The Ponseti Method: Congenital Clubfoot.

drmaizo (70)in #adsactly • 6 years ago (edited)

Statistics

Approximately 120,000 children are born each year in the world with a very peculiar deformity of the feet known as congenital clubfoot.

Eighty per cent of these children are born in developing countries, as it has been shown that the high birth rate in these countries has also been associated with their economic conditions.

Fortunately most of these patients are treated, those who do not evolve to deformities that cause physical and occupational disabilities.

Congenital clubfoot?

This is the name given to a deformity with which some children are born in the foot, depending on the degree of severity in some will be more noticeable and in others less so.

It consists of the foot being in an upside-down position (i.e. with the soles of the feet facing inwards) and the toes facing downwards (a term known as "equine", related to the natural position of horses). In general, a position that resembles that of a golf club.

Causes?

In general, several causes can generate this deformity, one of the factors that contributes most is genetics, that is, if there is a family history of having suffered this disease it is very likely that some of the family members could contract it.

In other cases it may be associated with other congenital diseases, such as spina bifida or Edwards syndrome, which is why a series of studies are indicated for the baby during the first few days of life.

Treatment:

Initially the treatment of congenital clubfoot was much discussed, since many advocates of surgery applied aggressive methods early on, while those who applied conservative methods such as massage or progressive positioning were not favored with their results.

Dr. Ignacio Ponseti, a Spanish doctor with a long history of experience, was the first person to develop an innovative method with the same name, although he initially applied it from the 1950s onwards and it was in 2000 that it was accepted worldwide as a "standard" treatment for this pathology.

By means of its method, the varus equine foot can be corrected in a period of approximately 2 months after more than 35 years of study and demonstration, it is extremely economical, well tolerated and a technique that is easy to use, so it is not only applicable to developing countries but also to the most developed ones.

The Method:

The method involves the progressive placement of several casts on the child's foot, or affected feet, over a gradual period of time until the final correct posture is achieved.

It is essential for the treating physician to know the anatomical and technical principles of its placement, since by means of the adequate positioning of the plaster the deformity is almost completely corrected.

The placement of the casts is traditionally stipulated for a weekly replacement, so it is essential for the collaboration of parents for proper maintenance of this, ie, prevent wetting, bad odor or damage, as it would be a step backwards in treatment.

Once the adequate time has elapsed (some cases may take longer than others depending on the severity), a minimum surgical treatment called an Achilles tendon tenotomy is recommended for most patients, in order to finally complete the correction and an adequate posture.

It is important to note that the surgical treatment is extremely minimal and in most cases the intervention does not last more than 5 minutes with an imperceptible incision in the patient's skin.

Final Recomendation:

Finally, it is always advisable to use a post-treatment device known as a Dennis Brown splint, which prevents recurrences (i.e., a recurrence of the disease), may seem a little uncomfortable for the baby, but when it comes to his or her health it is essential, so its use is day and night and is only removed to clean the child.

Do not hesitate to ask any questions you may have to your trusted orthopaedic surgeon and trauma surgeon. Greetings.