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Can Below-Knee Casts be Effective for Clubfoot Management in Walking-Age Children? A Prospective Cohort Study

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Abstract

Purpose

Above-knee casts pose a major challenge in the day-to-day activities among walking age clubfoot patients due to complete restriction of knee movement. This current study investigates the effectiveness of below-knee casts compared to above-knee casts for managing walking age clubfoot deformity.

Methods

After approval from the institutional ethical committee, we enrolled walking age clubfoot patients for deformity correction through corrective manipulation and casting through below-knee casts over 2 years. The corrective manipulation was performed using the Ponseti technique. The patients were followed for a minimum of 2 years period. To compare the effectiveness of below-knee casts over above-knee casts, we enrolled equal numbers of walking age clubfeet matched for age and gender. We compared the two groups in terms of initial and post-correction Dimeglio scores, individual deformities corrections (maximum ankle dorsiflexion, heel varus correction, foot abduction), failure rates, relapses, and complication rates.

Results

56 patients with 80 clubfeet with a mean follow-up of 39.98 months were considered for the final analysis. There were 29 patients in the below-knee cast group and 27 in the above-knee cast group, with 40 clubfeet each. The patients in the above-knee casting group had significantly better post-correction Dimeglio scores and individual deformity components corrections than the below-knee cast group. There were nil failures in the above-knee casting group and 7.5% in the below-knee cast group. The relapse rate was 15% in both groups, with none requiring any extensive soft tissue procedure. We did not encounter any major complications during the treatment and follow-up.

Conclusion

The deformity correction and maintenance are suboptimal with the below-knee casts. Therefore, above-knee casts should be the preferred management modality for correction of walking age clubfoot deformities.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India

    Akhil Agnihotri, Anil Mehtani & Alok Sud

  2. Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India

    Arvind Kumar & Siddhartha Sinha

  3. Pediatric Orthopaedics, King George’s Medical University, Lucknow, India

    Suresh Chand

  4. Department of Orthopedics, Maulana Azad Medical College, New Delhi, India

    Arvind Kumar

Authors
  1. Akhil Agnihotri
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  2. Arvind Kumar
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  6. Siddhartha Sinha
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Correspondence to Arvind Kumar.

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The study was approved by the Institutional ethics committee.

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Agnihotri, A., Kumar, A., Chand, S. et al. Can Below-Knee Casts be Effective for Clubfoot Management in Walking-Age Children? A Prospective Cohort Study. JOIO 56, 2182–2192 (2022). https://doi.org/10.1007/s43465-022-00732-2

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  • DOI: https://doi.org/10.1007/s43465-022-00732-2

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