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.

Methods:
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.

Results:
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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