SLR - February 2019 - John Borzak

"Fast Cast" and "Needle Tenotomy" Protocols with the Ponseti Method to Improve Clubfoot Management in Bangladesh

Reference: Evans et al. "Fast Cast" and "Needle Tenotomy" Protocols with the Ponseti Method to Improve Clubfoot Management in Bangladesh. Journal of Foot and Ankle Research (2017) 10:49.

Scientific Literature Review

Reviewed By: John Borzok, DPM
Residency Program: University Hospital, Newark, New Jersey

Podiatric Relevance: The Ponseti method is known as the gold standard for congenital clubfoot. This article demonstrated advantages with shorter casting intervals and pearls for consistent correction and outcomes.

Children up to 12 months underwent cast changes every three days, Percutaneous Achilles Tenotomy (PAT) with 19g needle and single post tenotomy cast for three weeks. Two-minute manipulation was performed prior to each cast application. One hundred twenty-three children were included in the study: 88 males, 35 females, 67 bil foot, 34 right, 22 left. PAT was performed in 103/123.

Average age for first casting: 51 days (13–240)
Average number of casts: 5 (2–10)
Average number of days from first cast to brace: 37.8 (10–22)
Corrective casting averaged: 17 days
PAT 452, 11 had minor complication, including bleeding

Conclusions: The main benefits of shorter casting intervals: less complications and scarring following the PAT and reduced plaster immobilization—on average, 25 days less than with the traditional method; more effective casts, less skin wounds; and happier parents. “Fast cast” now utilized by Walk For Life in Bangladesh for children <12 months. Palpation and positioning with adequate hold and stretch for at least two minutes is key to elongate soft tissue. Less time in each cast prevented cast softening or breakdown maintaining a strong fixation. A 19g needle with minimal local gave cost savings, reduced visual trauma to family and reduced wound complications hidden by the casting.

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