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LETTER TO EDITOR  
Year : 2014  |  Volume : 48  |  Issue : 5  |  Page : 537
Classification of relapse pattern in clubfoot treated with Ponseti technique


1 Department of Orthopaedics, Vivekananda Hospital, Baramunda, Bhubaneswar, India
2 Department of Orthopaedics, JN Medical College, Belgaum, Karnataka, India

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Date of Web Publication2-Sep-2014
 

How to cite this article:
Mahapatra SK, Hampannavar A. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop 2014;48:537

How to cite this URL:
Mahapatra SK, Hampannavar A. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop [serial online] 2014 [cited 2019 Dec 13];48:537. Available from: http://www.ijoonline.com/text.asp?2014/48/5/537/139896
Sir,

We read with interest the article "Classification of relapse pattern in clubfoot treated with Ponseti technique". [1] We congratulate the authors for the simplified and useful classification of relapses and its management protocol. [1] However, these are the few issues we want to discuss.

First of all, the most common pattern noted in this series was grade IIA or dynamic supination. [1] This is in contrast to Ponseti, who noted hind foot relapse or limitation of ankle dorsiflexion as the most common relapse pattern. [2] Secondly, authors have considered ankle dorsiflexion <15° with knee in extension as grade IA relapse, whereas Ponseti aimed at 15° ankle dorsiflexion with the knee in flexion as the correction. [2] Furthermore, in an evaluation of 85 normal feet in children, Tabrizi et al. found that, the mean ankle dorsiflexion was 12.8° with knees in extension and 21.5° with knees in flexion. [3] Hence, it is practically difficult to achieve >15° ankle dorsiflexion with the knee extended in a previously treated clubfoot.

Thirdly, authors have discussed surgical options for grades IB, IIA, IIB, and III relapses, but have failed to mention the role of repeat serial casting in the treatment of relapse after Ponseti correction. Serial manipulation and casting has been a very effective method in relapses, especially in supple feet. It can also be useful in relapse with rigid feet where it can help by increasing the flexibility of the foot, thus minimizing the amount of soft tissue release needed during the surgical correction of the deformity. [2],[4]

 
   References Top

1.Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop 2013;47:370-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Ponseti IV. Relapses: Congenital Clubfoot Fundamentals of Treatment. New York: Oxford University Press; 1996. p. 98-106.  Back to cited text no. 2
    
3.Tabrizi P, McIntyre WM, Quesnel MB, Howard AW. Limited dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg Br 2000;82:1103-6.  Back to cited text no. 3
    
4.Porecha MM, Parmar DS, Chavda HR. Midterm results of Ponseti method for the treatment of congenital idiopathic clubfoot - (a study of 67 clubfeet with mean five year followup). J Orthop Surg Res 2011;6:3.  Back to cited text no. 4
    

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Correspondence Address:
Sudhir Kumar Mahapatra
Department of Orthopaedics, Vivekananda Hospital, Baramunda, Bhubaneswar, C/O Niranjan Sahu, Khandayat Sahi, Mangalabag, Cuttack
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.139896

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