The Ponseti method, which is used in the treatment of congenital clubfoot in young children, is today recognized as the most effective and sparing for the he alth of the baby. In the world, it is accepted as the "gold standard" in the treatment of clubfoot.
Definition of congenital clubfoot
Congenital clubfoot is a complex disorder of the structure and function of the foot and lower leg. Abnormalities are present not only in bones, joints and muscles, but also in tendons, nerve endings or blood vessels.
According to statistics, clubfoot is found in 5% of newborn babies. Clubfoot is formed in the initial weeks of pregnancy, its cause has not yet been determined. According to some assumptions, this is due to poor heredity, since if one of the parents has such a disease, the probability of developing the disease increases by 4%.
Congenital clubfoot is unilateral or bilateral and is more common in boys. The disease is based on the pathological proliferation of connective tissue, which is why the deformation of the foot occurs. At the same time, the muscles are shortened, convergence and wrapping inward occurs.back and inner surface of the foot. The child will never be able to put the leg in the normal position on its own.
Standard treatments for clubfoot
Earlier, before the Ponseti method was used, clubfoot was corrected with corrective plaster bandages, and then an operation was performed on the foot, in which the tendons of several muscles were lengthened and stitched together, the ligaments of the foot were crossed, the joint was opened. There were frequent cases of affecting the bones on the foot during the operation.
The usual treatment for clubfoot involves the following steps:
- start treatment at 1 week of age;
- massage sessions are held first (1-2 weeks);
- alternation of plaster casts and paraffin applications, which are done over a long period of time: from several months to 2 years, depending on the severity of the pathology;
- final cast for 5 months;
- with little effectiveness of treatment at the age of 2 years, the child undergoes a surgical operation (Z-shaped plastic of the Achilles tendon).
According to statistics, the effectiveness of treatment with the standard method is 58%.
What is the Ponseti Method
Ignacio Ponseti is an outstanding American orthopedist who developed a new method of treating clubfoot in the 1950s and 60s. It is based on a detailed study of the structure of the child's foot and its pathological changes. Unlike traditional methods of treatment, this method allows you to make a correction quite quickly: 1.5-2 months are allotted for completecorrection, but subject to the timely start of plastering.
The Ponseti method allows you to correct the deformity of the foot in a conservative way, avoiding cicatricial changes in the joints, helps to preserve the motor capabilities of the foot and muscles.
The most important condition for the high efficiency of this technique is the early diagnosis of the disease (in the first week of life), while the joints and muscles of the child have high elasticity. Treatment should begin at the age of 1-2 weeks of a baby's life, be sure to start walking.
If the deformity is detected later, then Ponseti treatment is also possible, but the correction of the defect will be much longer in time.
Ponseti treatment steps
Treatment of clubfoot according to the Ponseti method consists of several successive stages of treatment:
- Correction of deformity with plaster casts that need to be changed every 6-7 days. The child's leg is plastered completely: from the fingers to the upper thigh. Each bandage is made in a certain position, allowing you to adjust the shape of the foot and even the bones. In total, it is necessary to carry out 4-7 procedures for plastering the leg, but their number depends directly on the severity of the disease and the age of the baby.
- The next step is achillestomy, i.e. lengthening of the Achilles tendon, which is always shortened in clubfoot. Most often, a closed operation is performed under local anesthesia (for children under 2 years old). After the operation, plastering is done for 3 weeks to fix the result.
- The last important step is the use of braces, consisting of two boots, fixed on a special sliding bar.
For high efficiency and a guarantee of a cure for this disease, the high qualification of the doctor performing the procedure is of great importance.
Gypsum technique
Ponseti casting is carried out weekly, and with each subsequent application of plaster, a certain type of foot deformity is eliminated. When applying a bandage, a doctor takes part, who correctly aligns the foot, and an assistant who directly performs the cast.
The plaster is applied in the form of a boot for the entire length of the leg, only the phalanges of the toes are left free to control the blood supply to the vessels and avoid squeezing them with plaster.
There are several mandatory rules that must be followed strictly to avoid mistakes in treatment:
- the first cast allows you to restore the angle of adduction of the foot and its internal rotation in the anterior part (cavus);
- during plastering, the knee joint is fixed in a bent position, which will prevent the bandage from shifting and avoid rubbing the delicate skin of the child;
- with each procedure, the angle of the foot should be less than 15 degrees;
- when changing the cast, the foot should not be in a free position for more than 1 hour;
- 2-4 procedures are aimed at correcting inward deviation of the fingers (varus deformity) and at eliminating the plantarfold;
- 5th step - allows you to correct the abduction of the heel above the talus, while the doctor fixes the normal foot in the desired position with the help of a splint (except for excessive bending in the ankle due to a shortened tendon).
The number of procedures should be no more than 6. The sequence and scheme of corrective gypsum casts, which are based on the Ponseti method, the photo perfectly demonstrates.
If the attending physician does more procedures, then this will already be a non-American treatment and may be harmful. At the next stages, Achilles is done and brace selection is made.
Achilleotomy
Treatment according to the Ponseti method, in some cases, before the 4th or 5th stage of gypsum, an achillotomy is performed, in which:
- calcaneal tendon ligation is done (subcutaneous operation);
- fixation of damaged ligament endings;
- operation is done under local anesthesia;
- At the end of the operation, a cast is made for the next 3 weeks.
This operation is fundamentally different from the standard surgery, which is performed with the standard method of correction. During it, the child is not given general anesthesia and after it there is no large scar, which subsequently usually limits the mobility of the patient's foot.
Using brace
The Ponseti Method provides for the final step of wearingbraces, special shoes that allow you to fix the position of the feet and legs in the desired position with the help of the strap in order to avoid the return of clubfoot. Boots are selected and ordered in advance.
Braces should be worn virtually around the clock for 3 months, only removed when bathing or changing.
In the future, they will only need to be worn during sleep (day and night) - the recovery period lasts 2-4 years to avoid relapse.
Disadvantages of the method
According to the reviews of parents who used the Ponseti method in the treatment of a child's clubfoot, the disadvantages are as follows:
- high cost of special shoes (brace), which are usually purchased from manufacturers in Germany or the USA;
- the duration of its delivery to other countries,
- relative fragility of the structure.
In recent years, the company "Medvezhonok" has launched the production of domestic analogues, and when purchasing braces, there is the possibility of acquiring them through the social insurance fund.
Method advantages
The high efficiency of the clubfoot correction method has been proven by the results of 50 years of research at the Specialized Center of Dr. Ponseti (University of Iowa, USA), and the technique has been tested in many medical institutions around the world.
Of all the other methods used to treat congenital clubfoot, the Ponseti method is the least traumatic, safe and does not depend on the severity of the deformity. Timewearing a plaster cast is much less than with other methods. The effectiveness in correcting foot deformity is 95% of cases.
With proper treatment, the child will no longer have any repeated deformities: he can wear ordinary shoes, there are no contraindications to sports and physical activity.
Ponseti method: reviews
Judging by the reviews of parents who treated children for congenital clubfoot with the American method, the effect is positive for almost everyone. Mothers who tried to treat children in the beginning in a standard way (massage + gypsum) expressed particular enthusiasm, after which some patients almost became disabled. Later, when they turned to medical centers to doctors who professionally use the Ponseti method to treat clubfoot, parents were able to cure their children's legs completely.
