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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 8, 1085-1089.
doi: 10.1302/0301-620X.88B8.17919  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity

N. Shack, MCSP, Clinical Specialist Physiotherapist1; and D. M. Eastwood, MB, FRCS, Consultant Orthopaedic Surgeon2

1 Department of Physiotherapy, The Royal Free Hospital, Pond Street, London NW3 2QG, UK.
2 Department of Orthopaedics, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.

Correspondence should be sent to Miss D. M. Eastwood; e-mail: D.M.Eastwood{at}btinternet.com

We studied 24 children (40 feet) to demonstrate that a physiotherapist-delivered Ponseti service is as successful as a medically-led programme in obtaining correction of an idiopathic congenital talipes equinovarus deformity. The median Pirani score at the start of treatment was 5.5 (mean 4.75; 2 to 6). A Pirani score of ≥5 predicted the need for tenotomy (p < 0.01). Of the 40 feet studied, 39 (97.5%) achieved correction of deformity. The remaining foot required surgical correction. A total of 25 (62.5%) of the feet underwent an Achilles tenotomy, which was performed by a surgeon in the physiotherapy clinic. There was full compliance with the foot abduction orthoses in 36 (90%) feet. Continuity of care was assured, as one practitioner was responsible for all patient contact. This was rated highly by the patient satisfaction survey.

We believe that the Ponseti technique is suitable for use by non-medical personnel, but a holistic approach and good continuity of care are essential to the success of the programme.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General