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Background: Idiopathic congenital talipes equinovarus (CTEV), or clubfoot, is a common congenital deformity affecting approximately 3.25 per 1,000 live births in India. The Ponseti method, a gold standard for CTEV management, offers high efficacy through sequential manipulation and casting, with the standard protocol involving weekly cast changes. The accelerated Ponseti method, reducing casting intervals to 3-5 days, has been proposed as a timeefficient alternative, particularly for resource-limited settings. Patients and Methods: This prospective, comparative study evaluated the efficacy of standard versus accelerated Ponseti methods using the Pirani scoring system. Ninety children with idiopathic CTEV were randomized into standard (weekly casting) or accelerated (biweekly casting) groups. Results: Both treatment methods demonstrated equivalent improvements in Pirani scores and similar rates of Achilles tenotomy and relapse over one year. However, the accelerated Ponseti methods significantly reduced treatment duration (p < 0.0001), addressing logistical and economic challenges while maintaining comparable clinical outcomes. Conclusion: These findings affirm the accelerated Ponseti method as an effective alternative, particularly for low-resource settings, by enhancing treatment accessibility and adherence without compromising correction quality. Future research with larger cohorts and extended follow-ups is warranted to validate long-term benefits. [ABSTRACT FROM AUTHOR]

Objective: The etiology of congenital talipes equinovarus (CTEV) is unknown, and the relationship between chromosome microdeletion/microduplication and fetal CTEV is rarely reported. In this study, we retrospectively analyzed fetal CTEV to explore the relationship among the CTEV phenotype, chromosome microdeletion/microduplication, and obstetric outcomes. Methods: Chromosome karyotype analysis and single nucleotide polymorphism (SNP) array were performed for the 68 fetuses with CTEV. Results: An SNP array was performed for 68 fetuses with CTEV; pathogenic copy number variations (CNVs) were detected in eight cases (11.8%, 8/68). In addition to one case consistent with karyotype analysis, the SNP array revealed seven additional pathogenic CNVs, including three with 22q11.21 microdeletions, two with 17p12p11.2 microduplications, one with 15q11.2 microdeletions, and one with 7q11.23 microduplications. Of the seven cases carrying pathogenic CNVs, three were tested for family genetics; of these, one was de novo, and two were inherited from either the father or mother. In total, 68 fetuses with CTEV were initially identified, of which 66 cases successfully followed-up. Of these, 9 were terminated, 2 died in utero, and 55 were live births. In 9 cases, no clinical manifestations of CTEV were found at birth; the false-positive rate of prenatal ultrasound CTEVdiagnosis was thus 13.6% (9/66). Conclusion: CTEV was associated with chromosome microdeletion/microduplication, the most common of which was 22q11.21 microdeletion, followed by 17p12p11.2 microduplication. Thus, further genomic detection is recommended for fetuses with CTEV showing no abnormalities on conventional karyotype analysis. [ABSTRACT FROM AUTHOR]

Introduction: Non-orthopaedic-trained healthcare professionals face challenges in identifying postnatal clubfoot deformities due to the lack of suitable assessment tools, resulting in misdiagnosis. Therefore, this study aimed to develop and validate the Neonatal Clubfoot Screening Checklist (NCSC) to assist non-orthopaedic-trained healthcare professionals in postnatal clubfoot assessment. Methods: The NCSC development involved five phases: conceptual understanding of deformity components, creation of pictorial representations, tool structure design, content and face validation, pilot study and field study. A cross-sectional prospective study was conducted in Sarawak General Hospital from January to June 2021. Non-orthopaedic-trained healthcare professionals were randomly assigned to two groups: one utilising the NCSC for newborn screening and another without it. Results were compared with assessments by the paediatric orthopaedic team. Kappa agreement tests and sensitivity and specificity analyses were performed to evaluate the tool's reliability and validity, respectively. Results: The content and face validity were satisfactory. Six hundred twelve feet were screened using the NCSC, and 596 feet were checked without the tool. The kappa agreement tests showed strong concordance (kappa coefficient=0.725-1.000, P<0.001) between the non-orthopaedictrained personnel and paediatric orthopaedic team for all NCSC items. The NCSC exhibited 100% sensitivity, specificity and positive and negative predictive values. Conclusion: The NCSC is a reliable tool for postnatal clubfoot screening, offering high sensitivity and specificity. It facilitates accurate differentiation of true-positive congenital talipes equinovarus from other foot conditions, reducing misdiagnoses and unnecessary referrals. The NCSC is valuable in resource-constrained settings and for healthcare professionals lacking specialised orthopaedic training. [ABSTRACT FROM AUTHOR]

Background: Various treatment modalities are available in the management of club feet but main stay of treatment is manipulation of serial casting and in majority of cases percutaneous Achilles tenotomy. The objective of this study was to assess the effectiveness of accelerated Ponseti Techniques (PST) in the treatment of congenital talipes equinovarus. Material and Methods: This descriptive study was conducted in the Orthopedic Department Jinnah Teaching Hospital Peshawar from July 2022 to July 2023. All the patients fulfilling the inclusion criteria were enrolled. The serial casting was given to all patients in the Outdoor Department. Outcome was assessed through the Pirani scoring system before and after casting. SPSS version 22 was used for statistical analysis. Frequencies and percentages were calculated for categorical variables. Mean± SD was calculated for numerical variables. Results: Out of 52 patients, 32 (61.56%) were males and 20(38.46%) were female. Mean age of patients was 5.8±2.4 months. Base line Pirani score was 6 and the mean follow up Pirani score of patients was 1.48 ±1.01. Serial casting through accelerated technique (PST) was effective in 80.8%of patients. Patients treated with the accelerated Ponseti protocol achieved a mean Pirani score of 4.2, indicating significant improvement in foot deformity. Patients treated with the accelerated PST achieved initial correction in an average of 6.5 weeks. Conclusion: Our study concludes that Accelerated PST is an effective treatment of Congenital Talipes Equinovarus. We recommend further studies with account taken into more variables which can determine the effectiveness of accelerated PST before recommending accelerated PST for club foot.. [ABSTRACT FROM AUTHOR]

Background: Clubfoot, also known as congenital talipes equinovarus is a prevalent childhood ailment that, if untreated, can lead to long-term discomfort and impairment. The Ponseti technique, aimed at achieving corrected foot positioning, is widely accepted. This study investigated the influence of clubfoot severity (Pirani score), patient age, and initial manipulation and casting weight on the overall number of casts needed for effective treatment. Methods: A prospective study was carried out involving 40 idiopathic clubfoot patients where manipulation and casting were performed following the Ponseti method. Patient age, weight, and foot Pirani score were evaluated concerning the total number of casts needed to achieve 70° of abduction. Results: The majority of participants were male infants aged 4–6 months, with a median age of 4.5 months. Half of them weighed between 3.00 and 4.99 kg at their first hospital visit, with a median weight of 3.20 kg. Bilateral clubfoot involvement was common (57.5%). Children with Pirani HFCS 2.0–3 often required percutaneous tenotomy (87.5%, p value 0.05). On average, patients needed 5 casts (range 3–9). The mean total Pirani scores were 4.71 for the right foot and 4.61 for the left foot. The study reported a positive correlation between higher total Pirani scores and the required number of casts. Conclusions: The Pirani scoring system is highly accurate in assessing clubfoot severity and predicting treatment success. It emerged as the single most significant predictor for both the total number of casts and the need for percutaneous tenotomy. [ABSTRACT FROM AUTHOR]

Abstract Background The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. Methods 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. Results Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). Conclusions The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. Level of evidence II.

After operative correction of adduction in the first stage of operative treatment (ligamentotomy, tendon elongation etc) of neglected congenital talipes equino-varus in children aged 4–6 years, some defect of the skin on medial side of the foot arises when correct position is assumed. The author covers this defect by pedicled skin graft from the dorsal surface of the foot, using the opportunity that on lateral surface of the inverted foot there is an excess of skin in the form round protuberance covering the cuboid bone and tuberosity of the fifth metatarsal. By flattening this round protuberance the area of the skin graft increases in such extent that not only the defect may be easily covered but the whole graft can be sutured to the edges of the operative wound.

Background: The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. Methods: 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. Results: Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). Conclusions: The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. Level of evidence: II. [ABSTRACT FROM AUTHOR]

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AimsThis study aimed to evaluate the impact of continuous nursing and telehealth education via WeChat in infants with congenital talipes equinovarus (CTEV) undergoing Ponseti therapy on reducing complications, care burden, and improving the quality of life for parents.MethodsThis is a single-center retrospective study. From July 2021 to December 2022, 44 CTEV children who undergoing Ponseti treatment in our hospital who received continuous nursing and telehealth education via WeChat (experimental group). In addition, during January 2020 to June 2021, 44 children with CTEV treated with Ponseti in our hospital who received routine nursing and traditional health education were selected as the control group. The incidence of complications, parental care burden and parental quality of life were compared between the two groups.ResultsThere was no significant difference in the demographic characteristics of patients and parents between the two groups, and the groups were comparable (p > 0.05). The incidence of complications including plaster loosens, plaster falling off, pressure ulcer was significantly lower in the intervention group compared to the control group (p

Abstract Background Congenital clubfoot is a fairly common and severe congenital malformation, most often of idiopathic origin. A smaller percentage of cases is related to chromosomal abnormalities and genetic syndromes. It is estimated that 0.5/1000 newborns are affected worldwide, with a male to female ratio of 2:1 and greater distribution in developing countries (80%). The “European Surveillance of Congenital Anomalies (EUROCAT)” reported clubfoot prevalence in European newborns, but data regarding Italy are missing or poor. We aim to provide detailed data on clubfoot incidence according to the Apulian Regional Registry on Congenital Malformations and to report current knowledge on clubfoot genetic factors. Methods We extrapolated data from the Regional Registry of Congenital Malformations to evaluate incidence and prevalence of congenital clubfoot in Apulia, Italy over a period of four years (2015–2018). We also performed a narrative review focusing on genetic mutations leading to congenital clubfoot. Results Over the period from 2015 to 2018 in Apulia, Italy, 124,017 births were recorded and 209 cases of clubfoot were found, accounting for an incidence rate of 1.7/1,000 and a prevalence rate of 1.6/1,000. Six families of genes have been reported to have an etiopathogenetic role on congenital clubfoot. Conclusions Incidence and prevalence of congenital clubfoot in Apulia, Italy, are comparable with those reported in the other Italian regions but higher than those reported in previous studies from Europe. Genetic studies to better classify congenital clubfoot in either syndromic or isolated forms are desirable.

Aims: The Ponseti method is the gold standard treatment for congenital talipes equinovarus (CTEV), with the British Consensus Statement providing a benchmark for standard of care. Meeting these standards and providing expert care while maintaining geographical accessibility can pose a service delivery challenge. A novel ‘Hub and Spoke’ Shared Care model was initiated to deliver Ponseti treatment for CTEV, while addressing standard of care and resource allocation. The aim of this study was to assess feasibility and outcomes of the corrective phase of Ponseti service delivery using this model. Methods: Patients with idiopathic CTEV were seen in their local hospitals (‘Spokes’) for initial diagnosis and casting, followed by referral to the tertiary hospital (‘Hub’) for tenotomy. Non-idiopathic CTEV was managed solely by the Hub. Primary and secondary outcomes were achieving primary correction, and complication rates resulting in early transfer to the Hub, respectively. Consecutive data were prospectively collected and compared between patients allocated to Hub or Spokes. Mann-Whitney U test, Wilcoxon signed-rank test, or chi-squared tests were used for analysis (alpha-priori = 0.05, two-tailed significance). Results: Between 1 March 2020 and 31 March 2023, 92 patients (139 feet) were treated at the service (Hub 50%, n = 46; Spokes 50%, n = 46), of whom nine were non-idiopathic. All patients (n = 92), regardless of allocation, ultimately achieved primary correction, with idiopathic patients at the Hub requiring fewer casts than the Spokes (mean 4.0 (SD 1.4) vs 6.9 (SD 4.4); p < 0.001). Overall, 60.9% of Spokes’ patients (n = 28/46) required transfer to the Hub due to complications (cast slips Hub n = 2; Spokes n = 17; p < 0.001). These patients ultimately achieved full correction at the Hub. Conclusion: The Shared Care model was found to be feasible in terms of providing primary correction to all patients, with results comparable to other published services. Complication rates were higher at the Spokes, although these were correctable. Future research is needed to assess long-term outcomes, parents’ satisfaction, and cost-effectiveness. Cite this article: Bone Jt Open 2023;4(11):865–872.

Purpose: The purpose of this study is to explore the regulatory function of COL1A1 against the apoptosis of embryonic stem cells (ESCs) and the potential function in congenital talipes equinovarus (CTEV). Methods: Muscle tissues were collected from 20 children with CTEV and 20 children without CTEV, followed by detecting the expression of COL1A1 using the RT‐PCR method. COL1A1 was knocked down in H1 and H9 human ESCs using the RNA interference technology, followed by determining the level of COL1A1, PITX1, TBX4, HOXD10, Fas, FasL, and Bax using the Western blotting assay. Results: COL1A1 was found markedly upregulated in muscle tissues of CTEV children. In H1 and H9 human ESCs, compared to the empty vector, COL1A1, PITX1, TBX4, HOXD10, Fas, FasL, and Bax were found notably downregulated after transfected with the siRNA targeting COL1A1. Conclusion: COL1A1 induced the apoptosis of ESCs by mediating the PITX1/TBX4 signaling and might be a potential target for treating CTEV. [ABSTRACT FROM AUTHOR]

BackgroundThe Ponseti method is the standard of care for managing idiopathic congenital talipes equinovarus (clubfoot) in the outpatient setting, but there are no clinical guidelines for inpatient treatment. Children in the neonatal intensive care unit (NICU) with clubfoot often delay treatment initiation due to medical reasons.MethodsWe systematically reviewed literature related to the treatment of clubfoot in the NICU, non-idiopathic clubfoot, and older infants, as well as barriers to care.ResultsIn a mixed NICU population of syndromic and idiopathic clubfoot, the Ponseti method has good functional outcomes with minimal interference with medical management. The Ponseti method has good functional outcomes with reduced need for extensive surgical procedures in non-idiopathic clubfoot and idiopathic clubfoot with delayed presentation (under one year of age).ConclusionsIt is possible to begin Ponseti treatment in the NICU without compromising medical management. It is not clear if this confers an advantage over waiting for outpatient casting.

Introduction: Congenital talipes equinovarus (CTEV) is one of the most common deformities that affects the human foot and ankle, and Ponseti method of correction is universally accepted procedure. Most of the patients need a percutaneous tenotomy of tendo Achilles for residual equinus deformity. Various methods of tenotomy such as cataract knife, No. 11 blade, and 21-G needle are available. We studied the effectiveness of percutaneous needle tenotomy of the Achilles tendon in CTEV children for residual equinus deformity. Materials and Methods: Forty-three patients of serially manipulated and casted CTEV patients were subjected to a percutaneous needle tenotomy at our institute, followed by cast and orthosis. Tenotomy and regeneration were confirmed ultrasonologically and complete tenotomy was demonstrated by animal cadaver study. Results: All the patients were followed up regularly and an average of 25° of passive dorsiflexion was achieved at an average of 2-year follow-up. No cases of skin scarring, neurovascular compromise, stiffness, or cast complications were noted in our series. Conclusion: We conclude that percutaneous needle tenotomy for residual equinus deformity in a serially casted CTEV patient is a simple, effective, and safe method in giving a functionally and cosmetically good plantigrade foot.

Distal Anterior Tibial Guided Growth has been shown to be useful to correct recurrent equinus deformity after open surgical release for Congenital Talipes Equinovarus. This has not been evaluated in a recurrence after use of the Ponseti method, where soft tissue releases are currently understood as the mainstay of treatment. Patients with recurrence of equinus component of CTEV, who underwent DATGG with at least 6-month follow-up were identified retrospectively. The criteria for performing this procedure were (1) equinus not correctable to neutral passively (2) the feeling of a bony block to dorsiflexion clinically as evidenced by a supple Achilles' tendon at maximum dorsiflexion and (3)a finding of a flat-top talus radiologically. Successful treatment was defined by the achievement of heel strike on observation of gait. Details of the index procedure including concurrent procedures, any complications and their treatment, past and subsequent treatment episodes were retrieved from electronic patient records. Pre-op and last available post-op X-rays were evaluated for change in the anterior distal tibial angle and for flat-top talus deformity. We identified 22 feet in 16 patients, with an average follow-up was 25 (8.8–47.3) months. The mean aDTA changed from 88.9 (82.3–94.5) to 77.0 (65.0–83.9) degrees, which was statistically significant (p < 0.0001) using the Paired t-test. Clinically, 17 feet (77 %) obtained a plantigrade foot with a normal heel strike. Complications were identified in 5 feet and include staple migration, oversized staple, superficial infection, iatrogenic varus deformity. Recurrence after completed treatment was noted in one foot. This procedure should form a part of the armamentarium of procedures for treating equinus component of CTEV recurrences even in feet not treated previously by open procedures. When used in patients without significant surgical scarring it helps to address bony and soft-tissue factors, leading to effective treatment. Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

The majority of infants with congenital talipes equinovarus (CTEV) require tenotomy of the tendoachilles. The pain response of this procedure in the awake infant has not been previously reported. In this observational study, multimodal pain management strategies, including oral sucrose, oral paracetamol, topical anesthetic, local anesthetic, a pacifier (dummy), and swaddling, were used. Physiological responses and pain were recorded. Pain was rated out of 10 at regular intervals, using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Ninety-one infants (65 men, mean age = 53 days, range = 19-217 days) were observed. At baseline, median FLACC, heart rate (HR), and oxygen saturation (Sp o 2) were 1, 159, and 97% respectively. Peak median FLACC and HR were 9 and 200, respectively, and lowest median Sp o 2 was 92%. The median (interquartile range) time for FLACC to return to 3 or less was 2 (2-5) minutes. Achilles tenotomy for CTEV in the awake infant is associated with high pain levels despite provision of multimodal pain relief measures. [ABSTRACT FROM AUTHOR]

Summary: Background: Estimates of the birth prevalence of clubfoot in low and middle income settings range from 0.5 to 2 per 1000 births. However, there is currently no estimate of global birth prevalence of clubfoot. Methods: We conducted a systematic review of studies reporting the birth prevalence of clubfoot across all countries and regions worldwide in the last 10 years. Africa Wide Information, EMBASE, CINAHL, Global Health, LILACS and Medline databases were searched for relevant studies from January 1st 2012 to February 9th 2023. Pooled prevalence estimates were calculated using the inverse variance method, and a random effects model was applied to account for heterogeneity between studies. Quality appraisal was performed using a modified Newcastle–Ottawa Quality Assessment Scale for Cohort studies. This review was registered with PROSPERO, CRD42023398410. Findings: The search generated 757 studies. Thirty-five studies from 36 countries and five WHO regions were included. The pooled prevalence of clubfoot was 1.18 per 1000 births (95% CI: 1.00–1.36) based on data from 44,818,965 births. The highest prevalence rates were observed in low- and middle-income countries, particularly in the South-East Asia Region (1.80, 95% CI: 1.32–2.28) and the Africa Region (1.31, 95% CI: 0.86–1.77). We estimate that 176,476 (95% CI: 126,126–227,010) children will be born with clubfoot globally each year. Interpretation: This study provides a comprehensive estimate of the global prevalence of clubfoot and highlights the significant burden of this condition, particularly in low- and middle-income countries. The findings underscore the need for improving access to effective treatment and prevention strategies in resource-limited settings. Funding: SR received funds from the Global Clubfoot Initiative and the Rhodes Trust.

Background: Congenital Talipes Equinovarus (CTEV) is a congenital disorder commonly occurring in newborns. The word talipes equinovarus comes from Latin: tali mean ankle, pes means foot, equino means plantar flexion, and varus means midline deviation. CTEV cases occur 1-2: 1000 live births, cases in males are more frequent than in females and can occur unilateral or bilateral. Bilateral conditions occur in half of the total number of cases. The aim of this study is that, in the future, especially parents know about this disorder so there will be no misinformation. Methods: This study uses a descriptive research method with a cross-sectional design that aims to determine the characteristics of CTEV patients at the Orthopedic and Traumatology Outpatient Clinic in Datu Beru General Hospital Takengon Central Aceh for August 2018-July 2022. Sampling was carried out by non-probability sampling and using the purposive sampling technique. This is a non-random sampling technique with specific considerations from the researcher (inclusion and exclusion criteria). Results: The number of births in Central Aceh Regency from August 2018-July 2022 amounted to 15,206. The incidence of CTEV in that period was 22 cases with a ratio of 1.4: 1000 live births. Conclusion: Males 15 cases (53.6%) and females 13 cases (46.4%). The age of patient's brought by parents was mostly1-6 months, with as many as 12 cases (42.9%). Bilateral conditions were 13 cases (46.4%), and 15 (53.6%) were unilateral. On average, patients with CTEV were corrected 5.2 times using the Ponseti method.

Congenital talipes equinovarus (CTEV) is one of the most common deformities that affects the human foot and ankle, and Ponseti method of correction is universally accepted procedure. Most of the patients need a percutaneous tenotomy of tendo Achilles for residual equinus deformity. Various methods of tenotomy such as cataract knife, No. 11 blade, and 21-G needle are available. We studied the effectiveness of percutaneous needle tenotomy of the Achilles tendon in CTEV children for residual equinus deformity. Materials and Methods: Forty-three patients of serially manipulated and casted CTEV patients were subjected to a percutaneous needle tenotomy at our institute, followed by cast and orthosis. Tenotomy and regeneration were confirmed ultrasonologically and complete tenotomy was demonstrated by animal cadaver study. Results: All the patients were followed up regularly and an average of 25° of passive dorsiflexion was achieved at an average of 2-year follow-up. No cases of skin scarring, neurovascular compromise, stiffness, or cast complications were noted in our series. Conclusion: We conclude that percutaneous needle tenotomy for residual equinus deformity in a serially casted CTEV patient is a simple, effective, and safe method in giving a functionally and cosmetically good plantigrade foot. [ABSTRACT FROM AUTHOR]

Background: Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). Methods: A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. Results: Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. Conclusions: Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems. [ABSTRACT FROM AUTHOR]

Purpose: There is however gross ambiguity regarding the use of term "foot abduction" in clubfoot treatment. We measured below defined angles at different stages of clubfoot treatment to decipher their precise interpretation. Methods: In a prospective evaluation of 25 unilateral clubfeet in infants' age less than six months treated with Ponseti technique, clinical leg foot and thigh foot angle were measured at talar head reduction (LHT0), pre-tenotomy, and post-tenotomy stage. A "normal" reference was available in the form of measurements of contralateral limb. Results: Talar head (LHT0) was reduced at mean leg foot angle of 26 degrees. The corresponding pre- and post-tenotomy angles were 42.6 and 50.0 degrees, respectively. The reference leg foot angles for contralateral limb were 49.8 degrees. The thigh foot angle for LHT0, pre-tenotomy, post-tenotomy, and contralateral side were, respectively, 39.2, 56, 68, and 65.6 degrees. There was an additional tibial external rotation component of mean 13.4 degrees (SD 4.5) in the thigh foot angle when compared to the leg foot angle at tenotomy. This increased to 18 degrees (SD 3.4) post-tenotomy. Conclusions: The study suggested that the foot abduction described in the "Ponseti Manual" probably intends thigh foot rather than leg foot angles. There was a significant difference in the angles when talar head reduced and tenotomy was decided. The foot abduction is an ambiguous term which should be replaced by the more specific leg or thigh foot abduction angle. [ABSTRACT FROM AUTHOR]

Objectives: To investigate maternal psychological status of children with congenital talipes equinovarus in different periods, and to clarify the influence on maternal psychological status of congenital talipes equinovarus treated with the Ponseti method. Methods: Sixty-seven mothers of children with congenital talipes equinovarus were investigated. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the psychological stress of the mothers at different periods. Paired-samples t-test was used to analyze the results. Results: The mothers of 67 children with congenital talipes equinovarus ranged from 25 to 38 years old, with an average of 33.5 years old. Before prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 42.537 ± 10.476, and the average score of Self-rating Depression Scale was 47.254 ± 12.846; after prenatal diagnosis of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 54.224 ± 13.050, and the average score of Self-rating Depression Scale was 57.403 ± 13.649 points. Before the postpartum treatment of congenital talipes equinovarus, the average score of Self-rating Anxiety Scale was 53.388 ± 12.716, the average score of Self-rating Depression Scale was 56.284 ± 13.617; after the treatment of congenital talipes equinovarus with the Ponseti method, the average score of Self-rating Anxiety Scale was 47.731 ± 12.259, and the average score of Self-rating Depression Scale was 51.910 ± 13.878 points. The above differences were statistically significant (P < 0.001). Conclusion: The prenatal diagnosis of congenital talipes equinovarus will increase the maternal psychological stress, and the maternal psychological status will be significantly improved after the deformity of congenital talipes equinovarus is corrected effectively by the Ponseti method. Level of evidence: level III, retrospective study. [ABSTRACT FROM AUTHOR]

Clubfoot is one of the most common musculoskeletal birth deformities worldwide. The prevalence varies among individual countries and populations. There is a lack of nationwide incidence studies in Central Europe. We analyzed the incidence of clubfoot in the Czech Republic over 14 years. Patients born with clubfoot in the Czech Republic were identified using The National Registry of Congenital Anomalies. Demographic data were included. Data from 2000 to 2014 were collected and analyzed regarding gender and regional distribution. The study's chosen time frame was grounded on the condition of the Czech industry. Following extensive transformations in 1989, the industry eliminated highly non-ecological operations with significant environmental impact and related health risks. The incidence of clubfoot during the study period was 1.9 (95% CI 1.8–2.0) per 1000 births; males comprised the majority (59%). The incidence significantly differed among individual regions of the Czech Republic (p < 0.001). The incidence in the Czech Republic was higher than in previous European studies. We found significant regional differences in incidence, which could indicate that there may be exogenous pathogenic factors. For this reason, we plan to follow up our work with an up-to-date study. [ABSTRACT FROM AUTHOR]

Although Dimeglio and Pirani scores are frequently employed to rate the severities of clubfoot and to evaluate treatment outcomes, it is unclear if these scores predict relapse after treatment. Ankle dorsiflexion has been suggested in recent years to be a promising predictor of relapse. The aim of this study was to investigate ankle dorsiflexion and Dimeglio and Pirani scores in predicting the relapse of clubfoot after treatment with the Ponseti method. We included patients with clubfoot previously treated by the Ponseti method, and retrospectively analyzed their initial ankle dorsiflexion, Pirani and Dimeglio scores, number of castings, and the occurrence of relapse. We analyzed 218 feet of 176 infants with clubfoot who showed an incidence of relapse of 17.0% (30/176). The mean initial Pirani and Dimeglio scores of the feet showing recurrence were significantly higher than individuals with non-recurrence (p <.001 each). We observed a robust association between Pirani and Dimeglio scores and the recurrence of clubfoot at the last follow-up (γ = 0.53, p =.001). In contrast, ankle dorsiflexion was negatively correlated with recurrence of clubfoot (γ = -0.21, p =.001). Dimeglio scores significantly predicted the recurrence of clubfoot (p =.014). Receiver operating characteristic curve analysis exhibited slightly better performance regarding the Dimeglio score relative to the Pirani score and ankle dorsiflexion in predicting recurrence. Ankle dorsiflexion and Pirani and Dimeglio scores were related to recurrence in patients with clubfoot. However, the Dimeglio score reflected superior accuracy in predicting the prognosis of clubfoot treated with the Ponseti method. [ABSTRACT FROM AUTHOR]

Background: Clubfoot is an intricate deformity of ankle and foot involving bony mal-alignment, adduction of forefoot, and hind-foot Varus, cavus, and equines caused by contracture of soft tissues. The many factor contribute to relapse of clubfoot, are neglected when advise the Proper pan of care. Objective: To find the association of clubfoot recurrence with no proper exercise and improper fitting of Denis Browne splint shoe. Materials & Methods: A cross sectional study was conducted at PIPOS Rehabilitation Service Program (PRSP), Peshawar. The data was collected from a sample of n=300 patients in Pakistan Institute of Prosthetic and Orthotic Science. The non-probability convenient sampling technique was used for data collection. The duration of the study was 6 months (April 2019 to October 2019). The male and female recurrent clubfoot children whose are either infant or till the age of 6 and registered in PRSP. The data collection was done through an international club foot registry form and self structured questionnaire. The results are presented in term of descriptive statistics and Chi-Square test was also performed to assess club foot and other variable association with each other. Results: The result showed n=110(37.3%) participants reported they had no proper fitting of Denis Browne Splint shoe (DBS) and n=97(32.3%) showed they underwent no proper exercise follow up. There was significant association of club foot recurrence with improper fitting of DBS (p

Clubfoot first described by Hippocrates has an incidence of 0.1%–0.2%. With the increased awareness and knowledge regarding the manipulation and plaster techniques, it has become less of a problem nowadays. However, it has been shown to be resistant in syndromic cases. The problem also relapses in case of insufficient bracing. This article provides a brief outline regarding clubfoot along with a short case of relapsed syndromic congenital talipes equinovarus managed with Ilizarov and six-axis device. [ABSTRACT FROM AUTHOR]

Clubfoot is one of the most common congenital anomalies, affecting every 1 of 1000 live births in the UK. Historically, clubfeet have been managed with a variety of conservative and operative techniques. Over the last two decades, the Ponseti serial casting method has become the gold standard of treatment. In July 2021, the British Society of Children's Orthopaedic Surgery (Gelfer et al, 2022) published a consensus statement that outlines the optimal management for clubfoot. This article provides an overview of clubfoot and a summary of the latest management guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To study the physical, emotional and social impact of clubfoot on the lives of affected children and their families. Methods: A purposive sample of children with treated idiopathic clubfoot and their parents was recruited from two geographical locations—the United Kingdom (UK) and India. Children were divided into age groups of 5–7 and 8–11 years. Questionnaires were administered separately to children and parents; the former comprised multiple-choice questions scored using an 'emoji' system, and the latter included open-ended questions divided into pre-defined themes of daily limitations, social life, general health, emotional barriers and family impact. Results: Thirty-four children and parents participated from UK; 96 children and parents participated from India. The majority of children (> 80%) reported no problems in daily activities, although 32.8% reported having pain. Difficulty finding appropriate footwear and limitation in sports were more common among UK children, whereas difficulty in squatting was more problematic for Indian children. Self and emotional perceptions regarding their appearance/condition were lower among older as compared to younger children in both countries. Parents' responses mirrored those of children; additionally they reported emotional and financial difficulties during initial treatment phase, and ongoing concerns about the future during the maintenance phase. Conclusion: Treated clubfoot continues to impact the lives of affected children and families. Perceptions of the condition and its impact vary between population groups; this needs to be appreciated when collecting and analysing outcomes. [ABSTRACT FROM AUTHOR]

Congenital talipes equinovarus is one of the most common lower limb congenital defects present at birth. The gold standard treatment is the Ponseti method and it harnesses the biomechanical properties of biological tissues. It involves serial gentle manipulation and casting. Part of this method is an Achilles tendon tenotomy prior to the final casts, boots and bars and if needed a tibialis anterior transfer for dynamic supination at a later stage. The Ponseti method does not result in normal feet but results in normal looking feet that are comfortable and function normally. [ABSTRACT FROM AUTHOR]

Introduction: Foot bimalleolar angle (FBM angle) and Pirani score are recognized as assessment and prognostic tools for objective assessment of clubfoot (congenital talipes equinovarus, or CTEV) treatment. The present study proposed to study various factors that determine the improvement in FBM angle and Pirani score in patients treated by the Ponseti technique., Materials and Methods: This prospective observational study was conducted after obtaining ethical clearance, and 42 children with CTEV (60 feet) were enrolled. Various parameters affecting FBM angle and Pirani scoring were recorded for each individual patient on a predesigned proforma. Patients were managed by serial manipulation and casting using the Ponseti technique with weekly follow-ups, and changes in FBM angle and Pirani score were recorded. The result was analyzed, and determinants of improvement in FBM angle, Pirani scoring, and recurrence were compared and reported., Results: Significant factors affecting FBM angle were age at treatment commencement, severity at presentation, and outside treatment. However, only severity at presentation emerged as the most significant variable. Significant factors affecting Pirani score improvement were age at the start of treatment, severity at presentation, and parent education. However, severity at presentation was the most significant variable. The recurrence of clubfoot was significantly associated with severity at presentation, education of parents, weekly visit compliance, and compliance with orthosis., Conclusion: The identification of independent risk factors, including various sociodemographic factors affecting CTEV treatment outcomes, can allow clinicians to intervene at various levels of management, including parental counselling and socio-economic support, as measures to enhance compliance and ascertain more promising outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Era's Lucknow Medical College and Hospital issued approval ELMC&H/RCell/EC/2020/114. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Aims: To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV). Methods: A list of outcome measurement tools (OMTs) was obtained from the literature through a systematic review. Further outcomes were collected from patients and families through a questionnaire and interview process. The combined list, as well as the appropriate follow-up timepoint, was rated for importance in a two-round Delphi process that included an international group of orthopaedic surgeons, physiotherapists, nurse practitioners, patients, and families. Outcomes that reached no consensus during the Delphi process were further discussed and scored for inclusion/exclusion in a final consensus meeting involving international stakeholder representatives of practitioners, families, and patient charities. Results: In total, 39 OMTs were included from the systematic review. Two additional OMTs were identified from the interviews and questionnaires, and four were added after round one Delphi. Overall, 22 OMTs reached ‘consensus in’ during the Delphi and two reached ‘consensus out’; 21 OMTs reached ‘no consensus’ and were included in the final consensus meeting. In all, 21 participants attended the consensus meeting, including a wide diversity of clubfoot practitioners, parent/patient representative, and an independent chair. A total of 21 outcomes were discussed and voted upon; six were voted ‘in’ and 15 were voted ‘out’. The final COS document includes nine OMTs and two existing outcome scores with a total of 31 outcome parameters to be collected after a minimum follow-up of five years. It incorporates static and dynamic clinical findings, patient-reported outcome measures, and a definition of CTEV relapse. Conclusion: We have defined a minimum set of outcomes to draw comparisons between centres and studies in the treatment of CTEV. With the use of these outcomes, we hope to allow more meaningful research and a better clinical management of CTEV. Cite this article: Bone Jt Open 2022;3(1):98–106.

Background: Clubfoot is a multifactorial disease with the prevalence of one in 1000 live births. The presentations of clubfoot are forefoot adductus, hindfoot varus, cavus, and equinus. Ponseti method is an efficient nonoperative clubfoot treatment containing manipulation, serial casting, and Achilles tendon tenotomy if necessary. Our prospective observational study assessed the outcome and probability of recurrence in the treated clubfoot with the Ponseti method. Methods: This prospective observational study was performed in Akhtar Hospital in Tehran, Iran. 27 patients with 38 feet of idiopathic clubfoot in our study were treated with the Ponseti method. The patients were assessed before and after treatment and demographic characteristics, Dimeglio scores, number of recurrenes, and need for tenotomy were recorded. Results: All patients (38 feet) successfully achieved complete deformity correction, but 13 feet had a relapse. The mean age of cases with relapse was more than cases without relapse. Cases with a higher initial Dimeglio score had a higher recurrence rate after Ponseti method treatment. Eight feet (five patients) out of 38 feet did not use Denis Browne (DB) splint as our protocol; all of them had a relapse. On the other hand, only 5 of 30 feet (16.7%) that used splint had recurrence. Conclusion: The treatment should be started as soon as possible because it is more effective at a younger age. Severe cases at the initial visit had more recurrence rate. Besides, the recurrence rate in cases that used DB orthosis improperly, irregularly, and incorrectly was higher than others.

Congenital clubfoot is a common pediatric malformation that affects approximately 0.1% of all births. 80% of the cases appear isolated, while 20% can be secondary or associated with complex syndromes. To date, two genes that appear to play an important role are PTIX1 and TBX4, but their actual impact is still unclear. Our study aimed to evaluate the prevalence of pathogenic variants in PITX1 and TBX4 in Italian patients with idiopathic clubfoot. PITX1 and TBX4 genes were analyzed by sequence and SNP array in 162 patients. We detected only four nucleotide variants in TBX4, predicted to be benign or likely benign. CNV analysis did not reveal duplications or deletions involving both genes and intragenic structural variants. Our data proved that the idiopathic form of congenital clubfoot was rarely associated with mutations and CNVs on PITX1 and TBX4. Although in some patients, the disease was caused by mutations in both genes; they were responsible for only a tiny minority of cases, at least in the Italian population. It was not excluded that other genes belonging to the same TBX4-PITX1 axis were involved, even if genetic complexity at the origin of clubfoot required the involvement of other factors. [ABSTRACT FROM AUTHOR]

Background: The resurgence and long duration of treatment of the Ponseti method in recent years has been punctuated by less than favourable long-term outcomes for surgically treated feet. Objectives of the study were to compare the two treatment techniques accelerated vs standard Ponseti technique among children's having Congenital Talipes Equinovarus. Methods: This was two years randomized control trial study carried out among total 104 idiopathic congenital talipes equinovarus patients in Orthopaedics and Spine Unit, Hayatabad Medical Complex, Peshawar. A convenient sampling technique was used in this study. Informed written consent was taken from each respondent. Patients in group A was subjected to accelerated ponseti technique and patients in group B was subjected to standard ponseti technique. At one month after treatment, all the patients were re assessed on the basis of pirani score. Data was collected and analyzed using SPSS version 21. Results: This study included a total 104 clinically diagnosed Congenital Talipes Equinovarus patients with mean age 5.5±2.1 months and 52 in each treatment group. Out of total 104 patients 68 (65.4%) were male and 36 (34.6%) were female. They're found significant difference in the mean ponseti scores of these two-group p=0.042 provided comparatively low mean pirani score in accelerated ponseti group. All female child in accelerated ponsati group was responded to the treatment with 100% effectiveness rate. The difference of effectiveness of treatment was significant p=0.015 for children age range 4-8 months divided in two treatment group with good effectiveness 80.8% in accelerated ponseti group. Conclusion: Accelerated ponseti technique is more effective than standard ponseti technique for Congenital Talipes Equinovarus. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: El pie zambo supone una de las malformaciones congénitas del pie más frecuentes. Generalmente la etiología es idiopática. Sin embargo, pueden presentar una causa sindrómica y asociarse con afecciones musculoesqueléticas, neurológicas o del tejido conjuntivo, recibiendo en estos casos, la denominación de pie zambo sindrómico.El tratamiento de elección del pie zambo idiopático es el método Ponseti, basado en la manipulación y yesos seriados. También se ha demostrado su utilidad en pie zambo asociado con artrogriposis y mielomeningocele, pero existen pocas publicaciones sobre la eficacia en el pie zambo sindrómico. Material y métodos: Estudio retrospectivo en seis pacientes (nueve pies) con pie zambo sindrómico tratados en un centro terciario siguiendo el método Ponseti. Tiempo de seguimiento mínimo de dos años (2-18). Los resultados fueron evaluados con la clasificación de Pirani, para valorar la severidad del pie zambo, previa y posteriormente al tratamiento. Resultados: En los seis pacientes tratados, se emplearon una media de 6,5 yesos. La escala de Pirani obtuvo una valoración media de 5,2, previamente al tratamiento, con un descenso hasta 1,27 tras el tratamiento, con una mejoría media de 3,93 puntos.En más de la mitad de los casos fue necesario una tenotomía del tendón Aquileo para corregir la deformidad en equino. Se utilizó una ortesis tobillo-pie para reducir las recidivas si retraso psicomotor o dismetría severa. La deformidad residual más frecuente fue el aducto, que no requirió tratamiento quirúrgico. Un paciente recidivó en dos ocasiones. Conclusiones: El método de Ponseti es útil en el tratamiento del pie zambo sindrómico, aunque precisa un número mayor de yesos correctores que en el pie zambo idiopático. La deformidad residual más frecuente en esta muestra fue el adductus. Abstract: Introduction: Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. Material and methods: Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. Results: Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. Conclusions: The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

Resumen: El pie bot es la deformidad congénita más frecuente de las extremidades inferiores del ser humano, afectando a 1 de cada 1000 recién nacidos vivos. Consiste en la presencia de cuatro deformidades estructurales en el pie y el tobillo: cavo del medio pie, aducto del antepié, varo del retropié y pie en equino.Su registro en la humanidad data del siglo XII A.C. en momias del antiguo Egipto.La fisiopatología de esta deformidad aún no está aclarada. El diagnóstico puede ser prenatal mediante visualización ecográfica, pero la forma más común de diagnóstico es postnatal. La evaluación de estos pacientes se basa en la exploración clínica. Entre las clasificaciones más utilizadas se encuentran: Diméglio, que enfatiza lo reductible ante maniobras manuales de la deformidad; Pirani, que evalúa la gravedad inicial y el progreso del tratamiento; y Ponseti International Association (PIA), que clasifica según etiología.Durante el siglo pasado se describieron numerosos procedimientos quirúrgicos, muchos de los cuales fueron quedando en desuso ante sus resultados insatisfactorios, pies rígidos y dolorosos, con función limitada. Actualmente el método Ponseti es el Gold estándar para su tratamiento, consistiendo en una manipulación y enyesado seriado buscando la corrección sistemática del pie, basado en los fundamentos de la cinemática y la fisiopatología de la deformidad. Summary: Clubfoot is the most frequent congenital deformity of the lower extremities of humans, affecting 1 out of 1000 live newborns. It consists of the presence of four structural deformities in the foot and ankle: midfoot cavus, forefoot adductus, hindfoot varus, and equinus foot.Its records in humanity date from the 12th century B.C., in ancient Egyptian mummies.The pathophysiology of this deformity is still unclear. Prenatal diagnosis by ultrasound imaging is feasible, but most common diagnosis is postnatal. The evaluation of these patients is based on clinical examination. Among the most used classifications are: Diméglio, which emphasizes the reductibility with manual maneuvers; Pirani, who assesses initial severity and progress of treatment; and Ponseti International Association (PIA), which classifies according to etiology.During the last century, numerous surgical procedures were described, many of which were disused due to their unsatisfactory results, stiffness and painful feet, with limited functionality. Currently the Ponseti method is the gold standard for its treatment. It consists of serial manipulation and casting, looking for a systematic correction of the deformity, based on the fundamentals of kinematics and pathophysiology of the deformity.

Aims: This study aims to define a set of core outcomes (COS) to allow consistent reporting in order to compare results and assist in treatment decisions for idiopathic clubfoot. Methods: A list of outcomes will be obtained in a three-stage process from the literature and from key stakeholders (patients, parents, surgeons, and healthcare professionals). Important outcomes for patients and parents will be collected from a group of children with idiopathic clubfoot and their parents through questionnaires and interviews. The outcomes identified during this process will be combined with the list of outcomes previously obtained from a systematic review, with each outcome assigned to one of the five core areas defined by the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT). This stage will be followed by a two round Delphi survey aimed at key stakeholders in the management of idiopathic clubfoot. The final outcomes list obtained will then be discussed in a consensus meeting of representative key stakeholders. Conclusion: The inconsistency in outcomes reporting in studies investigating idiopathic clubfoot has made it difficult to define the success rate of treatments and to compare findings between studies. The development of a COS seeks to define a minimum standard set of outcomes to collect in all future clinical trials for this condition, to facilitate comparisons between studies and to aid decisions in treatment.

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts.

Abstract Background An observational study was conducted to evaluate the recovery of older children with relapsed congenital clubfoot who underwent an Achilles tenotomy for the second time as part of the Ponseti treatment. Methods Thirteen patients (19 feet) with congenital clubfoot underwent Achilles tenotomy where magnetic resonance images of the severed tendons were taken after 1, 3, and 6 weeks post-procedure. The participants were categorized into older children who underwent tenotomy for the first time (group A: mean, 4.9±1.8, and range, 2.8–7 years old) and older children who underwent tenotomy for a second time (group B: mean, 4.9±1.5, and range, 3–6.8 years old). The area of high signal intensity between the severed tendons on MRI scans was computed using Python programming language and compared with clinical assessment. Results Three weeks after Achilles tenotomy, groups A and B had clinically intact tendons in 9 out of 11 and 2 out of 8 feet, respectively, according to both clinical and MRI assessment. From week 1 to week 3 post-tenotomy, computational analysis showed that the mean high signal intensity area of group A decreased by 88.5±15.2%, which was significantly different (P .048 < .05) than the percent reduction of high signal intensity area of group B (69.0±24.9%). Conclusion Children who underwent Achilles tenotomy for the second time showed slower tendon recovery on the third week post-procedure. A possible reason for slower healing times may be due to the location of tenotomy in being further away from the musculotendinous junction where extrinsic healing mechanisms take place.

Congenital talipes equinovarus (CTEV) is one of the most common congenital limb defects in children, which is a multifactorial and complex disease that associates with many unknown genetic, social-demographic, and environmental risk factors. Emerging evidence proved that gene expression or mutation might play an important role in the occurrence and development of CTEV. However, the underlying reasons and involved mechanisms are still not clear. Herein, to probe the potential genes and related signaling pathways involved in CTEV, we first identified the differentially expressed genes (DEGs) by mRNA sequencing in pediatric patients with CTEV compared with normal children. The gene of COL1A2 was upregulated, and AKT3 was downregulated at the transcriptional level. Western blot and quantitative polymerase chain reaction (qRT-PCR) results also showed that the expression of COL1A2 in CTEV was enhanced, and the AKT3 was decreased. Furthermore, the COL1A2 Knock-in (+COL1A2) and AKT3 Knock-out (-AKT3) transgenic mice were used to verify the effects of these two genes in the CTEV, and the results of which showed that both COL1A2 and AKT3 were closely related to the CTEV. We also investigated the effect of the PI3K-AKT3 signaling pathway in CTEV by measuring the relative expression of several key genes using Western blot and qRT-PCR. In line with the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis data, the PI3K-AKT3 signaling pathway might play a potentially important role in the regulation of pathological changes of CTEV. This study will provide new ideas for the mechanism investigation and prenatal diagnosis of CTEV.

ObjectiveTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.MethodsThis is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.ResultsIn total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8–96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5–6). During this follow-up, the Pirani score was 0.07 (0–0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet (p < 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.ConclusionAlthough the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.

Purpose: Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1year post-correction following Ponseti management in infants who were born preterm but treated at term age. Methods: A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs). Results: Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8–5.6) in the idiopathic group and 5.7 (95%CI: 5.0–6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1–6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0–7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery. Conclusion: Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to termborn infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Abstract Background Congenital talipes equinovarus (CTEV) is a common birth defect that causes severe deformities of one or both feet. Genetics have been proven to play a key role in the risk of CTEV. Our study aimed to evaluate the genetic susceptibility of common variants in the SOX9 gene to CTEV in a Han Chinese population. Methods In this study, we recruited 2,205 study participants, including 692 CTEV patients and 1513 healthy controls. A total of seven selected single-nucleotide polymorphisms (SNPs) within the SOX9 gene were genotyped, and environmental variables, including maternal smoking and alcoholic drinking habits, were assessed. In addition, bioinformatics analyses were performed to explore the potential biological functions of the associated SNPs. Results The SNP rs73354570 was identified to be significantly associated with the risk of CTEV (OR = 1.53, P = 2.11 × 10−5), and the C allele was associated with an increased risk of CTEV. A dose-dependent pattern could be observed in genotypic analyses. The OR for individuals with AC genotypes was 1.37 (95% CI 1.09–1.71), and the OR for individuals with CC homozygotes was 1.47 (95% CI 1.18–1.82). Further analyses identified that rs73354570 is located within a region of multiple binding proteins, including CEBPB and POLR2A, which suggested that this SNP was also part of genetic motifs that are found within several cell types. Conclusion Our results provide evidence supporting the important role of the SOX9 gene in the contribution to the risk of CTEV.

Clubfoot is one of the most common musculoskeletal birth deformities worldwide. The prevalence varies among individual countries and populations. There is a lack of nationwide incidence studies in Central Europe. We analyzed the incidence of clubfoot in the Czech Republic over 14 years. Patients born with clubfoot in the Czech Republic were identified using The National Registry of Congenital Anomalies. Demographic data were included. Data from 2000 to 2014 were collected and analyzed regarding gender and regional distribution. The study’s chosen time frame was grounded on the condition of the Czech industry. Following extensive transformations in 1989, the industry eliminated highly non-ecological operations with significant environmental impact and related health risks. The incidence of clubfoot during the study period was 1.9 (95% CI 1.8–2.0) per 1000 births; males comprised the majority (59%). The incidence significantly differed among individual regions of the Czech Republic (p < 0.001). The incidence in the Czech Republic was higher than in previous European studies. We found significant regional differences in incidence, which could indicate that there may be exogenous pathogenic factors. For this reason, we plan to follow up our work with an up-to-date study.

Background: Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). Methods: A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. Results: Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. Conclusions: Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems.

Purpose: To investigate the value of antero-posterior and lateral radiographs in predicting clubfoot relapse after treatment with the Ponseti method. Methods: This was a retrospective review of 104 children (157 feet) younger than 3months of age with idiopathic clubfoot treated using the Ponseti method at our institution between January 2007 and December 2014. All patients underwent Achilles tenotomy and were divided into two groups according to the need for further surgery to correct the deformity: relapsed group (24 patients; 36 feet) and non-relapsed group (80 patients; 121 feet). All anteroposterior and lateral foot radiographs were performed less than 3months after Achilles tenotomy. The talo-calcaneal (TC-AP) and talus-first metatarsal (TM-AP) angles were measured in the antero-posterior view, while the tibiocalcaneal (TIC-L), talus-first metatarsal (TM-L), and talo-calcaneal (TC-L) angles were measured in the lateral view. The multi-factor logistic regression model of the stepwise selection method was used to predict the relapse of clubfoot deformity from the potential predictive values. Results: The mean age at initial plain radiography examination was 99.45±21.54days. Differences in TC-AP, TM-AP, TC-L, and TIC-L between the two groups were statistically significant. However, only TM-AP and TIC-L were included in the “risk of relapse” formula using the multi-factor logistic stepwise selection method. Conclusion: Early antero-posterior and lateral radiographs in children younger than 3months of age at initial Ponseti treatment have positive predictive value for relapse. Reduced TM-AP angle and increased TIC-L were associated with an increased risk of relapse. Level of evidence: level III. [ABSTRACT FROM AUTHOR]