Materiały źródłowe

• #1 Ponseti treated idiopathic clubfoot – outcome predictive factors in the test of time: analysis of 500 feet followed for five to 20 years

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8582614/

  To investigate a set of risk factors on the outcome of Ponseti treated idiopathic clubfeet (ICF). […] There was a significant correlation between the Pirani score at presentation and the number of surgical procedures (chi-squared = 79.32; p 0.001). […] Foot severity and number of cast changes were the strongest predictors for future surgery. […] Estimation of the risk of deformity recurrence after initial correction may help in tailoring a cost-effective personal treatment and follow-up protocol. […] The initial Pirani score positively correlated with operation rate, number of casts, functional score and FAB compliance (p 0.05). […] Number of casts was significantly correlated with rate of surgery, functional score and FAB compliance (p 0.05). […] The results of multivariate logistic regression analysis are shown in Table 4.

• #2 Outcome Measures in Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24318/JPJ/fullText

  The Ponseti method for the treatment of clubfoot is in widespread use around the globe, and while a variety of measures or tools have been used to evaluate outcomes, few have been validated in different contexts, and none have been standardized or universally accepted. […] Despite extensive literature on clubfoot, there seems to be no standard or universally accepted means by which to evaluate the results of treatment. […] The main purpose of developing these scoring systems has been to grade the severity of the clubfoot, to predict the number of casts, need for tenotomy, and risk of relapse. […] However, their use for evaluating outcomes of treated clubfeet is neither validated nor intended. […] The clinical evaluation of a treated foot, especially in a walking child, might include static measurements of range of motion and alignment, evaluation of gait, presence of any symptoms and/or functional limitations, ability to participate in different activities, ability to wear different shoes, and the patients general satisfaction.

• #3 Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method? | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02261-4

  Initial Pirani and Dimeglio scores seem to be able to predict the required number of casts for modifying the deformity (as the short-term outcome which could also help the orthopaedic surgeon to have an estimation about the casting period) and the recurrence of the deformity (as the long-term outcome) of the patients with severe and very severe clubfeet. […] The mean initial Pirani score (P 0.001) and the mean initial Dimeglio score (P 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. […] The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction. […] In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot.

• #4 Ponseti treated idiopathic clubfoot – outcome predictive factors in the test of time: analysis of 500 feet followed for five to 20 years

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8582614/

  Sex, compliance and age of the child were not associated with the increased risk for surgery, whilst a Pirani score of 4.5 before casting was strongly associated with increased risk surgery (OR = 1.95). […] Children who underwent six to eight cast changes had a 2.9 higher probability of being operated on when compared with those with five casts or less. The probability increased to 11.9 when nine or more casts were needed to achieve correction. […] The prevalence of recurrence and surgery is dependent on the initial severity score, number of casts and possibly a very high rate of tenotomies performed.

• #5 Can clubfoot scoring systems predict the number of casts and future recurrences in patients undergoing Ponseti method? | Journal of Orthopaedic Surgery and Research | Full Text

  https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02261-4

  According to the ROC curves, an initial Pirani score of 5.75 could predict 91.7% of the recurrences and 67.9% of the non-recurrence cases correctly. […] However, based on the Pirani scoring system, the Pirani score could take any number from 0 to 6 with the smallest possible fraction of half a full point, but not a quarter or third or any other fractions. Therefore, we suggest using 5.5 as the cut-off point for recurrence prediction instead of 5.75, which was mentioned in our results. […] Also, it was shown that an initial Dimeglio score of 17.5 could predict 66.7 % of the recurrences and 61.3% of the non-recurrence cases accurately.

• #6 Clubfoot | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/clubfoot

  The Ponseti method can result in favorable long term outcome in over 85% […] The success of serial casting and tenotomy is reported to be approximately 95% for isolated clubfeet. The recurrence rate of the deformity is reported between 37-47% after initial correction. […] Good to excellent long term outcomes can be expected with this treatment despite a slight amount of residual deformity. The feet treated with comprehensive surgical release may have good short term outcomes during but result in painful, stiff feet in adulthood.

• #7 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  Approximately 50% of clubfeet in newborns can be corrected nonoperatively. Ponseti reported an 89% success rate using his technique (including an Achilles tenotomy); others have reported success rates of 10-35%. […] Most series have reported 75-90% satisfactory results of operative treatment (appearance and function of the foot). The amount of motion in the joints of the foot and ankle correlates with the degree of patient satisfaction. […] Satisfactory results were obtained in 81% of cases, and the range of ankle movement was a major factor in determining the functional result, which again was influenced by the degree of talar dome flattening (suggesting that the primary bone deformity present at birth dictates the eventual result of treatment). […] Recurrence rates of deformity were reported at around 25% (range, 10-50%). Menelaus reported a 38% recurrence rate.

• #8 Clubfoot (Talipes): Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1237077-overview

  The best results were obtained with children older than 3-4 months with a foot large enough to allow the procedure to be performed without compromise (8 cm, as specified by Simons). […] Less-than-satisfactory results may be associated with overcorrection, which occurs in approximately 15% of cases. […] Some studies have suggested that previous surgery seems to have a deleterious effect on the result. […] At the latest follow-up, outcomes with the Ponseti method were good in 72% of cases, fair in 12%, and poor in 16%. For the French functional method, outcomes were good in 67%, fair in 17%, and poor in 16%. […] Jeans et al assessed functional outcomes, at age 10 years, in 175 children (263 feet) initially treated nonoperatively for clubfoot with either the Ponseti or the French PT method and compared outcomes in feet that had undergone only nonoperative treatment with those that required subsequent surgery. They found that clubfeet treated without surgery had better ankle power and isokinetic strength than those that underwent intra-articular surgery for residual deformity or recurrence.

• #9 Clubfoot: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/16889-clubfoot

  Clubfoot doesn’t go away on its own. Early treatment is essential for a positive outcome. Babies who start treatment early have good results. They can wear regular shoes, walk, run and play without pain. They can even play sports. […] If only one foot was affected, you may notice that: The affected foot is a smaller size and less mobile than the unaffected foot. The calf muscles in the leg with the clubfoot may be smaller. Your child may get tired or complain about sore legs sooner than children without clubfoot. The affected leg may be slightly shorter. But this usually doesn’t cause major problems. […] If your child has another condition along with clubfoot, the outlook may depend on treatment for the other condition. […] Clubfoot can come back. It’s more likely to happen if the treatment schedule wasn’t followed correctly. If the foot returns to the clubfoot position, see your child’s healthcare provider. They can advise you on the next steps. You may need to repeat some stages of the treatment plan.

• #10 Outcome Measures in Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24318/JPJ/fullText

  The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) is the only validated patient/proxy reported outcome measure for pediatric foot and ankle pathology, although it is not specifically designed for clubfoot. […] Patient-reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health (NIH) as a standardized PROM to use in all aspects of healthcare. […] The Laaveg-Ponseti score has yet to be validated. […] The clubfoot DSI consists of 10 items to assess overall satisfaction, appearance, pain, and physical limitations. […] The International Clubfoot Study Group (ICFSG) classification system includes a comprehensive list of items. […] Though the Ponseti method has been established as the standard of care for the treatment of clubfoot with excellent short- and long-term results, there remains no well-accepted tool or outcome measure which can evaluate the success of treatment and compare studies in the literature.

• #11 Outcome Measures in Clubfoot

  https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/24318/JPJ/fullText

  It is also critical that a tool or outcome measure be translated into local languages and be validated within the context where it will be administered. […] A foot that is considered normal by the patient, parents, and the community at large in an affluent city in an economically developed environment may not be the same in a rural area in an economically underdeveloped region. […] Therefore, it would seem that a composite measure would be desirable, one that defines restoration of structure and also determines how the patient functions in life, perhaps as separate modules.

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