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The course aimed to discuss the methodology, current practice and evidence behind the Ponseti method of treatment for CTEV. 

Give insight into the development of Ponseti services and the use of Orthotic componentry and custom made prescriptions.

 

Course Testimonial:

This was a thoroughly enjoyable course that enhanced my understanding of both current and historical treatments of CTEV.  The course facilitators and presenters were engaging, and presented relevant common and complex CTEV cases, while clarifying the full patient journey using theoretical examples and a practical session for the attendees.  This course is a must for anyone working with paediatric patients during the treatment of CTEV, or to aid the knowledge of those practitioners working with adults who are experiencing ongoing issues related to their condition.  Laura Barr, Orthotist, NHS GGC. Laura Barr

 

Course Report:

The day began at Yorkhill Hospital with Mr Duncan, a Consultant Paediatric Orthopaedic Surgeon giving an overview of the presentation of a congenital talipesequinovarus foot.  He also talked about the discovery of using the distal aspect of the talus as the fulcrum and not just the talar head itself, as it is difficult to move the navicular around the talus if a much higher aspect of the talus is being pushed.  For the Ponseti treatment to be effective, it needs to be followed precisely and consistently.  In the past individuals have often tried to adapt the Ponseti method with little success.  A point worth pondering is that the Ponseti method in the past may have been ignored due to the perception that surgery by a qualified surgeon is better, even if there is little or no evidence to support this.  Especially as surgery was quite readily available in developed countries, and so in less developed countries, any surgery may have been deemed better than no treatment.  Due to the remote location of his clinic in Iowa to which his patients would not have been able to travel in to regularly, Ponseti documented changes in the foot posture from the serial plaster casting, over a period of five days, compared to several weeks as he recommends.  Furthermore he noted that tibialis anterior tendon transfers is usually recommended in addition to the serial plaster casting in the Ponseti treatment.

Later on, Sarah Paterson the Orthopaedic Physiotherapy Extended Scope Practitioner discussed plans for her to help implement Achilles tendon lengthening surgery, on top of her role in physiotherapy to help reduce the Orthopaedic Surgeons’ patient load.  She has been given the approval to do this, but will need much training and supervision before she can carry this out independently.

The day ended with a discussion of various types of boots and bars.  It was agreed by the majority of Orthotists in attendance that the boots most often issued from Orthotics tend to be Mitchell boots and Markell boots.  The A-Line bars that disconnect the boots with one click were most straightforward to use.  Some bars needed to be completely unscrewed to remove the boots off their attachment plates. 

It was a much enjoyable day with a great range of speakers discussing their involvement with the Ponseti treatment provided at Yorkhill Hospital.  The only thing that was missing was the physical demonstration of the Ponseti treatment, which could have been carried out with casting live in front of the audience or shown via video presentation.  On the whole the entire day was well organised, and provided a fresh reminder of the orthotic intervention as part of Ponseti management, and provided a few interesting points to consider. Lily Lee

 

Ponsetti Course Photo 1