“This pathology affects the male sex more frequently, for every woman, two men develop it, and in half of the cases it is bilateral, that is, it occurs in the fetal period and in other, less frequent cases, it occurs in the embryonic period”, stated Dr. Claudia Marcela Roncancio, a specialist in orthopedics, traumatology and pediatric orthopedics at the Medical Center.
Nature of the disease
The origin of this deformity is not known; 74% is associated with unknown reasons where it does not appear in the family history and 25% does exist in the family history with the possibility of being found in the genes and although the incidence in Colombia is unknown; In the world there is one case for every thousand live births, where it is estimated that around 150,000 children are born each year with this physical condition.
Dr. Melissa Rosero, a specialist in orthopedics, traumatology and pediatric orthopedics at the Medical Center emphasizes that the diagnosis is clinical and can be made by means of an obstetric ultrasound from the 16th week of pregnancy; In most cases the etiology is unknown and it can manifest with variable degrees of rigidity, thus determining the prognosis and response to treatment.
World Clubfoot DayVaro
Ponseti International Association (PIA) has designated June 3 as the World Clubfoot DayVaro. The date has been chosen to commemorate the birth of Dr. Ignacio Ponseti, (1914-2009) designer of the Ponseti Method to treat congenital deformities. The purpose of World Clubfoot Day is to raise awareness about the disability caused by this disease and how it can be prevented using the Ponseti Method.
Dr. José Morcuende, CEO and Medical Director of Ponseti International Association (PIA) points out that this day is an important step to generate global awareness that the Clubfoot Varus It is a treatable malformation. “By designating June 3 as the World Clubfoot Daywe not only highlight the work of Dr. Ponseti, but we help spread his idea that every child born with clubfoot has the right to an effective, non-surgical and low-cost treatment” says Dr. Morcuende, a specialist in Pediatric Orthopedics.
Dr. Claudia Marcela Roncancio, specialist in orthopedics, traumatology and pediatric orthopedics of the Medical Center ensures that the Ponseti Method currently used is 100% effective when applied correctly by a trained specialist; It is also considered the gold standard method, allowing a normal and productive life with minimal sequelae in patients who suffer from it.
Effective and responsible treatment
Treatment in the newborn and in children under one year of age is the method described by Ponseti, in which the elastic properties of infant collagen are used to correct deformities. This, It is a non-surgical treatment that consists of manual manipulation of the foot followed by the application of molded casts that are changed weekly and later an orthosis; According to the definition provided by the International Organization for Standardization, it is known as an external support or device applied to the body to modify the functional or structural aspects of the neuromusculoskeletal system.
Dr. Melissa Rosero, a specialist in orthopedics, traumatology and pediatric orthopedics at the Medical Center assures that to correct the deformities the Ponseti Method is applied as follows: it consists of manipulation and serial casting of the limb to be treated starting the first month of life, preferably with changes every week in an average of four to eight long casts until achieving the correction of three of the four deformities that make up this pathology; The last stage of the first correction phase consists of a minimally invasive surgery with an Achilles tendon tenotomy for equinus correction. After this, the last cast is placed, which lasts three weeks, and the second maintenance stage begins for four years with an abductor splint for the foot. The corrected foot has the same movement, function, and appearance as a normal, pain-free foot.
Other treatments applied for this deformity consist of a posteromedial release of the soft tissues that cause the deformity. There are several surgical techniques to perform this procedure and they can be performed when they are 6 months old with minimally invasive management, a significant recurrence could occur in the patient, however the probable sequelae of this management are related to the appearance of major fibrosis. in corrected feet, resulting in more rigid and in some cases painful feet, which is why they are not considered as the treatment of choice, being reserved to treat cases with more rigid or syndromatic feet that do not fully respond to the Ponseti Method.
Dr. Melissa Rosero, a specialist in orthopedics, traumatology and pediatric orthopedics at the Medical Center Note that management with a circular external tutor (ilizarov) is also described, used in older patients with already structured feet or with late management.
By not receiving adequate treatments, there may be limitations in the mobility and chronic pain as the bones continue to grow in the wrong position, molding them abnormally; and when it is not corrected early, children begin to walk with the foot that has not received treatment, developing a callus on the side of the foot, even resting on the ankle, causing pain; because the weight of the footprint, instead of falling on the sole of the foot, is concentrated on the lateral edge of the foot, said Dr. Melissa Rosero Arévalo, a specialist in orthopedics, traumatology and pediatric orthopedics at the Medical Center.
Public Health – Figures at the Medical Center
Its natural history causes disability making it a considerable public health event. According to scientific evidence, there is a correlation between the age at the start of treatment and better functional results, hence the importance of timely initiation of treatment, for this timely detection based on the knowledge of health personnel is necessary, as well as the of the community, being aware that this defect exists and that it should be placed in expert hands to start an adequate treatment, since it is the most frequent congenital deformity of the foot, not managing it represents a significant increase in costs. Despite this important correlation, with the current health system, the time between the assignment of general medical consultation and specialized care is three to four months, which affects the possibility of timely treatment with better functional results and a low rate of reoperations. , translating into lower costs for the insurer and the health system in general, confirmed Dr. Claudia Marcela Roncancio, specialist in orthopedics, traumatology and pediatric orthopedics of the Medical Center.
According to the Statistics of the Medical Centerto date, 108 cases have been received in the last 5 years for an average of 21.6 cases per year, in all phases of management from the initial diagnosis of patients born at the Institution and their treatment with the Ponseti Method to patients already managed in other Health Centers that have required intervention to manage complications related to the pathology.