The goal of my thesis is to elect the best method for the treatment of congenital clubfoot according to the latest scientific evidence, what are the criteria for classifying it, the pathologies related to it, how to counter and resolve the issue of relapses, which are the main methods used in the past and those that are still used today. Congenital clubfoot (PTC) means a deformity of the foot, present at birth, characterized by a stable vicious attitude of the foot due to alteration of the reciprocal relationships between the bones that compose it, which are associated with capsular, ligament, muscle-tendon and of the bands. There are various methods of treating it: Ponseti method, French functional, Kite, surgical treatment. For the realization of this thesis the databases of Pubmed, Pedro, Google Scholar were consulted. Systematic reviews, RCT studies and case studies that dealt with congenital clubfoot and Ponseti, Kite, functional French, surgical methods were considered by comparing them and talking about them separately to show the strengths and weaknesses of each method. The first study examined was "Ponseti's vs. Kite's method in the treatment of clubfoot "in which the Ponseti method was compared with Kite. In the Ponseti group, the correction was achieved in a greater number of feet than in the Kite group. The second study is "Short-term results of intensive physiotherapy in clubfoot deformity treated with the Ponseti method" in which they investigated the effectiveness of intensive physiotherapy in addition to the Ponseti method. The group that received both manual therapy and the combined Ponseti technique reported significant improvement. In the third study "Treatment of idiopathic clubfoot in pediatric age: the Ponseti method" 1180 children with clubfoot were treated with the Ponseti protocol. The compliance to the brace has proved to be a fundamental variable in order to effectively reduce the natural tendency of the clubfoot to develop a recurrence. The fourth paper “A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional method” compares the results obtained using the Ponseti method and the French functional method. The results for the feet treated with the Ponseti method were similar to the results for the feet treated with the French functional method, however the Ponseti method was chosen by twice as many families as the functional method, as the latter requires a daily commitment of the family and also a considerable economic burden. In the study "Italian survey on Ponseti method for clubfoot treatment" a questionnaire was prepared with questions aimed at analyzing the treatment of Ponseti in all its aspects. Analyzing the answers to the questionnaires, it can be stated that the Pirani and Dimeglio scales are used more to stage clubfoot. The latest study is "The treatment of congenital clubfoot with the Ponseti method" in which they evaluated the experience gained in the treatment of congenital clubfoot with the Ponseti method at a single pediatric referral center for 12 years. From the results it can be stated that a high Pirani score at the beginning of treatment corresponds to a higher probability of having to perform percutaneous tenotomy of the achilles. Having taken into consideration the aforementioned articles, I have come to the conclusion that the Ponseti method, despite its undoubted technical and organizational limitations, is to date to be considered the best method for the treatment of congenital clubfoot in pediatric age.
L’ obiettivo della mia tesi è quello di eleggere il miglior metodo per il trattamento del piede torto congenito secondo le ultime evidenze scientifiche, quali siano i criteri per classificarlo, le patologie ad esso correlato, come contrastare e risolvere la questione delle recidive, quali siano i principali metodi utilizzati in passato e quelli che vengono tuttora utilizzati. Si intende per piede torto congenito (P.T.C.) una deformità del piede, presente alla nascita, caratterizzata da uno stabile atteggiamento vizioso del piede per alterazione dei rapporti reciproci tra le ossa che lo compongono a cui si associano alterazioni capsulari, legamentose, muscolo-tendinee e delle fasce. Esistono vari metodi per trattarlo: metodo Ponseti, funzionale francese, Kite, trattamento chirurgico. Per la realizzazione di questa tesi sono state consultate le banche dati di Pubmed, Pedro, Google Scholar. Sono state prese in considerazione revisioni sistematiche, studi RCT e case studies che trattavano di piede torto congenito e metodiche Ponseti, Kite, funzionale francese, metodo chirurgico mettendole sia a confronto sia parlandone separatamente per mostrare i punti di forza e di debolezza di ogni metodica. Il primo studio preso in esame è stato “Ponseti’s vs. Kite’s method in the treatment of clubfoot” nel quale sono stati messi a confonto il metodo Ponseti con il Kite. Nel gruppo Ponseti, la correzione è stata ottenuta in un numero maggiore di piedi rispetto a quelli del gruppo Kite. Il secondo studio è “Short-term results of intensive physiotherapy in clubfoot deformity treated with the Ponseti method” nel quale hanno investigato l’efficacia di una fisioterapia intensiva in aggiunta al metodo Ponseti. Il gruppo che ha ricevuto sia la terapia manuale che la tecnica Ponseti combinata hanno riportato un miglioramento significativo. Nel terzo studio “Il trattamento del piede torto idiopatico in età pediatrica: la metodica Ponseti” sono stati trattati con il protocollo Ponseti 1180 bambini affetti da piede torto. La compliance al tutore si è dimostrata una variabile fondamentale per poter ridurre efficacemente la naturale tendenza del piede torto a sviluppare una recidiva. Il quarto lavoro “A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional method” confronta i risultati ottenuti utilizzando il metodo Ponseti e il metodo funzionale francese. I risultati per i piedi trattati con il metodo Ponseti erano simili ai risultati per i piedi trattati con il metodo funzionale francese, tuttavia il metodo Ponseti è stato scelto dal doppio delle famiglie rispetto al metodo funzionale, in quanto quest’ultimo presuppone un impegno quotidiano della famiglia e anche un onere economico non indifferente. Nello studio “Italian survey on Ponseti method for clubfoot treatment” è stato approntato un questionario con domande volte ad analizzare il trattamento di Ponseti in ogni suo aspetto. Andando ad analizzare le risposte dei questionari si può affermare per stadiare il piede torto vengono utilizzate maggiormente le scale di Pirani e di Dimeglio. L’ultimo studio è “Il trattamento del piede torto congenito con il metodo Ponseti” nel quale hanno valutato l’esperienza maturata nel trattamento del piede torto congenito con il metodo Ponseti presso un unico centro di riferimento pediatrico per 12 anni. Dai risultati si può affermare che uno score di Pirani alto ad inizio trattamento corrisponde ad una probabilità più alta di dover eseguire la tenotomia percutanea dell’achilleo. Avendo preso in considerazione gli articoli sopraccitati sono giunto alla conclusione che la metodica Ponseti, pur con i suoi indubbi limiti tecnici ed organizzativi è da considerarsi, ad oggi, il miglior metodo per il trattamento del piede torto congenito in età pediatrica.
Efficacia nel trattamento del piede torto congenito revisione della letteratura
CAPRIOTTI, DAVIDE
2020/2021
Abstract
The goal of my thesis is to elect the best method for the treatment of congenital clubfoot according to the latest scientific evidence, what are the criteria for classifying it, the pathologies related to it, how to counter and resolve the issue of relapses, which are the main methods used in the past and those that are still used today. Congenital clubfoot (PTC) means a deformity of the foot, present at birth, characterized by a stable vicious attitude of the foot due to alteration of the reciprocal relationships between the bones that compose it, which are associated with capsular, ligament, muscle-tendon and of the bands. There are various methods of treating it: Ponseti method, French functional, Kite, surgical treatment. For the realization of this thesis the databases of Pubmed, Pedro, Google Scholar were consulted. Systematic reviews, RCT studies and case studies that dealt with congenital clubfoot and Ponseti, Kite, functional French, surgical methods were considered by comparing them and talking about them separately to show the strengths and weaknesses of each method. The first study examined was "Ponseti's vs. Kite's method in the treatment of clubfoot "in which the Ponseti method was compared with Kite. In the Ponseti group, the correction was achieved in a greater number of feet than in the Kite group. The second study is "Short-term results of intensive physiotherapy in clubfoot deformity treated with the Ponseti method" in which they investigated the effectiveness of intensive physiotherapy in addition to the Ponseti method. The group that received both manual therapy and the combined Ponseti technique reported significant improvement. In the third study "Treatment of idiopathic clubfoot in pediatric age: the Ponseti method" 1180 children with clubfoot were treated with the Ponseti protocol. The compliance to the brace has proved to be a fundamental variable in order to effectively reduce the natural tendency of the clubfoot to develop a recurrence. The fourth paper “A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional method” compares the results obtained using the Ponseti method and the French functional method. The results for the feet treated with the Ponseti method were similar to the results for the feet treated with the French functional method, however the Ponseti method was chosen by twice as many families as the functional method, as the latter requires a daily commitment of the family and also a considerable economic burden. In the study "Italian survey on Ponseti method for clubfoot treatment" a questionnaire was prepared with questions aimed at analyzing the treatment of Ponseti in all its aspects. Analyzing the answers to the questionnaires, it can be stated that the Pirani and Dimeglio scales are used more to stage clubfoot. The latest study is "The treatment of congenital clubfoot with the Ponseti method" in which they evaluated the experience gained in the treatment of congenital clubfoot with the Ponseti method at a single pediatric referral center for 12 years. From the results it can be stated that a high Pirani score at the beginning of treatment corresponds to a higher probability of having to perform percutaneous tenotomy of the achilles. Having taken into consideration the aforementioned articles, I have come to the conclusion that the Ponseti method, despite its undoubted technical and organizational limitations, is to date to be considered the best method for the treatment of congenital clubfoot in pediatric age.| File | Dimensione | Formato | |
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tesi_PTC - 2.pdf
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https://hdl.handle.net/20.500.12075/796