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International Orthopaedics
Published in: International Orthopaedics 10/2016

01-10-2016 | Original Paper

Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score

Authors: Manuele Lampasi, Giovanni Trisolino, Caterina Novella Abati, Alessio Bosco, Leonardo Marchesini Reggiani, Costantina Racano, Stefano Stilli

Published in: International Orthopaedics | Issue 10/2016

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Abstract

Purpose

The modality of progression of the correction along casting sessions of Ponseti method has been poorly investigated and information regarding evolution of muscular abnormalities is missing. The aim of the study was to investigate dynamics of correction of the different components of clubfoot deformity in a clinical setting.

Methods

In a prospective study, 124 clubfeet consecutively treated by a single orthopaedic surgeon were evaluated with the Dimeglio system at each casting session and score progression was determined.

Results

For each component a typical pattern was recorded. Cavus and medial crease showed a rapid correction. Rotation, adduction and varus corrected gradually and simultaneously. The posterior crease usually persisted until final cast was discontinued. Equinus improved progressively after each cast and then to a larger extent with Achilles tenotomy. The parameter describing poor muscular condition, reported at presentation in 39 feet (31.5%), was the only item showing extremely different dynamics of correction (from rapid and complete resolution to persistence at last cast removal), which could be explained by the large diversity of entities included (hypertonia, imbalance, fatty infiltration, fibrosis, aplasia).

Conclusions

This study confirmed that dynamics of correction in clinical setting correspond essentially to theoretical principles of Ponseti method. Muscle abnormalities are not uncommon in clubfeet and have great influence on the progression of correction. If abnormalities are recorded, their evolution along the treatment should be monitored. A more objective evaluation would be required.
Literature
1.
Ponseti IV (1996) Congenital clubfoot: fundamentals of treatment, 1st edn. Oxford University Press, Oxford
2.
3.
4.
Kite JH (1939) Principles involved in the treatment of congenital club-foot. J Bone Joint Surg 21:595–606
5.
Smith PA, Kuo KN, Graf AN et al (2014) Long-term results of comprehensive clubfoot release versus the Ponseti method: which is better? Clin Orthop Relat Res 472(4):1281–1290CrossRefPubMed
6.
Limpaphayom N, Kerr SJ, Prasongchin P (2015) Idiopathic clubfoot: ten year follow-up after a soft tissue release procedure. Int Orthop 39(1):81–86CrossRefPubMed
7.
Dimeglio A, Canavese F (2012) The French functional physical therapy method for the treatment of congenital clubfoot. J Pediatr Orthop B 21(1):28–39CrossRefPubMed
8.
9.
Lehman WB, Mohaideen A, Madan S et al (2003) A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 12:133–140PubMed
10.
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113:376–380CrossRefPubMed
11.
Abbas M, Qureshi OA, Jeelani LZ et al (2008) Management of congenital talipes equinovarus by Ponseti technique: a clinical study. J Foot Ankle Surg 47:541–545CrossRefPubMed
12.
Desai S, Aroojis A, Mehta R (2008) Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 28:53–55CrossRefPubMed
13.
Ponseti IV, Zhivkov M, Davis N et al (2006) Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res 451:171–176CrossRefPubMed
14.
Ippolito E, Farsetti P, Caterini R, Tudisco C (2003) Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am 85-A(7):1286–1294PubMed
15.
van Wijck SF, Oomen AM, van der Heide HJ (2015) Feasibility and barriers of treating clubfeet in four countries. Int Orthop 39(12):2415–2422CrossRefPubMed
16.
Radler C, Manner HM, Suda R et al (2007) Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg Am 89:1177–1183CrossRefPubMed
17.
Kuhns LR, Koujok K, Hall JM, Craig C (2003) Ultrasound of the navicular during the simulated Ponseti maneuver. J Pediatr Orthop 23:243–245PubMed
18.
Pirani S, Zeznik L, Hodges D (2001) Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop 21:719–726PubMed
19.
Agarwal A, Gupta N (2014) Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop 38(3):569–572CrossRefPubMed
20.
Gao R, Tomlinson M, Walker C (2014) Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop 34(6):639–642PubMed
21.
Zhao D, Liu J, Zhao L, Wu Z (2014) Relapse of clubfoot after treatment with the Ponseti method and the function of the foot abduction orthosis. Clin Orthop Surg 6(3):245–252CrossRefPubMedPubMedCentral
22.
Chaudhry S, Chu A, Labar AS et al (2012) Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B 21(1):73–78CrossRefPubMed
23.
Moon DK, Gurnett CA, Aferol H et al (2014) Soft-tissue abnormalities associated with treatment-resistant and treatment-responsive clubfoot: findings of MRI analysis. J Bone Joint Surg Am 96(15):1249–1256CrossRefPubMedPubMedCentral
24.
Duce SL, D’Alessandro M, Du Y et al (2013) 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). PLoS One 8(1):e54100CrossRefPubMedPubMedCentral
25.
Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop B 4:129–136CrossRefPubMed
26.
27.
Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A (2009) Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired? J Child Orthop 3(3):171–178CrossRefPubMedPubMedCentral
28.
29.
Gelfer Y, Dunkley M, Jackson D, Armstrong J, Rafter C, Parnell E, Eastwood DM (2014) Evertor muscle activity as a predictor of the mid-term outcome following treatment of the idiopathic and non-idiopathic clubfoot. Bone Joint J 96-B(9):1264–1268CrossRefPubMed
30.
Bacino CA, Hecht JT (2014) Etiopathogenesis of equinovarus foot malformations. Eur J Med Genet 57(8):473–479CrossRefPubMed
31.
Lampasi M, Bettuzzi C, Palmonari M, Donzelli O (2010) Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br) 92(2):277–283CrossRef
32.
van Mulken JM, Bulstra SK, Hoefnagels NH (2001) Evaluation of the treatment of clubfeet with the Diméglio score. J Pediatr Orthop 21(5):642–647PubMed
33.
Flynn JM, Donohoe M, Mackenzie WG (1998) An independent assessment of two clubfoot-classification systems. J Pediatr Orthop 18:323–327PubMed
34.
Niki H, Nakajima H, Hirano T, Okada H, Beppu M (2013) Effect of Achilles tenotomy on congenital clubfoot-associated calf-muscle atrophy: an ultrasonographic study. J Orthop Sci 18(4):552–556CrossRefPubMed
35.
Kuo KN, Smith PA (2014) Does soft tissue matter in clubfoot treatment? Commentary on an article by Daniel K. Moon, MD, MS, MBA, et al. "Soft-tissue abnormalities associated with treatment-resistant and treatment-responsive clubfoot. Findings of MRI analysis". J Bone Joint Surg Am 96(15):e135CrossRefPubMed
36.
Wainwright AM, Auld T, Benson MK, Theologis TN (2002) The classification of congenital talipes equinovarus. J Bone Joint Surg (Br) 84(7):1020–1024CrossRef
37.
Cosma D, Vasilescu DE (2015) A clinical evaluation of the Pirani and Dimeglio Idiopathic Clubfoot classifications. J Foot Ankle Surg 54(4):582–585CrossRefPubMed
Metadata
Title
Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score
Authors
Manuele Lampasi
Giovanni Trisolino
Caterina Novella Abati
Alessio Bosco
Leonardo Marchesini Reggiani
Costantina Racano
Stefano Stilli
Publication date
01-10-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 10/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-016-3244-x

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