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

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. Abbott Society Scientific Program May 10 th , 2013 TALIPES EQUINOVARUS PONSETI METHOD • a condition causing a child’s foot to have a • gold standard treatment with success characteristic deformity rates reported between 92-100%. – Midfoot cavus • method involving: – Forefoot adductus and supination – manipulation – Hindfoot varus – serial casting – Equinus – bracing • estimated incidence of 1:1,000 births – heel cord release • estimated 100,000 children are born with clubfoot worldwide, and of those, 80% are • can be taught to non-orthopaedic born in developing nations surgeon health professionals to help • Neglected clubfoot is common in developing meet the great demand for clubfoot countries treatment Neglected Clubfoot in Uganda 18 • There is a large need for effective clubfoot Dr. Ignacio V. Ponseti treatment in underprivileged areas of the world Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg Am. 1980;62(1):23-31 1

5/11/2013 • brace is worn full time for 2- 3 months then at night only for 3-4 years • Casting begins in the first 1-2 weeks of life • Casts applied weekly for ~5-7 weeks OBJECTIVES PONSETI METHOD • The purpose of this study was to conduct a meta-analysis • Many countries have implemented programs to treat evaluating the effectiveness of clubfoot treatment by non- clubfoot with the Ponseti method orthopaedic surgeon healthcare providers – often involve treatment by a wide range of healthcare – secondary objectives: providers • identify barriers which make clubfoot treatment difficult, especially in countries where nationwide treatment programs have been established • Identify important traits of a successful program 2

5/11/2013 METHODS RESULTS • Nine studies in five different countries have implemented a • Studies included in this report: program in which non-orthopaedic surgeon healthcare providers – the Ponseti method was followed as previously described treated clubfoot using the Ponseti method. – treatment was administered by a healthcare professional – Malawi, Vietnam, Uganda, Canada, United Kingdom other than a board certified orthopaedic surgeon • Success rates in these studies ranged from 68-98.5%. – success rates defined as correction of the deformity were Country # feet treated # successful Percent successfully reported treated • An additional literature review conducted to identify both Malawi 482 327 68 barriers in implementing these programs as well as aspects that Malawi (completed 100 98 98 make a clubfoot treatment program successful treatment) Vietnam 85 Uganda 80 Canada 137 135 98.5 UK 40 39 97.5 RESULTS RESULTS • Eight studies in nine countries identified barriers and successful Barriers: aspects in the use of the Ponseti method in these clubfoot - Lack of adequate supplies treatment programs - Poverty – Malawi - length of travel – Paupa New - Compliance with full treatment course Guinea - Lack of sufficient training in some providers – Uganda - Unique cultural issues (ex. China’s one-child policy) – Guatemala - Lack of public awareness about the importance of early – Peru intervention – Chile - Lack of support from family members, specifically paternal – India support – China – United States 3

5/11/2013 CONCLUSIONS RESULTS • Under the supervision, guidance, and training of orthopaedic • Successful Aspects: surgeons, teaching healthcare providers the Ponseti method is - Well trained healthcare professionals an effective way to treat the thousands of children around the world without access to orthopaedic care. - Adequate resources and financial support from governments, agencies, or charities • There is a need to train more non-orthopaedic physicians and non-physicians the correct application of the Ponseti method - Adequate counseling and moral support from providers in order to treat clubfoot. - Family education about the importance of following through with the entire treatment including bracing - Access to information about clubfoot including pamphlets and internet resources REFERENCES • 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. 4

5/11/2013 REFERENCES REFERENCES • 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. • 19. Kampa R, Binks K, Dunkley M, et al. Multidisciplinary management of clubfeet using the Ponseti • 11. Jowett C R, Morceunde J A, Ramachandran M, et al. Management of congenital talipes method in a district general hospital setting. J ChildOrthop. 2008;2:463-467 equinovarus using the Ponseti method. J Bone Joint Surg Br. 2011;93:1160-1164 • 20. Evans A M, Van Thanh D. A review of the Ponseti method and development of an infant clubfoot • 12. Scher, D M. The Ponseti method for treatment of congenital clubfoot. Curr Opin Pediatr. program in Vietnam. J Am Podiatr Med Assoc. 2009;99:306-316. 2006;18:22- • 21. Janicki, J A, Narayanan U G, Harvey B J, et al. Comparison of surgeon and physiotherapist- • 13. Van Bosse H J P. Ponseti treatment for clubfeet: an international prespective. Curr Opin Pediatr. directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am. 2009;9(1):1101-1108 2011;23:41-45 • 22. Shack N, Eastwood D M. Early results of a physiotherapist-delivered Ponseti service for the • 14. Lavy, C B D, Mannion J, Mkandawire N C, et al. Club foot treatment in Malawi- a public health management of idiopathic congetital talipes equinovarsu foot deformity. J Bone Joint Surg [Br]. approach. Disability and Rehabilitation. 2007;29(11-12):857-862 2006;88-B:1085-1089 • 15. Tindall, A J, Steinlechner C W, Lavy C B D, et al. Results of manipulation of idiopathic clubfoot • 23. Docker C, Lewthwaite S, Kiely N. Ponseti treatment in the management of clubfoot deformity-a deformity in Malawi by orthopaedic clinical officers using the Ponseti method. A realistic alternative continuing role for paediatric orthopaedic services in secondary care centres. Ann R Coll Surg Engl. for the developing world? J Pediatr Orthop. 2005;25(5):627-629 2007;89:510-512 • 16. Gupta A, Singh S, Patel P, et al. Evaluation of the utility of the Ponseti method of correction of • 24. Lu N, Zhao L, Du Q, et al. From cutting to casting: impact and initial barriers to the Ponseti clubfoot deformity in a developing nation. International Orthopaedics. 2008;32:75-79 method of clubfoot treatment in China. Iowa Orthop J. 2010;30:1-6 • 17. Pirani S, Naddumba E, Mathias R, et al. Towards effective Ponseti clubfoot care. The Uganda • 25. Culverwell, A D and Tapping C R. Congenital talipes equinovarus in Papua New Guinea: a difficult sustainable clubfoot care project. Clin Orthop Relat Res. 2009;467:1154-1163 yet potentially manageable situation. International Orthopaedics. 2009;33:521-526. • 18. McElroy T, Konde-Lule J, Neema S, et al. Understanding the barriers to clubfoot treatment • 26. Avilucea F R, Szalay E A, Bosch P P, et al. Effect of cultural factors on outcome of Ponseti adherence in Uganda: A rapid ethnographic study. Disability and Rehabilitation. 2007;29(11-12):845- treatment of clubfeet in rural America. J Bone Joint Surg Am. 2009;9(1):530-540 855 • 27. Jayawardena A, Boardman A, Cook T, et al. Diffusion of innovation: enhancing the dissemination of the Ponseti method in Latin America through virtual forums. Iowa Orthop J.2011;31:36-42 5