Treatment of clubfoot in Ponseti
To describe the characteristic deformation of the foot, when the foot is turned inward from the longitudinal axis of the shin, the term "club foot" is used.
Congenital clubfoot refers to a group of vicesdevelopment of limbs and is a combination of various deformities of the foot, usually accompanied by foot supination and abnormality of the shank musculature. The clubfoot of two feet occurs in about 50 percent of cases. The medical term for general or "classical" clubfoot form is Talipes equinovarus. As a rule, congenital pathology occurs in boys more often than in girls (ratio 2: 1). The causes of the disease are not fully understood.
Along with a congenital defect there is also an acquired form, the so-called neurogenic clubfoot, caused in most cases by a violation of innervation.
The diagnosis of typical foot defects is made by the doctor at onceafter birth. The clubfoot will not bother the child until he learns to stand and walk. However, the treatment of clubfoot is assigned as soon as possible after birth, in order to take advantage of the elasticity of the tissues that form the articular bags, ligaments and tendons, and continues consistently. This is very important in order to achieve optimal results, since the untreated foot will remain warped, which in general influences the movements of the foot, leads subsequently to arthritic pain.
Children, as a rule, try to treat without surgery, a conservative method known as treatment of clubfoot in Ponseti (therapeutic massage and plaster bandages).
Most clubfoot can be cured inabout six to eight weeks after birth. The orthopedic surgeon discusses various treatment options with the parents. His proposals for correcting the deformation of the foot should be based on a clear understanding of the functional anatomy of the foot, biological reactions of muscles, ligaments, bones.
Treatment of clubfoot in Ponseti - manageda technique developed by Dr. Ignacio Ponseti more than 50 years ago at the University of Iowa (USA) and extremely well-established. The Ponseti technique was introduced in the UK in the late 1990s and popularized throughout the country by physiotherapist of the National Health Service Steve Wild. In the 2000s, the method became widely used thanks to Dr. John Herzenberg in the US and Europe, and thanks to the surgeon of the National Health Service of the UK, Steve Mannayon, in Africa.
Now treatment of clubfoot in Ponseti is considered the "gold standard" in most developed countries.
Therapy begins on the first-second week of lifechild, with the phase of straightening, when manipulation of the tendons and ligaments of the foot does not cause pain. After each procedure, a plaster bandage is used to maintain the degree of correction achieved. It is imposed from the toes to the groin, once a week in a new position for five to seven weeks (depends on the degree of clubfoot severity). During this process, the bones of the foot gradually become aligned.
If you do not need moreno correction, in most cases, a tenotomy is performed - the division by the operative way of the calcaneal tendon, which requires an elongation, since with clubfoot it is always shortened. Under local anesthesia, it is completely divided across the scalpel. Full dorsal extension of the foot is achieved. Then, once again, put a plaster bandage on the foot for three or four weeks.
After tenotomy, the stage of fixationthe results of correction with the help of special therapeutic shoes (braces or "Denis Brown's tires") on a metal sliding rail that fixes the feet in a certain position, correcting the residual deformation in the area of the ankle. After three to four months, wearing braces can be reduced to fifteen hours a day, later they can only be used during night's sleep. Wear braces up to two to four years to avoid recurrence of clubfoot.
Every year in the world with clubfoot is born almost150,000 children. Treatment of clubfoot in Ponseti is painless, successful in almost 100 percent of all cases of congenital pathology, saving on expensive operations technique.
