Conservative management of idiopathic clubfoot: Kite versus Ponseti method

Document Sample
Conservative management of idiopathic clubfoot: Kite versus Ponseti method Powered By Docstoc
					Journal of Orthopaedic Surgery 2009;17(1):67-71




Conservative management of idiopathic
clubfoot: Kite versus Ponseti method
AV Sanghvi,1 VK Mittal 2
	 Department	of	Orthopaedics,	Government	Medical	College	&	New	Civil	Hospital,	Surat,	Gujarat,	India
1

	 Department	of	Orthopaedics,	Shri	HJ	Doshi	Hospital,	Rajkot,	Gujarat,	India
2




                                                               incidence of residual deformity and recurrence was
                                                               slightly lower.
ABSTRACT                                                       Conclusion. The Ponseti method can achieve more
                                                               rapid correction and ankle dorsiflexion with fewer
Purpose. To compare the long-term results of the Kite          casts, without weakening the Achilles tendon.
and Ponseti methods of manipulation and casting for
clubfoot.                                                      Key words: clubfoot; manipulation, orthopedic
Methods. 42 patients (with 64 idiopathic clubfeet)
were equally randomised to Kite or Ponseti treatments
in the early weeks of life. 14 males and 7 females (34         INTRODUCTION
clubfeet) were treated by the Kite method, whereas 13
males and 8 females (30 clubfeet) were treated by the          Clubfoot deformity in children is difficult to treat
Ponseti method. All the clubfeet were manipulated,             because of the complex pathological anatomy of
casted, and followed up (for a mean of 3 years) by one         the growing foot. It is important to understand the
experienced orthopaedic surgeon. The final results             pathological anatomy and mechanics of correction
were compared.                                                 and to follow up patients carefully. In early weeks of
Results. The success rates for the Kite and Ponseti            life (with pliable deformities), the treatment of choice
treatments were similar (79% vs 87%). With the                 is always conservative. Thus, the manipulation and
Ponseti method, the number of casts was significantly          casting techniques of Kite and Ponseti are commonly
fewer (7 vs 10); the duration of casting required to           used with good outcomes,1–6 but comparison of
achieve full correction was significantly shorter (10 vs       their long-term outcomes is lacking. The type and
13 weeks); the maximum ankle dorsiflexion achieved             duration of treatment depend on the age of patient
was significantly greater (12 vs 6 degrees); and the           and severity of deformity. We therefore compared the




Address	correspondence	and	reprint	requests	to:	Dr	Sanghvi	Amish	V,	‘AVSAR’,	4/4,	Patel	Colony,	Jamnagar,	361008,	Gujarat,	
India.	E-mail:	amishsanghvi@rediffmail.com
68	   AV	Sanghvi	and	VK	Mittal	                                                            Journal of Orthopaedic Surgery


long-term results of these 2 methods by conducting a
                                                            (a)
randomised prospective study.


MATERIALS AND METHODS

42 patients (with 64 idiopathic clubfeet) were equally
randomised to the Kite or Ponseti methods of
manipulation and casting in the early weeks of life. 14
males and 7 females (34 clubfeet: 13 bilateral, 5 right,
3 left) were treated by the Kite method, whereas 13
males and 8 females (30 clubfeet: 9 bilateral, 6 right,
6 left) were treated by the Ponseti method. All the
clubfeet 
				
DOCUMENT INFO
Description: To compare the long-term results of the Kite and Ponseti methods of manipulation and casting for clubfoot. 42 patients (with 64 idiopathic clubfeet) were equally randomised to Kite or Ponseti treatments in the early weeks of life. 14 males and 7 females (34 clubfeet) were treated by the Kite method, whereas 13 males and 8 females (30 clubfeet) were treated by the Ponseti method. All the clubfeet were manipulated, casted, and followed up (for a mean of 3 years) by one experienced orthopaedic surgeon. The final results were compared. The success rates for the Kite and Ponseti treatments were similar (79% vs 87%). With the Ponseti method, the number of casts was significantly fewer (7 vs 10); the duration of casting required to achieve full correction was significantly shorter (10 vs 13 weeks); the maximum ankle dorsiflexion achieved was significantly greater (12 vs 6 degrees); and the incidence of residual deformity and recurrence was slightly lower. The Ponseti method can achieve more rapid correction and ankle dorsiflexion with fewer casts, without weakening the Achilles tendon.
BUY THIS DOCUMENT NOW PRICE: $6.95 100% MONEY BACK GUARANTEED
PARTNER ProQuest LLC
ProQuest creates specialized information resources and technologies that propel successful research, discovery, and lifelong learning.