Why is experience important in the Ponseti method? (and it’s not as easy as some people think) (VIDEO)

We present a series of videos on clubfoot and the Ponseti method, based on Dr. Manuele Lampasi’s twenty-year experience in this field (Ponseti International). This video invites young practitioners approaching the method to reflect on some important issues.

Dr. Lampasi was among the orthopedic surgeons who contributed most to the spread of the Ponseti method in Italy over 15 years ago, first introducing it at the Rizzoli Orthopedic Institute in Bologna and then at Meyer in Florence while he was Head of Pediatric Orthopedics and sought to train many colleagues in Italy. He is among the Italians with the greatest number of international publications on the subject, having contributed to the understanding of various aspects of this condition.

Here are some of the topics covered:

• Treatment success rates
• How many casts?
• The scars
• Anesthesia for tenotomy
• Casts problems
• Correct use of the brace
• Clinical evaluation: is it important?
• how to perform the manipulations

Part 1: Treatment success rates in the Ponseti method

The Ponseti method is highly effective, so effective that many feet can be corrected even with imprecise application. But this is a double-edged sword, because these “easy” successes give the false impression that the method is being applied correctly. It is important for practitioners to recognize where they are in their learning curve and adjust their training and practice accordingly. Only strict application of the Ponseti method can guarantee optimal results.

Part 2: How many casts do you need?

Incorrect application leads to a large number of casts, sometimes even 10, 15, 20 casts, months of treatment, feet that can swell or deform, etc.

Part 3: The Scars in the Ponseti method

Incorrect application of the Ponseti method sometimes results in scars of variable length, stitches, scars that tend to “elongate” with growth, or adhesions to the deep layer, instead of the expected millimetric scar.

Part 4: anesthesia for tenotomy

Anesthesia for Achilles tendon tenotomy is a matter of debate. Possible alternatives include tenotomy with anesthetic cream/local anesthesia and surgery under general anesthesia/sedation. At our center, we perform the tenotomy using the former, with the patient awake, without sedation, and without the need for hospitalization or prolonged fasting.

To ensure greater sterility during the procedure, we perform the procedure in the operating room, assisted by an anesthesiologist for greater clinical safety. The patient resumes breastfeeding while the cast is applied and quickly returns home.

GO TO THE DEDICATED FORM:
Achilles tendon tenotomy: a minimally invasive technique under local anesthesia

Part 5: Cast Problems in the Ponseti method

If casts are applied incorrectly, more casts fall off. This leads to a lack of progression in the correction, the need for multiple casts, and feet that tend to deform (atypical clubfoot), etc.

Skin lesions are also more frequent: swelling (requiring emergency cast removal), bedsores, phlebitis, saw wounds, etc.

Part 6: Correct use of the brace in the Ponseti method

It is important to use the correct brace with the correct adjustments and timing. If the Ponseti method is not applied correctly, braces with incorrect adjustments, timing, or the wrong braces are used.

Part 7: The importance of clinical evaluation of clubfoot

A correct clinical assessment is the basis for proper treatment planning. It is important to know how to assess the severity of a clubfoot using international classifications, to recognize any neurological problems, and to know how to best manage them.

Our center has published several international studies on these aspects. The most common errors are: mild clubfoot assessed as severe; positional clubfoot assessed as clubfoot; associated problems recognized late.