Ponseti Management of Clubfoot in Chittagong Disvision: Experience of 1000 feet Dr. Myen Uddin Majumdar Dr. Jabed Akhter Tuhin Dr. Rajib Hasan Dr. Moshiur Rahman Dr. Mamun Mustafa Dr. O M Faisal Hossain M Baker (Physio) Mintu Chakma Dr. Shamim Khan HMO Unit 1, Dept of Orthopedic Surgery CMCH 1
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Ponseti Management of Clubfoot in Chittagong Division: Experience of 1000 Clubfeet
The aim of this study is to evaluate the effectiveness of the Ponseti method in children presenting before 5 years of age with either untreated or complex (initially treated unsuccessfully by other conservative methods) idiopathic clubfeet Type of study : Retrospective clinical study. Duration of study : From February 2010 to November 2011 (21months) Place of study : 6 ZCF clinics of Chittagong, Cox’s bazar, Khagrachhari, Comilla, Noakhali & Chandpur. Study population : Patients with CTEV attended at these ZCF clinics. Treatment of congenital club foot by ponseti technique is very effective method with excellent result for below 1 years children. Brace follow up is essential for long term better outcome. With proper monitoring and support, Ponseti service can be effectively and successfully administered in a district general hospitals.
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Ponseti Management of Clubfoot in Chittagong Disvision: Experience of 1000 feet
Dr. Myen Uddin MajumdarDr. Jabed Akhter TuhinDr. Rajib HasanDr. Moshiur RahmanDr. Mamun MustafaDr. O M FaisalHossain M Baker (Physio)Mintu Chakma
Speaker:
Dr. Shamim KhanHMO Unit 1, Dept of Orthopedic SurgeryCMCH
Clubfoot / CTEV
It is the most common congenital deformity of ankle and foot.
Some Facts about Congenital Clubfoot…
Clubfoot is one of the most common congenital deformities.
About 1 - 2 in every 1000 children is born with clubfoot worldwide.
A normal developing foot turns into a Clubfoot around the 3rd month of foetal life.
The cause is not exactly known, but is believed that genetic & environmental factors are involved.
More in boys than in girls.
One or both feet may be involved.
New born baby with Clubfoot
The treatment should start soon after birth
Early treated
Neglected
CLUBFOOT SIGNS
Forefoot Cavus
Mid foot Adductus
Heel Varus
Hind foot Equinus 1st Metatarsal is more in Plantar flexion than the
rest of the Metatarsals Clubfoot is smaller than a normal foot. Calf is smaller
CAVE sign
CLUBFOOT SIGNS (Continued)
Forefoot Cavus
- Increase in the height of the medial arch of the foot
- the forefoot in relation to the mid foot is in Pronation.
CLUBFOOT SIGNS (Continued)
Talus Plantar Flexed beneath Tibia
Adducted & supinated Navicular
Wedge Shaped head of talus, Lateral part of Talar head is uncovered
Wedge shaped Navicular
Adducted and varus calcaneus
Medially displaced & adducted Cuboid
MidfootAdduction
CLUBFOOT SIGNS (Continued) Heel in Varus
Supination and Adduction of the Calcaneus. Calcaneus is locked under the Talus
Hind foot Equinus Severe Plantar flexion in the ankle joint. High Calcaneus (not in the heel pad). Talus in severe Flexion.
Clubfoot : Bangladesh Picture Every year, at least
5000 children are born with a clubfoot deformity in Bangladesh.
Around 1000 children born with clubfoot in CHITTAGONG division each year.
…..That is 2 - 3 babies every day!!!
Clubfoot: Chittagong Division
CBR: 22.98 births/1,000 population (2011 est.), Infant mortality rate: 50.73 deaths/1,000 live births, Clubfoot incidence: 1.5/1000 live birth
Our Fight against Clubfoot
Started on July 2009
Started on Feb 2010
Treat under 5 years old
children with clubfoot
using the Ponseti
technique absolutely
free of cost.
Build the capacity to
detect clubfoot by
increasing awareness.
What we do?
Basic Ponseti treatment Protocol
Manipulation & Casts for 5-6 weeks
Achilles tenotomy (if needed)
Foot abduction brace/ FAB 3 months continuously Reducing use with age Night use to age 5-6
years Monitor child
6 – 12 months To age 15 years
April 11, 202315
Aim of Study
The aim of this study is to evaluate the
effectiveness of the Ponseti method in
children presenting before 5 years of age
with either untreated or complex (initially
treated unsuccessfully by other
conservative methods) idiopathic
clubfeet
April 11, 202316
MATERIALS AND METHOD
Type of study : Retrospective clinical study.
Duration of study : From February 2010 to November
2011 (21months)
Place of study : 6 ZCF clinics of Chittagong, Cox’s bazar,
Khagrachhari, Comilla, Noakhali & Chandpur.
Study population : Patients with CTEV attended at these