Z Orthop Unfall 2019; 157(04): 411-416
DOI: 10.1055/a-0762-1241
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Klumpfußtherapie nach Ponseti – aktueller Standard

Clubfoot Therapy in Accordance with Ponseti – Current Standard
Julia F. Funk
Centrum für Muskuloskeletale Chirurgie, Abteilung für Kinder- und Neuroorthopädie, Charité – Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health
,
Susanne Lebek
Centrum für Muskuloskeletale Chirurgie, Abteilung für Kinder- und Neuroorthopädie, Charité – Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2018 (online)

Zusammenfassung

In dieser Übersicht wird die Klumpfußbehandlung unter besonderer Berücksichtigung der von Ponseti entwickelten konservativen Methode dargestellt. Im Kontext der verfügbaren Literatur werden die pathoanatomischen Grundlagen, die zu der Entwicklung der einfachen Korrekturhandgriffe führten, beschrieben. Die Auswirkungen der verschiedenen Ruhigstellungsmaterialien auf das Behandlungsergebnis werden ebenso beleuchtet wie die Probleme bei der Abduktionsschienentherapie. Weiterhin werden das Erkennen von Rezidiven und das von Ponseti entwickelte Konzept zur Rezidivbehandlung erörtert. Dass die Methode sich zum weltweiten Goldstandard entwickelt hat, belegen neben der globalen Verbreitung auch in Ländern mit geringem Einkommen Untersuchungen, die zeigen, dass sie auch bei nicht idiopathischen, vernachlässigten und voroperierten Klumpfüßen gute initiale Ergebnisse bewirkt. In verschiedenen Untersuchungen wurde auch mit instrumenteller Bewegungsanalyse gezeigt, dass konservativ behandelte Klumpfüße deutlich besser funktionieren, weil sie weniger arthrotische Veränderungen und Schmerzen zeigen als ausgedehnt operierte. Diese Informationen sind für den Behandler nicht nur nützlich bei der pränatalen Beratung hinsichtlich der besten verfügbaren Therapie, sondern helfen auch, die Compliance der Eltern bei der mehrjährigen Abduktionsschienenbehandlung hoch zu halten. Zu diesem Zweck wird auch der Vergleich zur konservativen physiotherapeutischen bzw. französischen Methode gezogen. Abschließend wird der Forschungsstand hinsichtlich der genetischen Ursachen der Klumpfußentwicklung beleuchtet.

Abstract

This manuscript evaluates the recent standard concept for clubfoot treatment. With regard to the history of clubfoot therapy and the return to conservative methods, the focus is laid on Ponsetiʼs treatment concept. Due to its development according to the precise analysis of the pathoanatomy, the practical principle is simple and easy to learn and consists basically of two redression maneuvers, percutaneous achillotenotomy, and boots and bar abduction treatment. Therefore, about 60 years after its implementation in Iowa it can be said to be the worldwide golden standard. It is known that Ponseti treated feet are better with regard to function and pain when compared to surgically treated clubfeet. The best results can be achieved when one sticks exactly to the method. Hence, plaster of Paris above the knee casts yield better results than fibreglass materials or short-leg casts. The brace should be worn 23 hours a day for 3 months and during sleep until the fourth birthday of the child. For reasons including the structured concept of treating relapses, the method is applicable in high and low income countries. Before transferring the tibialis anterior tendon, it is mandatory to correct the relapse of the heel varus. The Ponseti method can also correct clubfeet of non-idiopathic origin. Although a higher rate of relapses must be expected in these cases, initial Ponseti treatment lowers the extent of the necessary surgery. Emphasis is put on the importance of counselling prenatally as well as during the boots and bar period. To yield the best results, it is necessary to train and counsel physicians as well as parents. There is no need to fear significant delay in reaching motor milestones when clubfeet are treated conservatively. Other conservative methods – such as the French physiotherapy method – are able to correct the deformity, but usually do not consist of a concept as structured as the Ponseti method. They are also often more time consuming for the families when compared to Ponsetiʼs technique and are not available ubiquitously. While the diagnosis of the clubfoot deformity is still a clinical one and scores are the main tools for grading the severity today followed by X-rays and to some extent sonography, in experimental settings MRI may be helpful in finding abnormalities in muscles, blood vessels, and cartilage structures. The study of genetic associations of pathway abnormalities and single nucleotide polymorphisms with regard to the development of clubfeet enhances our knowledge concerning the origin of the deformity during limb development. In the future, this may enable us to provide not only a better prognosis for the outcome but also a more individualised therapy for each child born with a clubfoot.

 
  • Literatur

  • 1 Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 2009; 467: 1146-1153
  • 2 Adams F. ed. The genuine Works of Hippocrates. Baltimore: Williams & Wilkins Co.; 1939
  • 3 Stromeyer GFL. Die Durchschneidung der Achillessehne, als Heilmethode des Klumpfußes, durch zwei Fälle erläutert. Mag Ges Heilk 1833; 39: 195-218
  • 4 Graf A, Hassani S, Krzak J. et al. Long-term outcome evaluation in young adults following clubfoot surgical release. J Pediatr Orthop 2010; 30: 379-385
  • 5 Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992; 74: 448-454
  • 6 Ponseti IV, Smoley EN. Congenital clubfoot: the results of treatment. J Bone Joint Surg Am 1963; 45: 261-344
  • 7 Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. New York: Oxford University Press; 1996
  • 8 Pittner DE, Klingele KE, Beebe AC. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. J Pediatr Orthop 2008; 28: 250-253
  • 9 Gray K, Pacey V, Gibbons P. et al. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev 2014; (08) CD008602 DOI: 10.1002/14651858.CD008602.pub3.
  • 10 Scher DM, Feldman DS, van Bosse HJ. et al. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 2004; 24: 349-352
  • 11 Codivilla A. On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. Am J Orthop Surg 1905; 22: 353-369
  • 12 Evans A, Chowdhury M, Rana S. et al. ‘Fast cast’ and ‘needle Tenotomy’ protocols with the Ponseti method to improve clubfoot management in Bangladesh. J Foot Ankle Res 2017; 10: 49 doi:10.1186/s13047-017-0231-4
  • 13 Bor N, Katz Y, Vofsi O. et al. Sedation protocols for Ponseti clubfoot Achilles tenotomy. J Child Orthop 2007; 1: 333-335
  • 14 Parada SA, Baird GO, Auffant RA. et al. Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants with idiopathic clubfoot. J Pediatr Orthop 2009; 29: 916-919
  • 15 Lebel E, Karasik M, Bernstein-Weyel M. et al. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. J Pediatr Orthop 2012; 32: 412-415
  • 16 Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. J Pediatr Orthop 2009; 29: 564-569
  • 17 Ganesan B, Luximon A, Al-Jumaily A. et al. Ponseti method in the management of clubfoot under 2 years of age: a systematic review. PLoS One 2017; 12: e0178299 doi:10.1371/journal.pone.0178299
  • 18 Švehlík M, Floh U, Steinwender G. et al. Ponseti method is superior to surgical treatment in clubfoot – long-term, randomized, prospective trial. Gait Posture 2017; 58: 346-351
  • 19 Richards BS, Faulks S, Rathjen KE. et al. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am 2008; 90: 2313-2321
  • 20 Hosseinzadeh P, Steiner RB, Hayes CB. et al. Initial correction predicts the need for secondary achilles tendon procedures in patients with idiopathic clubfoot treated with Ponseti casting. J Pediatr Orthop 2016; 36: 80-83
  • 21 Hosseinzadeh P, Peterson ED, Walker J. et al. Residual forefoot deformity predicts the need for future surgery in clubfeet treated by Ponseti casting. J Pediatr Orthop B 2016; 25: 96-98
  • 22 Pirani S, Outerbridge HK, Sawatzky B. et al. A reliable method of clinically evaluating a virgin clubfoot evaluation. 21st SICOT Congress. 1999
  • 23 Dimeglio A, Bensahel H, Souchet P. et al. Classification of clubfoot. J Pediatr Orthop B 1995; 4: 129-136
  • 24 Dobbs MB, Rudzki JR, Purcell DB. et al. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 2004; 86: 22-27
  • 25 van Praag VM, Lysenko M, Harvey B. et al. Casting is effective for recurrence following Ponseti treatment of clubfoot. J Bone Joint Surg Am 2018; 100: 1001-1008
  • 26 Zionts LE, Zhao G, Hitchcock K. et al. Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States?. J Bone Joint Surg Am 2010; 92: 882-889
  • 27 Miller NH, Carry PM, Mark BJ. et al. Does strict adherence to the Ponseti method improve isolated clubfoot treatment outcomes? A two-institution review. Clin Orthop Relat Res 2016; 474: 237-243
  • 28 Faldini C, Fenga D, Sanzarello I. et al. Prenatal diagnosis of clubfoot: a review of current available methodology. Folia Med (Plovdiv) 2017; 59: 247-253
  • 29 Radler C, Myers AK, Burghardt RD. et al. Maternal attitudes towards prenatal diagnosis of idiopathic clubfoot. Ultrasound Obstet Gynecol 2011; 37: 658-662
  • 30 Sala DA, Chu A, Lehman WB. et al. Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method. J Pediatr Orthop 2013; 33: 55-58
  • 31 Zapata KA, Karol LA, Jeans KA. et al. Clubfoot does not impair gross motor development in 5-year-olds. Pediatr Phys Ther 2018; 30: 101-104
  • 32 Zionts LE, Dietz FR. Bracing following correction of idiopathic clubfoot using the Ponseti method. J Am Acad Orthop Surg 2010; 18: 486-493
  • 33 Morgenstein A, Davis R, Talwalkar V. et al. A randomized clinical trial comparing reported and measured wear rates in clubfoot bracing using a novel pressure sensor. J Pediatr Orthop 2015; 35: 185-191
  • 34 Seegmiller L, Burmeister R, Paulsen-Miller M. et al. Bracing in Ponseti clubfoot treatment: improving parental adherence through an innovative health education intervention. Orthop Nurs 2016; 35: 92-97
  • 35 Harmer L, Rhatigan J. Clubfoot care in low-income and middle-income countries: from clinical innovation to a public health program. World J Surg 2014; 38: 839-848
  • 36 Alavi Y, Jumbe V, Hartley S. et al. Indignity, exclusion, pain and hunger: the impact of musculoskeletal impairments in the lives of children in Malawi. Disabil Rehabil 2012; 34: 1736-1746
  • 37 Shabtai L, Specht SC, Herzenberg JE. Worldwide spread of the Ponseti method for clubfoot. World J Orthop 2014; 5: 585-590
  • 38 Vaca SD, Warstadt NM, Ngayomela ICH. et al. Evaluation of an e-learning course for clubfoot treatment in Tanzania: a multicenter study. J Med Educ Curric Dev 2018; DOI: 10.1177/2382120518771913.
  • 39 Steenbeek M, David OC. Steenbeek Brace for Clubfoot. 2nd ed.. Kampala: Global Help; 2009
  • 40 Matar HE, Makki D, Garg NK. Treatment of syndrome-associated congenital talipes equinovarus using the Ponseti method: 4–12 years of follow-up. J Pediatr Orthop B 2018; 27: 56-60
  • 41 Funk JF, Lebek S, Seidl T. et al. Vergleich der Behandlungsergebnisse bei kongenitalen idiopathischen und nichtidiopathischen Klumpfüßen: Prospektive Evaluation der Ponseti-Therapie. Orthopäde 2012; 41: 977-983
  • 42 Moroney PJ, Noël J, Fogarty EE. et al. A single-centre prospective evaluation of the Ponseti method in nonidiopathic congenital talipes equinovarus. J Pediatr Orthop 2012; 32: 636-640
  • 43 Janicki JA, Narayanan UG, Harvey B. et al. Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method. J Pediatr Orthop 2009; 29: 393-397
  • 44 Bensahel H, Csukonyi Z, Desgrippes Y. et al. Surgery in residual clubfoot: one-stage medioposterior release “à la carte”. J Pediatr Orthop 1987; 7: 145-148
  • 45 Zukunft-Huber B. Der kleine Fuß ganz groß: Dreidimensionale manuelle Fußtherapie bei kindlichen Fußfehlstellungen. 2. Aufl.. München: Urban & Fischer/Elsevier GmbH; 2010
  • 46 Chotel F, Parot R, Seringe R. et al. Comparative study: Ponseti method versus French physiotherapy for initial treatment of idiopathic clubfoot deformity. J Pediatr Orthop 2011; 31: 320-325
  • 47 Dobbs MB, Gurnett CA. The 2017 ABJS Nicolas Andry Award: advancing personalized medicine for clubfoot through translational research. Clin Orthop Relat Res 2017; 475: 1716-1725
  • 48 Zhang TX, Haller G, Lin P. et al. Genome-wide association study identifies new disease loci for isolated clubfoot. J Med Genet 2014; 51: 334-339
  • 49 Moon DK, Gurnett CA, Aferol H. et al. Soft-tissue abnormalities associated with treatment resistant and treatment-responsive clubfoot: findings of MRI Analysis. J Bone Joint Surg Am 2014; 96: 1249-1256
  • 50 Graf AN, Kuo KN, Kurapati NT. et al. A long-term follow-up of young adults with idiopathic clubfoot: does foot morphology relate to pain?. J Pediatr Orthop 2017; DOI: 10.1097/BPO.0000000000001060.