Tag Archive for: CTEV

Walking Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot

Volume 7 | Issue 3 | September-December 2021 | Page: 08-12 | Devashis Barick, Nilesh Joshi, Nikhil Tiwari, Amit Nemade, Ameya Sawarkar


Authors: Devashis Barick MS Ortho. [1], Nilesh Joshi MS Ortho. [1], Nikhil Tiwari MS Ortho. [1], Amit Nemade MS Ortho. [1], Ameya Sawarkar MS Ortho. [1]

[1] Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence
Dr Amit Nemade
Assistant Professor, Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com


Aim- Parents of children affected with idiopathic clubfoot are anxious that motor development should progress normally. Treatment using Ponseti Method involves cast immobilization, bracing and tenotomy which inhibit the normal movement thereby increasing parental concern. The purpose of this study was to evaluate age at which independent walking was established in infants with idiopathic clubfoot treated using Ponseti method.
Materials & Methods- There were 70 patients in this prospective longitudinal study. All subjects were full term at birth, less than 12 weeks of age at the initiation of treatment for clubfoot and no prior outside treatment had been provided. Patients were treated using the Ponseti method. The children were evaluated prospectively for the commencement of independent walking.
Results- The mean age at which independent walking started was 13.64 + 2.74 months (9 months-22 months). Fifty percent of the affected children were walking by the age of 14 months. Children with relapse walked later by 2.8 months (p=0.017). Children with a family history walked at 11.7 months (p=0.049) which was significantly earlier than the patients without a family history. Other variables had no significant influence on walking age.
Conclusion- A delay of 1.5 months in independent walking age is expected in children with idiopathic clubfoot, which is helpful while counselling the parents at the start of treatment. Relapse during treatment delays walking age further.
Keywords: CTEV, Motor milestone, Independent walking.


1. Bacino CA, Hecht JT. Etiopathogenesis of equinovarus foot malformations. Eur J Med Genet [Internet]. 2014;57(8):473–9. Available from: http://dx.doi.org/10.1016/j.ejmg.2014.06.001
2. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.
3. Ponseti I, Smoley E. Congenital Club Foot: The Results of Treatment. J Bone Jt Surg. 1963;45(2):261–344.
4. Sala DA, Chu A, Lehman WB, Van Bosse HJP. Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method. J Pediatr Orthop. 2013;33(1):55–8.
5. Andriesse H, Westbom L, Hägglund G. Motor ability in children treated for idiopathic clubfoot. A controlled pilot study. BMC Pediatr. 2009;9(December).
6. Garcia NL, McMulkin ML, Tompkins BJ, Caskey PM, Mader SL, Baird GO. Gross motor development in babies with treated idiopathic clubfoot. Pediatr Phys Ther. 2011;23(4):347–52.
7. Hughes K, Gelfer Y, Cokljat M, Wientroub S, Yavor A, Hemo Y, et al. Does idiopathic congenital talipes equinovarus have an impact on attainment of developmental milestones? A multicentre international study. J Child Orthop. 2019;13(4):353–60.
8. Zionts LE, Packer DF, Cooper S, Ebramzadeh E, Sangiorgio S. Walking age of infants with idiopathic clubfoot treated using the ponseti method. J Bone Jt Surg – Am Vol. 2014;96(19):e164.
9. Dillmann J, Schwarzer G, Peterlein CD. Motor and cognitive functioning in children treated for idiopathic clubfoot at the age of 3 years. BMC Pediatr. 2019;19(1):4–9.
10. Zapata KA, Karol LA, Jeans KA, Jo CH. Gross Motor Function at 10 Years of Age in Children with Clubfoot Following the French Physical Therapy Method and the Ponseti Technique. J Pediatr Orthop. 2018;38(9):e519–23.
11. Kenmoku T, Kamegaya M, Saisu T, Ochiai N, Iwakura N, Iwase D, et al. Athletic ability of school-age children after satisfactory treatment of congenital clubfoot. J Pediatr Orthop. 2013;33(3):321–5.
12. Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: A comparison between the traditional and the ponseti method and controls. J Child Orthop. 2018;12(4):383–9.
13. Gundawar CS, Desai SS, Borkar SS, Ranade A, Patel S, Oswal A V. Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method. Indian J Orthop [Internet]. 2021;55(1):183–7. Available from: https://doi.org/10.1007/s43465-020-00214-3
14. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Jt Surg – Ser B. 2006;88(8):1082–4.
15. Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop. 2013;47(4):370–6.
16. Zanardi A, Fortini V, N. Abati C, Bettuzzi C, Salvatori G, Prato E, et al. Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus ponseti method. J Child Orthop. 2019;13(5):471–7.
17. Capute AJ, Shapiro BK, Palmer FB, Ross A, Wachtel RC. Normal Gross Motor Development: the Influences of Race, Sex and Socio‐Economic Status. Dev Med Child Neurol. 1985;27(5):635–43.
18. Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics. 1998;102(5):1135–40.
19. De Onis M. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatr Int J Paediatr. 2006;95(SUPPL. 450):86–95.
20. Prudham GND. Norms for Four Standard Developmental Milestones by Sex, Social Class and Place in Family. Dev Med Child Neurol. 1969;11(4):413–22.
21. Lööf E, Andriesse H, André M, Böhm S, Iversen MD, Broström EW. Gross Motor Skills in Children with Idiopathic Clubfoot and the Association between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion. J Pediatr Orthop. 2019;39(7):359–65.
22. Karol LA, Jeans KA, Kaipus KA. The Relationship Between Gait , Gross Motor Function , and Parental Perceived Outcome in Children With Clubfeet. J Pediatr Orthop. 2016;36(2):145–51.
23. Majnemer A, Rosenblatt B. Reliability of parental recall of developmental milestones. Pediatr Neurol. 1994;10(4):304–8.

How to Cite this Article:  Barick D, Joshi N, Tiwari N, Nemade A, Sawarkar A Walking | Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 08-12.

(Article Text HTML)      (Full Text PDF)

The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically

Volume 7 | Issue 2 | May-August 2021 | Page: 12-16 | Anil Agarwal, Prateek Rastogi

Authors: Anil Agarwal [1], Prateek Rastogi[2]

[1] Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
[2] Department of Orthopedics, Sharda Medical College, Greater Noida, Uttar Pradesh, India.

Address of Correspondence
Dr. Anil Agarwal
4/103, East End Apartments, Mayur Vihar Ph-1 Ext., Delhi-110096, India.
E-mail: rachna_anila@yahoo.co.in


We graphically analyzed the correction of total Pirani and Dimeglio scores and their subcomponents at sequential casting sessions for children with idiopathic clubfeet.
Correction of scores at weekly sessions was represented graphically. The tenotomy effect was accounted for separately. We classified 1st to 3rd casts as early, 4th and 5th cast midlevel, and beyond 5 as final casts to describe casting treatment.
A total of 88 clubfeet (34 bilateral) in 54 patients were studied. Both total Pirani and Dimeglio graphs were characterized by a steep fall in early casts; subsequent minimal improvement in midlevel and final casts; later marked correction with tenotomy. Equinus in both scores stood as the most resistant deformity, showed full correction only following tenotomy. Dimeglio graphs captured coupling of various foot motions better over early casts than Pirani graphs.
Both Pirani and Dimeglio scores can adequately guide caregivers to progressive deformity correction in clubfoot.
Keywords: Clubfoot, CTEV, Pirani, Dimeglio, Scores, Graphs


1. Staheli L. Clubfoot: Ponseti management. Seattle, WA: Global HELP; 2009.
2. Pirani S, Naddumba E, Staheli L. Ponseti Clubfoot management: Teaching manual for healthcare providers in Uganda. Seattle, WA: Global HELP; 2008.
3. Chaudhry S, Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B. 2012;21: 73-78.
4. Lampasi M, Trisolino G, Abati CN, Bosco A, Marchesini Reggiani L, Racano C, et al. Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score. Int Orthop. 2016;40:2199-2205.
5. Lampasi M, Abati CN, Stilli S, Trisolino G. Use of the Pirani score in monitoring progression of correction and in guiding indications for tenotomy in the Ponseti method: are we coming to the same decisions? J Orthop Surg (Hong Kong). 2017;25:2309499017713916
6. Agarwal A, Shanker M. Temporal variation of scores along the course of the Ponseti treatment in older children: A ready guide to progress of treatment. J Pediatr Orthop. 2020;40:246-250.
7. Pirani S, Outerbridge HK, Sawatzki B, et al. A reliable method of clinically evaluating a virgin clubfoot evaluation. In: Proceedings of the 21st SICOT World Congress, Sydney, Australia, 18-23 April 1999.
8. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4:129-136.

How to Cite this Article:  Agarwal A, Rastogi P | The Evaluation of Deformity Correction in Idiopathic Clubfoot During Ponseti Casting Sessions: Two Scoring Methods Depicted Graphically |
International Journal of Paediatric Orthopaedics | May-August 2021; 7(2): 12-16.

(Article Text HTML)      (Download PDF)

Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration

Volume 7 | Issue 1 | January-April 2021 | Page: 02-05 | Shobhit Gupta, Anil Agarwal, Mukesh Shanker

Authors: Shobhit Gupta MS Orth. [1], Anil Agarwal MS Orth. [1], Mukesh Shanker MS Orth. [1]

[1] Department of Orthopaedic, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Address of Correspondence
Dr. Shobhit Gupta,
Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
E-mail: drshobhitgupta@gmail.com


Calf circumference is reduced in the leg affected by clubfoot. The effect of brace duration and whether calf circumference increases with age has not been studied in the Indian population. We conducted a cross sectional study on 156 children with idiopathic non-operated clubfeet treated by serial Ponseti casting method. The mean age was 32.7 months (range, 2-120 months). We found significant calf circumference difference in legs with clubfoot which increased with age. The duration of bracing did not significantly affect calf circumference.
Keywords: CTEV; Clubfeet; Calf circumference.


1. Shimode K, Miyagi N, Majima T, Yasuda K, Minami A. Limb length and girth discrepancy of unilateral congenital clubfeet. J Pediatr Orthop B, 2005; 14: 280-4.
2. Maffulli N, Capasso G, Testa V, Borrelli L. Histochemistry of the triceps surae muscle in idiopathic congenital clubfoot. Foot Ankle, 1992; 13: 80-4.
3. Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A. Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired? J Child Orthop, 2009; 3: 171-8.
4. Ippolito E, Dragoni M, Antonicoli M, Farsetti P, Simonetti G, Masala S. An MRI volumetric study for leg muscles in congenital clubfoot. J Child Orthop, 2012; 6: 433-8.
5. Duce SL, D’Alessandro M, Du Y, Jagpal B, Gilbert FJ, Crichton L, et al. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot). PLoS One, 2013; 8: e54100.
6. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop, 1990; 10: 109-19.
7. Fulton Z, Briggs D, Silva S, Szalay EA. Calf circumference discrepancies in patients with unilateral clubfoot: Ponseti versus surgical release. J Pediatr Orthop, 2015; 35: 403-6.
8. Barker S, Downing M, Chesney D, Maffulli N. Assessment of calf volume in congenital talipes equinovarus by computer analysed digital photography. Surgeon, 2012; 10: 84-9.
9. Bohner Beke A, Leidecker E, Koch T, Sramo A, Kránicz J. Lower leg atrophy in congenital talipes equinovarus. Paediatria Croatica, 2014; 58: 176-83.
10. Gamble J, Batista E, Rinsky I. How small is the leg and foot in unilateral clubfoot. Orthopaedic Proceedings, 2012; 94-B: 34.
11. Bechtol CO, Mossman HW. Clubfoot; an embryological study of associated muscle abnormalities. J Bone Joint Surg Am, 1950; 32: 827-38.
12. Flinchum D. Pathological anatomy in talipes equinovarus. J Bone Joint Surg Am, 1953; 35: 111-4.
13. Gray K, Barnes E, Gibbons P, Little D, Burns J. Unilateral versus bilateral clubfoot: an analysis of severity and correlation. J Pediatr Orthop B, 2014; 23: 397-9.
14. Agarwal A, Agrawal N, Barik S, Gupta N. Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis. J Orthop Surg (Hong Kong), 2018; 26(2): 1 – 2.

How to Cite this Article: Gupta S, Agarwal A, Shanker M | Calf Circumference in Clubfoot: The Effect of Patient Gender, Age, Laterality and Brace Duration | International Journal of Paediatric Orthopaedics | January-April 2021; 7(1): 02-05.

(Abstract)      (Full Text HTML)      (Download PDF)