Clubfoot:The Ponseti Method
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Jennifer Wambui, the Chief Exec. Director, CaCAI has a superb presentation about the Ponseti Method of Clubfoot treatment. The whole presentation is based on her own experience with Clubfoot and how she has triumphed over it.
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1. Patient is placed in lateral decubitus position and a right-angled lateral incision is made to minimize soft tissue damage.
2. The fracture line at the angle of Gissane is identified.
3. Fragments are temporarily held in place with K-wires under fluoroscopy while the reconstruction restores the 3D shape of the calcaneus.
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This document provides an overview of the Ponseti technique for treating clubfoot. It discusses the pathophysiology and classification of clubfoot, as well as the key steps of the Ponseti method including serial casting, Achilles tenotomy, and foot abduction bracing. The Ponseti technique uses gentle manipulation and serial casting to gradually correct the deformity, with a tenotomy sometimes needed to achieve full correction. Proper bracing is essential to maintain correction long-term. Recurrence rates are low (under 10%) when the Ponseti method is followed correctly. Surgery is rarely needed when this technique is used.
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website: http://www.am-medicine.com
Facebook page : https://www.facebook.com/pages/Am-medicine/207726329406832
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Principle of tension band wiring n its application
1. The tension band technique converts tensile forces into compressive forces through the application of a tension band on the tension side of a bone.
2. Examples of where tension band fixation is commonly used include patella and olecranon fractures, as well as fractures of the greater tuberosity and greater trochanter.
3. Tension band wiring, plating, and external fixation can all function as tension bands by applying a compressive force across a fracture to promote healing.
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The document discusses fractures of the bones in the foot, including the metatarsals and phalanges. It describes the anatomy of the foot bones and their divisions. It discusses the causes, presentations, findings and treatments for different types of metatarsal fractures, including stress fractures, shaft fractures, neck fractures, and fractures of the fifth metatarsal. It also covers phalangeal fractures of the toes. Treatment options discussed include closed reduction, percutaneous pinning, open reduction and internal fixation with plates or screws.
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Calcaneal fractures
Here are the key steps in the ORIF procedure:
1. Patient is placed in lateral decubitus position and a right-angled lateral incision is made to minimize soft tissue damage.
2. The fracture line at the angle of Gissane is identified.
3. Fragments are temporarily held in place with K-wires under fluoroscopy while the reconstruction restores the 3D shape of the calcaneus.
4. The "constant" sustentacular fragment is used to begin the reconstruction, working anteriorly and medially.
5. Traction may be needed to restore the posterior facet.
6. The lateral wall fragment is closed like a door last to complete the
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The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
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1. The historical aspects and development of treatment methods over time, from Hippocrates to modern techniques.
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3. Treatment methods including the Ponseti method of serial casting and bracing, which has a 95% success rate when compliant.
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- Indications for orthotics include pain relief, immobilization, deformity correction, symptom relief, unloading axial forces, and improving or assisting movement.
- Design considerations include weight, adjustability, function, cost, durability, fit, donning/doffing ease, and ventilation.
- Effects may include decreased pain, increased strength/function, improved proprioception and
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Ankle fractures
The ankle joint consists of the talus bone articulating with the medial and lateral malleoli and the tibial plafond. Any stable ankle injury can potentially be treated non-surgically, while unstable fractures require open reduction and internal fixation for better long-term outcomes. Fractures are classified using systems like Lauge-Hansen and Danis-Weber based on the mechanism of injury. Treatment depends on factors like stability, displacement and bone involvement. Surgical treatment focuses on anatomic reduction and stable fixation of fractures while protecting neurovascular structures.
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Clubfoot is a birth defect where one or both feet are twisted into an abnormal position. It is caused by genetic and environmental factors and affects males more than females. Treatment involves stretching the feet into correct position with casting or taping and bracing to maintain correction. Parents are taught exercises and bracing is worn long-term to prevent recurrence. Nursing focuses on monitoring for skin issues from casting, teaching parents exercises and brace use, and supporting the child's development.
CONGENITAL TALIPES EQUINO VARUS
This document discusses congenital talipes equino-varus (CTEV), also known as clubfoot. CTEV is a congenital deformity of the foot and ankle characterized by equinus, inversion, adduction and cavus. It occurs in about 1 in 1000 live births. The document describes the types and causes of CTEV, pathological changes, treatment methods including Ponseti technique and surgery, and long-term management with bracing. Non-operative treatment is usually attempted first using serial casting and manipulation techniques.
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- Total hip arthroplasty involves replacing the hip joint with prosthetic components. It is commonly performed for arthritis and other hip diseases.
- The procedure has evolved significantly since the early attempts in the 1900s using materials like gold foil and glass. Modern THA designs aim to reduce friction and stress on the implants.
- Key considerations in THA include restoring normal hip biomechanics, maximizing stability while allowing a full range of motion, and minimizing wear on the prosthetic components over many years. Proper positioning and design of the femoral stem and acetabular cup are important.
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Femoral head fractures occur in 5-15% of hip dislocations and often go undiagnosed. The Pipkins classification categorizes femoral head fractures into four types based on location and severity, with implications for surgical management and prognosis. Type I fractures involve the non-weight bearing portion, Type II the weight bearing portion, Type III include an associated neck fracture, and Type IV include an acetabular fracture. Diagnosis is typically via x-ray or CT scan. Treatment depends on fracture type, with smaller Type I fragments sometimes treated non-operatively, Type II fractures requiring open reduction and internal fixation, and arthroplasty considered for more complex or elderly fractures. Complications can include avascular necrosis, arthritis
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Cubitus varus
Cubitus varus is a deformity of the elbow where there is a decreased carrying angle, causing the forearm to deviate medially when extended. It is commonly caused by malunion of a supracondylar fracture of the humerus in children. Corrective options include observation with expected remodeling, hemiepiphysiodesis to alter growth, and corrective osteotomy. The French osteotomy technique involves a lateral closed wedge osteotomy held with screws or wires and remains a popular surgical approach. Complications can include stiffness, nerve injuries, recurrent deformity, nonunion and malunion.
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The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
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This document discusses clubfoot (CTEV), including:
1. The historical aspects and development of treatment methods over time, from Hippocrates to modern techniques.
2. The anatomy, components, and classification of clubfoot deformities.
3. Treatment methods including the Ponseti method of serial casting and bracing, which has a 95% success rate when compliant.
4. Surgical indications and techniques for resistant or relapsed cases.
The key points covered are the evolution of clubfoot treatment, the Ponseti method as the gold standard non-surgical approach,
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The document discusses orthotic devices, including their purposes, types, materials, design considerations, and more. Some key points:
- Orthotic devices are externally applied to parts of the body to correct deformities, limit motion, relieve pain, and improve function. Common types include braces and splints.
- Indications for orthotics include pain relief, immobilization, deformity correction, symptom relief, unloading axial forces, and improving or assisting movement.
- Design considerations include weight, adjustability, function, cost, durability, fit, donning/doffing ease, and ventilation.
- Effects may include decreased pain, increased strength/function, improved proprioception and
Physeal injuries
Bone growth occurs through two mechanisms: endochondral ossification and intramembranous ossification. Physeal injuries represent 15-30% of fractures in children and commonly involve the phalanges, wrist, and distal tibia. Physeal fractures are classified using the Salter-Harris system from Type I to V based on the location of the fracture line and potential for growth disturbance. Types I-III involve the physis while Types IV-V cross into the epiphysis, increasing the risk of growth arrest or deformity. Proper classification guides treatment to restore anatomy and minimize long term sequelae.
Ankle fractures
The ankle joint consists of the talus bone articulating with the medial and lateral malleoli and the tibial plafond. Any stable ankle injury can potentially be treated non-surgically, while unstable fractures require open reduction and internal fixation for better long-term outcomes. Fractures are classified using systems like Lauge-Hansen and Danis-Weber based on the mechanism of injury. Treatment depends on factors like stability, displacement and bone involvement. Surgical treatment focuses on anatomic reduction and stable fixation of fractures while protecting neurovascular structures.
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Club foot
Clubfoot is a birth defect where one or both feet are twisted into an abnormal position. It is caused by genetic and environmental factors and affects males more than females. Treatment involves stretching the feet into correct position with casting or taping and bracing to maintain correction. Parents are taught exercises and bracing is worn long-term to prevent recurrence. Nursing focuses on monitoring for skin issues from casting, teaching parents exercises and brace use, and supporting the child's development.
CONGENITAL TALIPES EQUINO VARUS
This document discusses congenital talipes equino-varus (CTEV), also known as clubfoot. CTEV is a congenital deformity of the foot and ankle characterized by equinus, inversion, adduction and cavus. It occurs in about 1 in 1000 live births. The document describes the types and causes of CTEV, pathological changes, treatment methods including Ponseti technique and surgery, and long-term management with bracing. Non-operative treatment is usually attempted first using serial casting and manipulation techniques.
Ponseti Management of Clubfoot in Chittagong Division: Experience of 1000 Clu...
The aim of this study is to evaluate the effectiveness of the Ponseti method in children presenting before 5 years of age with either untreated or complex (initially treated unsuccessfully by other conservative methods) idiopathic clubfeet
Type of study : Retrospective clinical study.
Duration of study : From February 2010 to November 2011 (21months)
Place of study : 6 ZCF clinics of Chittagong, Cox’s bazar, Khagrachhari, Comilla, Noakhali & Chandpur.
Study population : Patients with CTEV attended at these ZCF clinics.
Treatment of congenital club foot by ponseti technique is very effective method with excellent result for below 1 years children.
Brace follow up is essential for long term better outcome.
With proper monitoring and support, Ponseti service can be effectively and successfully administered in a district general hospitals.
Club foot
This document discusses clubfoot (congenital talipes equinovarus), a common birth defect where the foot is twisted into an abnormal position. It defines the condition and notes the most common type involves an elevated heel (equinus) and inwardly turned foot (varus). Potential causes are discussed like family history or issues during pregnancy. Diagnosis involves examination of the feet and ruling out other conditions. Treatment typically begins at birth and involves stretching and casting or surgery to gradually correct the position, often followed by bracing.
EVALUATION OF THE APPLICATION OF PONSETI METHOD: IN CONTEXT OF BANGLADESH
This study evaluated the application of the Ponseti method for treating clubfoot in 281 children in Bangladesh. The key findings were:
1. The Ponseti method successfully corrected clubfoot in 82% of cases, with 71.3% requiring Achilles tenotomies.
2. Common characteristics were a 2:1 male to female ratio and bilateral involvement in 54% of cases.
3. While the Ponseti method was largely effective, 1/3 of babies dropped out during the casting phase, indicating barriers to long-term treatment that need to be addressed.
4. The study demonstrated the Ponseti method can successfully treat clubfoot in Bangladesh when properly applied, though sustainability
Ctev
This document summarizes congenital talipes equino varus, or club foot, which occurs in approximately 1-2 per 1000 live births. Club foot is characterized by an inverted heel, hindfoot varus, and forefoot adduction and supination. It is caused by unknown factors that may include genetic defects or abnormal positioning in the womb. Treatment involves manipulation, casting, and sometimes surgery to correct contractures and produce a plantigrade foot.
CTEV UG
This document provides an outline on clubfoot (CTEV), including its epidemiology, causes, anatomy, pathoanatomy, clinical features, imaging, and treatment. CTEV is a relatively common birth defect affecting 1-2 per 1000 births. It involves four deformities: cavus, adductus, varus, and equinus (CAVE). The causes are unknown but may involve genetic or positional factors. Treatment focuses on serial manipulation and casting, especially the Ponseti method, to gradually correct the deformities in a specific order and avoid the need for invasive surgery. The goal is to produce a functional, plantigrade foot.
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How Rotarians Can Help Eradicate Disability From Clubfoot Birth Defect
Clubfoot occurs when a baby’s tendons are shorter than
usual, positioning the foot at a sharp angle to the ankle,
like the head of a golf club. Because 80 percent of the
200,000 children born with clubfoot each year are in
low or middle income countries, many do not receive
treatment, resulting in a disability that affects their
mobility and quality of life. Learn how the low-cost, low-tech Ponseti method can prevent long-term disabilities
and how Rotarians can help improve access to treatment.
Moderator: Thomas Cook, Rotary Club of Iowa City,
Iowa, USA
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CONGENITAL TALIPES EQUINOVARUS
Congenital talipes equinovarus (CTEV), also known as clubfoot, is a complex deformity of the foot characterized by four components - talus in plantar flexion (equinus), subtalar joint in medial rotation and inversion, and forefoot adduction. It has multifactorial etiology with both genetic and environmental factors playing a role. Treatment involves serial casting of the foot based on Ponseti's method to gradually correct the deformity, which may be augmented with a small percutaneous tenotomy of the Achilles tendon if needed. Proper bracing is then used to maintain the correction achieved. Imaging such as X-rays and MRI can help evaluate the severity of deformity and
Club foot
Clubfoot is a birth defect where the foot is twisted into an abnormal position. It occurs in about 1 in 1,000 births and is more common in males. The cause is unknown but may involve abnormal foot positioning in the uterus. Treatment involves application of casts or use of splints to manipulate the foot into a corrected position.
Club foot ctev
Clubfoot, or congenital talipes equino varus (CTEV), is a birth defect where the foot is twisted inward and downward. It has 4 main deformities - adduction of the forefoot, inversion/varus of the hindfoot, equinus of the hindfoot, and cavus of the midfoot. Incidence is 1-2 per 1000 births and is more common in males. Etiology may include chromosomal, embryonic, neurological, and fetal theories. Pathoanatomy involves twisting of the talus, calcaneus, and other bones. Treatment goals are to realign the bones through serial casting or surgery. The Ponseti method uses serial plaster casts and foot manipulation to gradually
Club foot deformity
Talipes, also known as club foot, is a congenital deformity where the foot is twisted from its normal position. There are three main components of Talipes equinovarus: plantar flexion at the ankle joint (equinus deformity), inversion at the subtalar joint (varus deformity), and adduction at the tarsometatarsal joints (adduction deformity of the forefoot). Radiological findings that indicate club foot include the talo-calcaneal angle measuring 0 degrees or reversed on AP radiograph, and the mid-talar and mid-calcaneal lines pointing lateral to the metatarsal heads rather than through them. The mid-talar line also forms
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Congenital Tallipes Equino Varus (CTEV)
This document provides an outline and overview of paediatric orthopaedics, focusing on congenital talipes equino varus (clubfoot). It defines clubfoot as an idiopathic condition causing cavus, adductus, varus, and equinus deformities. It discusses the epidemiology, potential causes, anatomical abnormalities, clinical features, imaging, and main treatment approach of serial casting developed by Ponseti. The goal of treatment is to produce a plantigrade, supple foot through gradual correction of the deformities.
Ctev
This document discusses idiopathic clubfoot, including its classification, causes, epidemiology, and treatment options. It focuses on the Ponseti method of manipulation and serial casting as the preferred treatment for idiopathic clubfoot. The Ponseti method involves specific techniques to correct cavus, adductus, varus, and equinus deformities through non-surgical manipulation and casting, sometimes including a percutaneous tenotomy of the Achilles tendon. Compliance with brace wear after treatment is critical to prevent recurrence of the deformity. The document also addresses evaluation methods, examples of clinical cases, common errors in technique, and strategies for managing clubfoot at the public health
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Clubfoot:The Ponseti Method
- 1. Clubfoot: Ponseti Management Early Detection and Correction of Clubfoot will save your child’s feet! Jennifer Wambui; Chief Exec. Director, CaCAI
- 2. Clubfoot on my left foot never stopped me from being a photo-model!
- 3. …Or a gospel artist
- 4. ….Or be a TV actress
- 5. ….Or try to be a
- 6. It wasn’t easy nevertheless! I had to go through an excruciating pain of six surgeries; painful, expensive and not very effective!
- 7. How I wish doctors then new about the Ponseti Method…… • I wouldn’t have experienced the dreadful pain • The method would have corrected my foot effectively enabling me to wear high- heeled shoes, which I sorely miss today! • My parents wouldn’t have spend much money
- 8. Hence CaCAI………… To ensure no other child goes through this hell, Clubfoot Correction Awareness Initiative (CaCAI) was born!
- 9. CaCAI’s core mission is to……. • Raise awareness on the need for early detection and correction of Clubfoot via the Ponseti Method. Early intervention is painfree, inexpensive and effective.
- 10. The Ponseti Method……. • The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by the late Dr. Ignacio V. Ponseti of the University of Iowa, USA in the 1950s
- 11. The Ponseti Method has……… • Over the past decades become accepted throughout the world as the most effective and least expensive treatment of clubfoot
- 12. When should the Ponseti management start? • When possible, start soon after birth (7 to 10 days). However, most clubfoot deformities can be corrected throughout childhood using this management.
- 13. When treatment is started early, how many cast changes are usually required? • Most clubfoot deformities can be corrected in approximately 6 weeks by weekly manipulations followed by plaster cast applications. If the deformity is not corrected after six or seven plaster cast changes, the treatment is most likely faulty.
- 14. When is it late for the Ponseti Method? • The goal is to start treatment in the first few weeks after birth. However, correction can be achieved in many cases until late childhood.
- 15. Still useful when delayed? • Management that is delayed until early childhood may be started with Ponseti casts. In some cases, operative correction will be required, but the magnitude of the procedure may be less than would have been necessary without Ponseti management.
- 16. Did you know…….. • When one parent is affected with clubfoot, there is a 3% to 4% chance that the offspring will also be affected. However, when both parents are affected, the offspring have a 30% chance of developing clubfoot.
- 17. Just so you know…… • Surgery improves the initial appearance of the foot but does not prevent recurrence. Adult foot and ankle surgeons report that these surgically treated feet become weak, stiff, and often painful in adult life.
- 18. Most information is courtesy of… Global HELP Organization
- 19. CaCAI urges you to… Spread the word. Thank you! By Jennifer Wambui
- 20. All is with my feet!