Clubfoot treatment according to Ponseti

from Wikipedia, the free encyclopedia

The clubfoot treatment according to Ponseti is an orthopedic redression therapy (bloodless correction of a deformity), which is used to correct an idiopathic clubfoot . The Ponseti treatment provides for a special manual reduction with gradual correction according to anatomical criteria.

Historical

Ignacio Ponseti developed his treatment method to eliminate idiopathic clubfoot as early as the 1950s. Nevertheless, in the past, people in Germany mainly worked with redression plaster casts and limited dorsal soft tissue relaxation, or from the 1980s onwards with more extensive perital soft tissue interventions. It was not until the turn of the century that the method became more widely used in Germany thanks to the great successes achieved above all in English-speaking countries. As early as 2005 at the annual conference of the German Association for Foot and Ankle in Augsburg it became clear that the Ponseti concept had largely established itself as the standard therapy for idiopathic clubfoot.

execution

Basically, the treatment is carried out in three steps:

  1. Redression phase : An attempt is made to start treatment in the first week of life for the best possible success. The foot is successively redressed and retained in a padded cast every week. Over the course of the treatment, which lasts several weeks, the foot is gradually led into an abduction of around 70 degrees, measured against the knee joint's axis of movement.
  2. Tenotomy : If no further gain in correction can be achieved by the redression procedure, a percutaneous tenotomy is performed in most cases . In this small operation, the Achilles tendon is locally anesthetized and completely transversely cut with a scalpel. In the vast majority of cases, this results in complete dorsiflexion of the foot. Then the foot is immobilized for another 3–4 weeks using a plaster cast. In the further course of treatment, it was shown that the Achilles tendon healed completely within a few weeks.
  3. Denis-Browne splint : Following the tenotomy, the patient is put on an all-day Denis-Browne splint. These are two therapeutic shoes, each attached to a metal rail. The shoes can be rotated variably, so the clubfoot is fixed in 70 degrees and the unaffected foot in 40 degrees external rotation. Thus, the treatment result can be maintained and possible residual deformities in the ankle area can be corrected. After about 3–4 months, rail usage can be reduced to 15 hours a day. With increasing improvement, the splint only needs to be put on at night, but this continuously until the age of four. This ensures that the children do not have an internally oriented gait pattern, which was not infrequently the case with other treatment methods.

Web links

literature