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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 11, 1512-1515.
doi: 10.1302/0301-620X.90B11.20629  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Ponseti casting

A NEW SOFT OPTION

M. B. S. Brewster, MBChB, MRCSEng, Specialist Registrar in Trauma and Orthopaedics1; M. Gupta, MBBS, MRCSEdin, Specialist Registrar in Trauma and Orthopaedics2; G. T. R. Pattison, MBBS, FRCSEd(Tr & Orth), Consultant Paediatric Orthopaedic Surgeon1; and I. D. Dunn-van der Ploeg, Artsexamen, FRCS, FRCS (Trauma and Orthopaedics), Consultant Paediatric Orthopaedic Surgeon1

1 University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
2 City Hospital, Dudley Road, Birmingham B18 7QH, UK.

Correspondence should be sent to Mr M. B. S. Brewster; e-mail: markbrewster{at}doctors.org.uk

We have modified the Ponseti casting technique by using a below-knee Softcast instead of an above-knee plaster of Paris cast. Treatment was initiated as soon as possible after birth and the Pirani score was recorded at each visit. Following the manipulation techniques of Ponseti, a below-knee Softcast was applied directly over a stockinette for a snug fit and particular attention was paid to creating a deep groove above the heel to prevent slippage. If necessary, a percutaneous Achilles tenotomy was performed and casting continued until the child was fitted with Denis Browne abduction boots.

Between April 2003 and May 2007 we treated 51 consecutive babies with 80 idiopathic club feet with a mean age at presentation of 4.5 weeks (4 days to 62 weeks). The initial mean Pirani score was 5.5 (3 to 6). It took a mean of 8.5 weeks (4 to 53) of weekly manipulation and casting to reach the stage of percutaneous Achilles tenotomy. A total of 20 feet (25%) did not require a tenotomy and for the 60 that did, the mean Pirani score at time of operation was 2.5 (0.5 to 3). Denis Browne boots were applied at a mean of 10 weeks (4 to 56) after presentation. The mean time from tenotomy to boots was 3.3 weeks (2 to 10). We experienced one case of cast-slippage during a period of non-attendance, which prolonged the casting process. One case of prolonged casting required repeated tenotomy, and three feet required repeated tenotomy and casting after relapsing while in Denis Browne boots.

We believe the use of a below-knee Softcast in conjunction with Ponseti manipulation techniques shows promising initial results which are comparable to those using above-knee plaster of Paris casts.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General