Foot (Edinburgh, Scotland) · 2026
Sequential correction of clubfoot deformities with Ponseti casting and tenotomy: Insights from the Dimeglio scoring framework.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Barik Sitanshu, Agarwal Anil, Patel Yogesh
Аннотация
BACKGROUND: This study evaluated the point during Ponseti treatment when the foot reaches a neutral position and quantified how percutaneous Achilles tenotomy influences each component of clubfoot deformity. An additional aim was to provide a visual representation of correction trends using the Dimeglio scoring framework.
METHODS: Infants under six months of age with unilateral idiopathic clubfoot were assessed at each visit with the Dimeglio score. Changes in total and individual deformity parameters were analyzed throughout serial casting and following tenotomy.
RESULTS: The total number of casts required before tenotomy ranged from 3 to 12 (mean 6.2). The largest drop in total Dimeglio score occurred between the initial and second casts. All the individual components exhibited the steepest reduction between the first and second casts (17.90 - equinus, 19.20 - hindfoot varus, 44.40 - midfoot rotation, and 18.80 - forefoot adduction). All the deformities except equinus approached neutral through the third cast and equinus through the fourth cast. Tenotomy improved (mean) equinus by 140, hindfoot varus by 20, midfoot rotation by 50 and forefoot adduction by 3.20.
CONCLUSIONS: All major deformity elements show concurrent early improvement when managed with the Ponseti technique. Significant change occurs within the first few casts, with tenotomy offering additional correction beyond equinus alone. Larger-scale studies could help standardize the graphical correction profiles observed here.
LEVEL OF EVIDENCE: IV.
METHODS: Infants under six months of age with unilateral idiopathic clubfoot were assessed at each visit with the Dimeglio score. Changes in total and individual deformity parameters were analyzed throughout serial casting and following tenotomy.
RESULTS: The total number of casts required before tenotomy ranged from 3 to 12 (mean 6.2). The largest drop in total Dimeglio score occurred between the initial and second casts. All the individual components exhibited the steepest reduction between the first and second casts (17.90 - equinus, 19.20 - hindfoot varus, 44.40 - midfoot rotation, and 18.80 - forefoot adduction). All the deformities except equinus approached neutral through the third cast and equinus through the fourth cast. Tenotomy improved (mean) equinus by 140, hindfoot varus by 20, midfoot rotation by 50 and forefoot adduction by 3.20.
CONCLUSIONS: All major deformity elements show concurrent early improvement when managed with the Ponseti technique. Significant change occurs within the first few casts, with tenotomy offering additional correction beyond equinus alone. Larger-scale studies could help standardize the graphical correction profiles observed here.
LEVEL OF EVIDENCE: IV.