AN ALTERNATIVE ORTHOSIS TO PREVENT RELAPSE OF THE CLUBFOOT DEFORMITY AFTER CORRECTION WITH THE PONSE

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AN ALTERNATIVE ORTHOSIS TO PREVENT RELAPSE OF THE
CLUBFOOT DEFORMITY AFTER CORRECTION WITH THE
PONSETI METHOD

• Timur YILDIRIM, Aysegul BURSALI,
  Sarper GURSU, Kerem AYDIN
• Baltalimani Metin Sabanci Bone and Joint Diseases
  Education and Research Hospital

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• Its essential to use an abduction orthosis after
  clubfoot correction with the Ponseti method. The
  Dennis-Brown bar is the most commonly used device
  for this purpose. However in some cases its not
  possible to use this bar. In this study we aimed
  to present an alternative device to be used in
  cases where Dennis-Brown bar is not suitable.

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• Among our 167 patients with clubfoot deformity,
  all of whom were treated with the Ponseti method,
  14 (8.3) were not suitable candidates for using
  the Dennis-Brown device because of
  non-compliance.

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• 12 of these patients were male, 2 were female
  with a mean age of 4,5 months at presentation
  (between 11 days and 14 months). 6 of these
  patients had bilateral clubfeet and 8 had
  unilateral (20 clubfeet). Mean period of follow
  up was 17 months (6-47 months). 8 patients had
  previous history of treatments other then the
  Ponseti method. The number of the casts used for
  the correction of the deformity was in average
  5.3. 10 of the patients underwent percutaneus
  achilles tenotomy under local anesthesia.

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• The device we used is originally designed for
  correcting metatarsus adductus deformity. Its
  made up of 2 pieces and has a calcaneal support,
  which is our modification, attached to it. It
  provides external rotation of the knees and the
  feet are kept in abduction.

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• The device is used for 14 patients. 10 patients
  were given this device because they couldnt
  tolerate using the Dennis-Brown bar. 2 had very
  fat feet so that they could not wear shoes. 1 of
  them was very small (11 days old at presentation)
  and fitting shoes could not be made for his feet.
  The last child to use this device had a
  rudimentary left leg and a right clubfoot. Non of
  the families reported non-compliance with this
  device. Complications such as contractures,
  decrease in the range of motion in any joints
  depending on the device were not seen. No patient
  has recurrent deformity up to date.

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• Bracing after correction of clubfoot deformity
  with the Ponseti method is a necessity. But as
  explained in some cases this might be a problem
  because of the non-compliance with the
  Dennis-Brown bar. In such cases this device could
  be used successfuly.

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Thank you