Clubfoot
Advice for parents:
- Advice for parents : How to handle Ponseti method casts ? see fact sheet
- Advice for parents : How to handle the Ponseti brace ? see fact sheet
Why it is important to consult a doctor who is experienced in the Ponseti method
We present a series of videos on clubfoot and the Ponseti method, based on Dr. Manuele Lampasi’s twenty-year experience in this field, a Ponseti International Certified physician, to encourage young doctors who are approaching the method to reflect on some important issues.
Dr. Lampasi , a Ponseti International certified physician, was among the orthopedic surgeons who contributed most to the spread of the Ponseti method in Italy over 15 years ago, introducing it for the first time at the Rizzoli Orthopedic Institute in Bologna and then at Meyer in Florence while he was Head of Pediatric Orthopedics and seeking 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 topics covered:
- Treatment success rates
- How many casts?
- The scars
- Anesthesia for tenotomy
- Cast problems
- Correct use of the brace
- Clinical evaluation: is it important?
- Tutorial: how to perform the manipulations after treatment
Part 1: Treatment success rates of Ponseti method for clubfoot
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’s important for practitioners to recognize where they are on 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 needed?
Incorrect application leads to a large number of casts, sometimes even 10, 15, 20 casts, months and months of treatment, feet that can swell or deform, etc.
VIDEO (youtube)
Part 3: The Scars in the Ponseti method for clubfoot
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.
VIDEO
4th part: anesthesia for tenotomy in the Ponseti method for clubfoot
Anesthesia for Achilles tendon tenotomy is a matter of debate. Possible options include a tenotomy with anesthetic cream/local anesthesia and surgery under general anesthesia/sedation.
At OrthoChildren center, we perform tenotomy using the first method, with the patient awake, without sedation, and without the need for hospitalization or prolonged fasting. It’s performed in the operating room to ensure greater sterility during the procedure, with the assistance of an anesthesiologist for greater clinical safety. The patient resumes breastfeeding while the cast is applied and promptly returns home.
VIDEO
Part 5: Cast Problems in the Ponseti method for clubfoot
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 removal of casts), bedsores, phlebitis, saw injuries, etc.
VIDEO
Part 6: Correct use of the brace in the Ponseti method for clubfoot
It is important to use the correct brace and with the right adjustments and timing.
In case of incorrect application of the Ponseti method, braces with incorrect adjustments, incorrect timing or incorrect braces are used
VIDEO
Part 7: The importance of clinical evaluation in the Ponseti method for clubfoot
A proper clinical assessment is the basis for proper treatment planning. It’s important to know how to assess the severity of a clubfoot using international classifications, recognize any neurological problems, and know how to best manage them.
Dr Lampasi has published several international works on these aspects
The most common errors are: mild feet assessed as severe; positional feet assessed as clubfeet; associated problems recognized late.
VIDEO