5/11/2013 CLUBFOOT: NON-ORTHOPAEDIC I have no disclosures SURGEON - - PowerPoint PPT Presentation

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5/11/2013 CLUBFOOT: NON-ORTHOPAEDIC I have no disclosures SURGEON HEALTHCARE PROVIDERS ARE A VALUABLE TOOL IN TREATMENT KATIE FREEMAN, MD ELIANA DELGADO, MD AMANDA WHITAKER, MD UNIVERSITY OF CALIFORNIA SAN FRANCISCO 58 th Annual LeRoy C.

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CLUBFOOT: NON-ORTHOPAEDIC SURGEON HEALTHCARE PROVIDERS ARE A VALUABLE TOOL IN TREATMENT

KATIE FREEMAN, MD ELIANA DELGADO, MD AMANDA WHITAKER, MD UNIVERSITY OF CALIFORNIA SAN FRANCISCO

58th Annual LeRoy C. Abbott Society Scientific Program May 10th, 2013

I have no disclosures

  • a condition causing a child’s foot to have a

characteristic deformity – Midfoot cavus – Forefoot adductus and supination – Hindfoot varus – Equinus

  • estimated incidence of 1:1,000 births
  • estimated 100,000 children are born with

clubfoot worldwide, and of those, 80% are born in developing nations

  • Neglected clubfoot is common in developing

countries

  • There is a large need for effective clubfoot

treatment in underprivileged areas of the world

TALIPES EQUINOVARUS

Neglected Clubfoot in Uganda18

Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital

  • clubfoot. J Bone Joint Surg Am. 1980;62(1):23-31
  • gold standard treatment with success

rates reported between 92-100%.

  • method involving:

– manipulation – serial casting – bracing – heel cord release

  • can be taught to non-orthopaedic

surgeon health professionals to help meet the great demand for clubfoot treatment

PONSETI METHOD

  • Dr. Ignacio V. Ponseti
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  • Casting begins in the first 1-2

weeks of life

  • Casts applied weekly for ~5-7

weeks

  • brace is worn full time for 2-

3 months then at night only for 3-4 years

  • Many countries have implemented programs to treat

clubfoot with the Ponseti method – often involve treatment by a wide range of healthcare providers

PONSETI METHOD

  • The purpose of this study was to conduct a meta-analysis

evaluating the effectiveness of clubfoot treatment by non-

  • rthopaedic surgeon healthcare providers

– secondary objectives:

  • identify barriers which make clubfoot treatment difficult,

especially in countries where nationwide treatment programs have been established

  • Identify important traits of a successful program

OBJECTIVES

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  • Studies included in this report:

– the Ponseti method was followed as previously described – treatment was administered by a healthcare professional

  • ther than a board certified orthopaedic surgeon

– success rates defined as correction of the deformity were reported

  • An additional literature review conducted to identify both

barriers in implementing these programs as well as aspects that make a clubfoot treatment program successful

METHODS

  • Nine studies in five different countries have implemented a

program in which non-orthopaedic surgeon healthcare providers treated clubfoot using the Ponseti method. – Malawi, Vietnam, Uganda, Canada, United Kingdom

  • Success rates in these studies ranged from 68-98.5%.

RESULTS

Country # feet treated # successful Percent successfully treated Malawi 482 327 68 Malawi (completed treatment) 100 98 98 Vietnam 85 Uganda 80 Canada 137 135 98.5 UK 40 39 97.5

  • Eight studies in nine countries identified barriers and successful

aspects in the use of the Ponseti method in these clubfoot treatment programs – Malawi – Paupa New Guinea – Uganda – Guatemala – Peru – Chile – India – China – United States

RESULTS

Barriers:

  • Lack of adequate supplies
  • Poverty
  • length of travel
  • Compliance with full treatment course
  • Lack of sufficient training in some providers
  • Unique cultural issues (ex. China’s one-child policy)
  • Lack of public awareness about the importance of early

intervention

  • Lack of support from family members, specifically paternal

support

RESULTS

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  • Successful Aspects:
  • Well trained healthcare professionals
  • Adequate resources and financial support from governments,

agencies, or charities

  • Adequate counseling and moral support from providers
  • Family education about the importance of following through

with the entire treatment including bracing

  • Access to information about clubfoot including pamphlets and

internet resources

RESULTS

  • Under the supervision, guidance, and training of orthopaedic

surgeons, teaching healthcare providers the Ponseti method is an effective way to treat the thousands of children around the world without access to orthopaedic care.

  • There is a need to train more non-orthopaedic physicians and

non-physicians the correct application of the Ponseti method in order to treat clubfoot.

CONCLUSIONS

  • 1. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg Am.

1980;62(1):23-31

  • 2. Ponseti IV. Treatment of congenital clubfoot. J Bone Joint Surg Am. 1992;74(3):448-454
  • 3. Ponseti IV. Clubfoot management. J Pediatr Orthop. 2000;20(6):699-700.
  • 4. Ponseti IV. Congenital club foot: fundamentals of treatment. 1st ed. New York:Oxford University

Press; 1996.

  • 5. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-upnote. J Bone Joint

Surg Am. 1995;77:1477-89.

  • 6. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala DA. Treatment ofidiopathic clubfoot

using the Ponseti method: minimum 2-year follow-

  • up. J PediatrOrthop B.

2007;16:98-105.

  • 7. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti
  • method. J Foot Ankle Surg. 2003;42:259-67.
  • 8. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M,Bazzi JS, Feldman DS. A

method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic

  • clubfoot. J Pediatr Orthop B. 2003;12:133-40.
  • 9. Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg [Am].

1963;45:261-275.

REFERENCES

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  • 10. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004) Radical reduction in the rate of extensive

corrective surgery for clubfoot using the Ponseti method. Pediatrics 113(2);376–380.

  • 11. Jowett C R, Morceunde J A, Ramachandran M, et al. Management of congenital talipes

equinovarus using the Ponseti method. J Bone Joint Surg Br. 2011;93:1160-1164

  • 12. Scher, D M. The Ponseti method for treatment of congenital clubfoot. Curr Opin Pediatr.

2006;18:22-

  • 13. Van Bosse H J P. Ponseti treatment for clubfeet: an international prespective. Curr Opin Pediatr.

2011;23:41-45

  • 14. Lavy, C B D, Mannion J, Mkandawire N C, et al. Club foot treatment in Malawi- a public health
  • approach. Disability and Rehabilitation. 2007;29(11-12):857-862
  • 15. Tindall, A J, Steinlechner C W, Lavy C B D, et al. Results of manipulation of idiopathic clubfoot

deformity in Malawi by orthopaedic clinical officers using the Ponseti method. A realistic alternative for the developing world? J Pediatr Orthop. 2005;25(5):627-629

  • 16. Gupta A, Singh S, Patel P, et al. Evaluation of the utility of the Ponseti method of correction of

clubfoot deformity in a developing nation. International Orthopaedics. 2008;32:75-79

  • 17. Pirani S, Naddumba E, Mathias R, et al. Towards effective Ponseti clubfoot care. The Uganda

sustainable clubfoot care project. Clin Orthop Relat Res. 2009;467:1154-1163

  • 18. McElroy T, Konde-Lule J, Neema S, et al. Understanding the barriers to clubfoot treatment

adherence in Uganda: A rapid ethnographic study. Disability and Rehabilitation. 2007;29(11-12):845- 855

REFERENCES

  • 19. Kampa R, Binks K, Dunkley M, et al. Multidisciplinary management of clubfeet using the Ponseti

method in a district general hospital setting. J ChildOrthop. 2008;2:463-467

  • 20. Evans A M, Van Thanh D. A review of the Ponseti method and development of an infant clubfoot

program in Vietnam. J Am Podiatr Med Assoc. 2009;99:306-316.

  • 21. Janicki, J A, Narayanan U G, Harvey B J, et al. Comparison of surgeon and physiotherapist-

directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am. 2009;9(1):1101-1108

  • 22. Shack N, Eastwood D M. Early results of a physiotherapist-delivered Ponseti service for the

management of idiopathic congetital talipes equinovarsu foot deformity. J Bone Joint Surg [Br]. 2006;88-B:1085-1089

  • 23. Docker C, Lewthwaite S, Kiely N. Ponseti treatment in the management of clubfoot deformity-a

continuing role for paediatric orthopaedic services in secondary care centres. Ann R Coll Surg Engl. 2007;89:510-512

  • 24. Lu N, Zhao L, Du Q, et al. From cutting to casting: impact and initial barriers to the Ponseti

method of clubfoot treatment in China. Iowa Orthop J. 2010;30:1-6

  • 25. Culverwell, A D and Tapping C R. Congenital talipes equinovarus in Papua New Guinea: a difficult

yet potentially manageable situation. International Orthopaedics. 2009;33:521-526.

  • 26. Avilucea F R, Szalay E A, Bosch P P, et al. Effect of cultural factors on outcome of Ponseti

treatment of clubfeet in rural America. J Bone Joint Surg Am. 2009;9(1):530-540

  • 27. Jayawardena A, Boardman A, Cook T, et al. Diffusion of innovation: enhancing the dissemination
  • f the Ponseti method in Latin America through virtual forums. Iowa Orthop J.2011;31:36-42

REFERENCES