HealthMedicine

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 a "gold standard" for treatment of clubfoot.

Definition of Congenital Clubfoot

Congenital clubfoot is a complex violation 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. A clubfoot is formed in the initial weeks of pregnancy, its cause is not yet 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 of treatment of clubfoot

Previously, before the Ponseti method was used, correction of clubfoot was done with corrective gypsum dressings, and then performed an operation on the foot, at which the elongation and stitching of the tendons of several muscles occurs, the ligaments of the foot intersect, the joint is opened. Cases of affecting and bones on the foot during surgery were frequent.

The usual method of treating clubfoot includes the following steps:

  • Treatment begins with a 1-week-old baby;
  • First, there are 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 application of a plaster bandage for a period of 5 months;
  • At low effectiveness of treatment at the age of 2 years, the child undergoes a surgical operation (Z-shaped plastic of the Achilles tendon).

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

What is Ponseti's method?

Ignacio Ponseti - an outstanding American orthopedist, developed in the 1950-60's a new method of treating clubfoot. 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.

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 the treatment should be at the age of 1-2 weeks of life of the baby, be sure to start walking.

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

Stages of treatment according to the Ponseti method

Treatment of clubfoot by the Ponseti method consists of several successive stages of treatment:

  1. Correction of deformity with plaster casts, which must 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 achillotomy, i.e. lengthening of the Achilles tendon, which is always shortened with clubfoot. The most commonly done is a closed operation 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 plating by the Ponseti method is carried out weekly, and with each successive application of gypsum, a certain type of deformation of the foot is eliminated. When the dressing is applied, a physician who correctly aligns the foot, and an assistant directly performing the plastering, participate.

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 to avoid the gypsum being transported by them.

There are several mandatory rules that must be followed strictly 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 (kavus);
  • When 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 exit of the foot should be less than 15 degrees;
  • When changing gypsum, the foot should not be in the free position for more than 1 hour;
  • 2-4 procedures are aimed at correcting the deviation inward of the fingers (varus deformity) and in the elimination of the plantar fold;
  • Step 5 - 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 fold in the ankle because of a shortened tendon).

The number of procedures should not be 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

Treatment according to the Ponseti method provides, in some cases before the 4th or 5th stage of gypsum, an achillotomy, in which:

  • Ligation of the calcaneal tendon (subcutaneous operation);
  • Fixation of damaged endings of ligaments;
  • The operation is done under local anesthesia;
  • At the end of the operation, plastering is done for the next 3 weeks.

This operation is fundamentally different from the standard surgery 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.

Using brace

The Ponseti method provides, as a final stage, the wearing of braces, a special shoe that allows you to fix the position of the feet and legs in the desired position with the aid of the plank to avoid returning clubfoot. Boots are selected and ordered in advance.

Wearing braces should be 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 at the time of sleep (day and night) - the recovery period lasts 2-4 years to avoid relapse.

Disadvantages of the method

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

  • High cost of special footwear (brace), which are usually purchased from manufacturers in Germany or the USA;
  • The duration of its delivery to other countries,
  • Relative brittleness of the structure.

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

Advantages

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 properly conducted 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 responses 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 were almost invalids. Turning later to medical centers for doctors who professionally use the Ponseti method to treat clubfoot, parents were able to cure their children's legs completely.

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