Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

Background: Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.Methods: We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.Results: Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.Conclusions: Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications

Complications of growing rod technique for early onset scoliosis

Early onset scoliosis (EOS) is defined as scoliosis occurring in children less than 10 years of age. The EOS is a separate entity of discussion as development of lungs is restricted due to restricted growth of the chest wall, unlike in adolescent scoliosis which is more of a cosmetic problem. Therefore, in EOS, control of deformity at early stage and growth of the spine should go hand-in-hand. The most favored option in recent era is growing rods which allow growth of the spine but in a controlled manner. However due to fusionless nature, these techniques have high rate of complications. The complications primarily include implant related, wound related, and anesthetic complications. Recently impact of multiple surgeries on psychology of developing child has been reported. This narrative reviews the literature about complications associated with growing rod surgeries in EOS