Ponseti Method for Treating Clubfoot

The Ponseti method, which is used to treat congenital clubfoot of young children, is now recognized as the most effective and sparing for the health of the baby. In the world it is adopted as the "gold standard" for treatment of clubfoot.

Definition of congenital clubfoot

Congenital clubfoot is a complex disorder of the structure and function of the foot and lower leg. Disturbances are present not only in bones, joints and muscles, but also in tendons, nerve endings or vessels.

According to statistics, clubfoot is found in 5% of newborn babies. The clubfoot is formed in the initial weeks of pregnancy, its cause has not yet been determined. According to some assumptions, this is due to poor heredity, since in the presence of such a disease in one of the parents the probability of manifestation of the disease increases by 4%.

Congenital clubfoot is one- or two-sided and is more common in boys. At the heart of the disease is the pathological proliferation of connective tissue, which is what causes the deformation of the foot. This shortens the muscles, there is a convergence and wrapping inside the back and inner surface of the foot. The child himself will never be able to put the foot into a normal position.

Standard methods for treating clubfoot

Previously, before the Ponseti method was used, correction of clubfoot was done with corrective gypsum dressings, and then the foot was performed on the foot, in which the tendons of several muscles lengthened and stitched, the ligaments of the foot crossed, the joint was opened. Cases of affecting and bones on the foot during surgery were frequent.

The usual method of treating clubfoot involves the following steps:

• treatment to begin with a 1-week-old baby;
• at the beginning of the massage sessions( 1-2 weeks);
• alternation of gypsum dressings and paraffin applications, which are made during a large period of time: from several months to 2 years, depending on the severity of the pathology;
• the final casting of a plaster band for a period of 5 months;
• with a low effectiveness of treatment at the age of 2 years, the child is surgical( Z-shaped plastic Achilles tendon).

According to statistics, the effectiveness of treatment by the standard method is 58%.

What is Ponseti's method

Ignacio Ponseti is an outstanding American orthopedist who developed a new method of treating clubfoot in the 1950s-1960s. He is based on a detailed study of the structure of the baby's foot and its pathological changes. Unlike traditional methods of treatment, this method allows you to make a correction quite quickly: 1.5-2 months are allocated for a complete correction, but with the timely start of gypsum.

The Ponseti method allows you to correct the deformation of the foot in a conservative way, avoiding cicatricial changes in the joints, helps to keep the motor capabilities of the foot and muscle.

The most important condition for the high effectiveness of this method is the early diagnosis of the disease( in the first week of life), while the joints and muscles of the child have high elasticity. Begin treatment should be at the age of 1-2 weeks of life of the baby, be sure to start walking.

If the deformation is detected later, treatment with the Ponseti method is also possible, however, the correction of the defect will be much longer in time.

Ponseti treatment steps

Ponseti clubfoot treatment consists of several consecutive stages of treatment:

1. Correction of deformity with gypsum dressings, which need to be changed every 6-7 days. The baby's leg gips completely: from the fingers to the top of the thigh. Each bandage is made in a certain position, allowing you to adjust the shape of the foot and even bones. In total it is necessary to carry out 4-7 procedures for gipsovaniyu legs, but their number depends directly on the severity of the disease and the age of the baby.
2. The next stage is the achillotomy, i.e. the elongation of the Achilles tendon, which is always shortened with clubfoot. Most often, a closed operation is performed under local anesthesia( for children under 2 years old).After the operation, plastering is done for 3 weeks to fix the result.
3. The last important step is the use of braces consisting of two shoes fixed on a special sliding bar.

For high efficiency and guarantee of cure for this disease, high qualification of the doctor performing the procedures is of great importance.

Gypsum technique

Gypsum plastering is carried out on a weekly basis, and with each subsequent application of gypsum, a certain type of deformation of the foot is eliminated. When applying the dressing involved a doctor who correctly aligns the foot, and the assistant, directly performing plastering.

The application of gypsum is made in the form of a boot for the entire length of the leg, only the phalanges of the toes are left free to control the supply of blood to the vessels and avoid the gypsum's gypsum.

There are several mandatory rules that must be observed in order to avoid mistakes in treatment:

• , the first plastering allows to restore the angle of the casting of the foot and its internal turn in the front part( Cavus);
• during plastering the knee joint is fixed in a bent position, which will prevent the bandage from moving and avoid rubbing the child's delicate skin;
• with each procedure, the angle of the output of the foot should be less than 15 degrees;
• should not be in the free position for more than 1 hour when changing the gypsum of the foot;
• 2-4 procedures are aimed at correcting the deviation in the inside of the fingers( varus deformation) and in the elimination of the plantar fold;
• 5-th step - allows you to correct the removal of the heel over the talus bone, while the doctor makes the fixation of the normal foot to the desired position with the help of a langete( the exception is an excessive bend in the ankle because of a shortened tendon).

The number of procedures should be no more than 6. The sequence and the scheme of corrective gypsum, based on the Ponseti method, the photo perfectly demonstrates.

If the attending physician does more procedures, then this will already be treated not according to the American method and can be harmful. At subsequent stages, achillotomy and brace selection are done.

Achillotomy

Ponseti treatment involves, in some cases before the 4th or 5th stage of gypsum plaque, an achillotomy, in which:

• is the dressing of the calcaneal tendon( subcutaneous operation);
• fixes damaged endings of ligaments;
• operation is done under local anesthesia;
• at the end of the operation, plastering is carried out for the next 3 weeks.

This operation is radically different from the standard surgical procedure, which is performed with the standard method of correction. During the procedure, the child does not undergo general anesthesia and afterwards no large scar remains, which subsequently usually limits the mobility of the patient's foot.

Use of the

brace The Ponseti method involves wearing braces, a special shoe, as a final step, which allows you to fix the position of the feet and legs in the desired position with the aid of the strap to avoid returning clubfoot. Boots are selected and ordered in advance.

Wear braces almost around the clock for 3 months, take off only during bathing or changing clothes.

In the future, they will need to be worn only during sleep( day and night) - the recovery period lasts 2-4 years to avoid relapse.

Disadvantages of the

method According to the parents who used the Ponseti method to treat the clubfoot of the child, the disadvantages are as follows:

• high cost of special footwear( braces), which are usually purchased from manufacturers in Germany or the USA;
• the duration of its delivery to other countries,
• relative fragility of the design.

In recent years, the company "Teddy Bear" has established the production of domestic counterparts, and when buying braces there is an opportunity to purchase them through the social insurance fund.

Advantages of the

method The high efficiency of the clubfoot correction method is proved by the results of 50 years of research at the Ponseti Specialized Center( University of Iowa, USA), and the technique has been tested in many medical institutions of the world.

Of all the other methods by which congenital clubfoot is treated, the Ponseti method is the least traumatic, safe and does not depend on the severity of the origin of the deformity. The time of wearing a cast is much less than with other methods. The effectiveness in correcting the deformation of the foot is 95% of the cases.

With proper treatment, there will be no repeated deformations in the child: he can wear regular shoes, there are no contraindications to exercise and physical activity.

Ponseti method: reviews

Judging by the reviews of parents who treated children from congenital clubfoot with the American method, the effect is almost all positive. Special enthusiasm is expressed by mothers who tried to treat children in the beginning in the standard way( massage + gypsum), after which some patients almost did not remain disabled. Turning later to medical centers to doctors who professionally use the Ponseti method to treat clubfoot, parents were able to cure their children's legs completely.