Biomaterial Database

Effect of cast removal timing in the correction of idiopathic clubfoot by the Ponseti method. 2007

Gaston Terrazas-Lafargue, and Jose A Morcuende

The Ponseti Clubfoot Treatment Center, University of Iowa, Iowa City, Iowa, USA.

Clubfoot correction by the Ponseti method is highly successful with an average of 5 casts in the majority of patients. However, early experience with the technique demonstrated that many cases required more than 5 casts for correction. The purpose of this study was to evaluate the effects of timing of cast removal before subsequent manipulation and casting in the correction of club-foot using the Ponseti method. We reviewed 90 patients (129 clubfeet) treated between December 2000 and June 2006. Two groups were evaluated. Group A: 44 patients (63 clubfeet) had their cast removed by the parents the night before the visit. Group B: 46 patients (66 feet) had their cast removed in the clinic just before the new casts were applied. Overall, full correction was obtained in 128 (99%) clubfeet, with only 1 clubfoot requiring surgical release. Group A required an average of 10 casts (range: 4 to 22), compared to 5 casts (range: 4 to 10) in Group B (p = 0.001). Average time for correction was 13 weeks in Group A and 6 weeks in Group B (p = 0.001). There were 20 relapses (22%), 12 (27%) in Group A and 8 (17%) in Group B (p = 0.42). In conclusion, removing the cast just before the new cast is applied significantly decreases the number of casts required for correction and shortens the length of treatment.

UI	MeSH Term	Description	Entries
D007223	Infant	A child between 1 and 23 months of age.	Infants
D008297	Male		Males
D008349	Manipulation, Orthopedic	The planned and carefully managed manual movement of the musculoskeletal system, extremities, and spine to produce increased motion. The term is sometimes used to denote a precise sequence of movements of a joint to determine the presence of disease or to reduce a dislocation. In the case of fractures, orthopedic manipulation can produce better position and alignment of the fracture. (From Blauvelt & Nelson, A Manual of Orthopaedic Terminology, 5th ed, p264)	Orthopedic Manipulation
D002370	Casts, Surgical	Dressings made of fiberglass, plastic, or bandage impregnated with plaster of paris used for immobilization of various parts of the body in cases of fractures, dislocations, and infected wounds. In comparison with plaster casts, casts made of fiberglass or plastic are lightweight, radiolucent, able to withstand moisture, and less rigid.	Fiberglass Casts,Plaster Casts,Plastic Casts,Cast, Surgical,Surgical Cast,Surgical Casts,Cast, Fiberglass,Cast, Plaster,Cast, Plastic,Casts, Fiberglass,Casts, Plaster,Casts, Plastic,Fiberglass Cast,Plaster Cast,Plastic Cast
D003025	Clubfoot	A deformed foot in which the foot is plantarflexed, inverted, and adducted.	Equinovarus,Talipes Equinovarus,Clubfeet,Clubfeet, Congenital,Clubfoot, Congenital,Congenital Talipes Equinovarus,Pie Torcido,Congenital Clubfeet,Congenital Clubfoot,Pie Torcidos,Talipes Equinovarus, Congenital
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013997	Time Factors	Elements of limited time intervals, contributing to particular results or situations.	Time Series,Factor, Time,Time Factor
D019233	Retreatment	The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful.	Retreatments
D019637	Orthopedic Procedures	Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures.	Orthopedic Surgery,Surgery, Orthopedic,Orthopedic Rehabilitation Surgery,Orthopedic Surgical Procedures,Orthopedic Procedure,Orthopedic Rehabilitation Surgeries,Orthopedic Surgeries,Orthopedic Surgical Procedure,Procedure, Orthopedic,Procedure, Orthopedic Surgical,Procedures, Orthopedic,Procedures, Orthopedic Surgical,Rehabilitation Surgeries, Orthopedic,Rehabilitation Surgery, Orthopedic,Surgeries, Orthopedic,Surgeries, Orthopedic Rehabilitation,Surgery, Orthopedic Rehabilitation,Surgical Procedure, Orthopedic,Surgical Procedures, Orthopedic