Foot Development And Related Research Of Ponseti Management For Clubfoot

[Objective]To evaluate the influencing factors of Ponseti method in the treatment of idiopathic clubfoot and the development of foot and ankle,to evaluate the functional evaluation of Ponseti method in the treatment of recurrent clubfoot after surgery,and to conduct bioinformatics analysis and research on the potential pathways related to the etiology and pathogenesis of clubfoot.[Methods]1)A retrospective analysis was carried out on the database of children with clubfoot who were admitted to our hospital and Ying-Hua Medical Group of Children's Bone & Joint Healthcare from October 2007 to December 2013 and completed treatment and follow-up.2)A retrospective analysis was performed on the database of children with idiopathic clubfoot with recurrence after PR or PMR,who were admitted to our hospital and Ying-Hua Medical Group of Children's Bone & Joint Healthcare from January 2010 to December 2014 and completed treatment and follow-up.3)To explore the interactions among the abnormal genes and abnormally active pathways which focus on clubfoot-related pathway enrichment analysis,generic gene-coding protein-protein interactions(PPI),Gene-mi RNA interactomes,TF-gene interactions and TF-mi RNA coregulatory interactions using bioinformatics analysis.[Results]1)The age at beginning treatment between 1 month and 3 months predicted the least number of casts and maximum ankle dorsiflexion after initial treatment,while older than 3 months to start treatment significantly influence the brace compliance and the final functional outcomes.The relapse of clubfoot had close relationship with ankle dorsiflexion after the initial correction and brace adherence.Meanwhile,a long follow-up time and an increase in the number of casts required for the initial correction were also related to the increase in the recurrence,which affected the ankle dorsiflexion during the final follow-up,but did not affect the final functional outcomes(ICFSG score).2)The larger the dorsiflexion of the ankle after the initial correction,the smaller the R/L value was,which was more conducive to the development of the talus dome.The larger the R/L,the smaller the final dorsiflexion of the ankle.PAT surgery(p=0.05)and good brace adherence(p<0.05)decreased the values of a angle.Ponseti treatment did not significantly affect the changes in the size of navicular ossification nuclei,but the older the children were,the bigger the ossification nuclei were.The younger the initial treatment age,the smaller the foot length.In male patients,the width of the forefoot and the width of the heel were smaller.The higher the Dimeglio score of the initial deformity,the smaller the heel width.The wider the heel width,the higher the final ICFSG score.3)Ponseti treatment for recurrent idiopathic clubfoot following PMR or PR achieved a satisfactory functional outcome in most patients.The Dimeglio and Pirani scoring systems provided a prognostic value for the initial number of casts and functional outcomes for clubfeet recurring after PMR or PR treated by the Ponseti method.The better functional outcomes were attributed to less initial severity of the previously operated clubfeet.4)In addition to supporting the proposed hypotheses,such as ECM abnormality,fetal movement reducing,genetic abnormality,muscle abnormality,neurological abnormality,skeletal abnormality,uterine compression and vascular abnormality,we found that cellular or immune responses to external stimulus,and molecular transport or metabolism as new potential etiological mechanism of clubfoot.[Conclusion]The age at beginning treatment between 1 month and 3 months predicted the least number of casts and maximum ankle dorsiflexion after initial treatment,while older than 3 months to start treatment significantly influence the brace compliance and the final functional outcomes.The relapse of clubfoot had close relationship with ankle dorsiflexion after the initial correction and brace adherence.The larger the dorsiflexion of the ankle after the initial correction,the smaller the R/L value was,which was more conducive to the development of the talus dome.The larger the R/L,the smaller the final dorsiflexion of the ankle.PAT surgery(p=0.05)and good brace adherence(p<0.05)decreased the values of a angle.Ponseti treatment did not significantly affect the changes in the size of navicular ossification nuclei,but the older the children were,the bigger the ossification nuclei were.The younger the initial treatment age,the smaller the foot length.In male patients,the width of the forefoot and the width of the heel were smaller.The higher the Dimeglio score of the initial deformity,the smaller the heel width.The wider the heel width,the higher the final ICFSG score.Ponseti treatment for recurrent idiopathic clubfoot following PMR or PR achieved a satisfactory functional outcome in most patients.Cellular or immune responses to external stimulus,and molecular transport or metabolism as new potential etiological mechanism of clubfoot.