipulative treatment,  a posteromedial  release  was performed when the patient  was between eight and twelve months of age in the first group and a limited posterior release was performed when the patient was between two and four months of age in the second group.

Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release

Background

Although long-term follow-up studies have shown favorable results, in terms of foot function, after treat- ment of idiopathic clubfoot with serial manipulations and casts, we know of no long-term follow-up studies of patients in whom clubfoot was treated with an extensive surgical soft-tissue release.

Forty-five patients (seventy-three feet) in whom idiopathic clubfoot was treated with either a posterior re- lease and plantar fasciotomy (eight patients) or an extensive combined posterior, medial, and lateral release (thirty- seven patients) were followed for a mean of thirty years. Patients were evaluated with detailed examination of the lower extremities,  a radiographic evaluation that included grading of osteoarthritis,  and three independent quality-of- life questionnaires, including the Short Form-36 Medical Outcomes Study.

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