BACKGROUND: Congenital talipes equinovarus (CTEV) is a prevalent pediatric deformity with a multifactorial etiology. The objective of this meta-analysis was to explore the association between genetic variations in COL9A1 and the susceptibility to CTEV.
METHODS: A comprehensive analysis of pertinent literature released before November 15, 2023, in electronic bibliographic databases was carried out. The importance of the connection was clarified through odds ratios (ORs) with 95% confidence intervals (CIs), utilizing random or fixed-effects models depending on study heterogeneity. Statistical analysis was executed using Comprehensive Meta-Analysis software (Version 4.0).
RESULTS: A total of eight case-control studies involving 833 CTEV patients and 1280 healthy individuals were included in the analysis. Among these, four studies investigated the rs1135056 variant, encompassing 432 CTEV cases and 603 controls; two studies examined the rs35470562 variant, with 189 CTEV cases and 378 controls; and two studies explored the rs592121 variant, including 212 CTEV cases and 299 controls. The results revealed a significant association between the rs1135056 and rs35470562 polymorphisms in the COL9A1 gene, suggesting an increased risk of CTEV in the overall population. Conversely, no such association was found for the rs592121 variant.
CONCLUSIONS: Our findings reveal a substantial association between the genetic variants COL9A1 rs1135056 and rs35470562 and susceptibility to CTEV. Conversely, the variant rs592121 did not exhibit any corresponding link. However, the limitations imposed by the small study population have compromised the statistical reliability and generalizability of the results.

OBJECTIVE: This retrospective analysis aimed to assess the effectiveness of Split Tibialis Anterior Tendon Transfer (Split TATT) in treating residual idiopathic congenital talipes equinovarus (CTEV) deformities.
METHODS: 15 patients (20 feet) with CTEV, with a mean age of 6.4 ± 3.2 years, initially treated with Ponseti casting, underwent Split TATT. Clinical and radiological evaluations, including Diméglio and Garceau scores, dorsiflexion, and X-ray measurements, were conducted preoperatively and post-operatively at a minimum 2-year follow-up.
RESULTS: Significant improvements were observed in Diméglio and Garceau scores. Dorsiflexion increased by an average of 3°, and radiological analysis revealed nuanced changes. Despite a weak Kappa coefficient, positive trends in dorsiflexion and Garceau scores were noted. Preoperative Garceau scores did not reliably predict postoperative results.
CONCLUSIONS: Split TATT demonstrates promising results in improving muscular balance and functional outcomes in CTEV. While radiological changes are subtle, positive trends in clinical scores indicate meaningful outcomes.
METHODS: IV Retrospective study.

UNASSIGNED: The aim of this study was to track the correction of individual components of Pirani scoring system (PSS) over the manipulation and tenotomy phase of Ponseti casting method in idiopathic clubfoot. Additionally, non-zero PSS scores were analysed to find out the residual deformities.
UNASSIGNED: The included feet were assessed initially according to the six component PSS. The individual scores of each component of midfoot and hindfoot were scored at each visit till the final follow up. The final scoring was done before the start of the bracing phase of the feet (with or without tenotomy).
UNASSIGNED: Evaluation was performed for 42 feet in 28 infants (14 bilateral) with mean age of 42.5 ± 39.2 days (range, 15-150 days). All the six components of PSS showed a significant change from the first cast till the pre tenotomy cast. Post tenotomy, there was a significant change in the scores of posterior crease (0.4 ± 0.2 to 0.1 ± 0.1, p < 0.001) and rigid equinus (0.8 ± 0.3 to 0.1 ± 0.2, p < 0.001). 66.7 % (28/42) of the feet had an abnormal empty heel sign of either 0.5 [22/42 (52.3 %)] or 1 [6/42 (14.4 %)] at initiation of bracing.
UNASSIGNED: The individual components of Pirani scoring system changed to a variable extent as the treatment progressed. Curvature lateral border and talar head reached normalcy prior to tenotomy. Posterior crease and rigid equinus showed a significant reduction after tenotomy. The non-zero empty heel component may require careful interpretation both post treatment and during follow ups.

UNASSIGNED: Neglected clubfoot deformities are very rigid & stiff that need surgical correction. Unlike countries like china, Uganda, and Malawi, no dedicated National program has been implemented for clubfoot management in India. The burden of disability from untreated or partly treated clubfoot is relatively high. With the existing issues, it has been observed that untreated clubfoot is a public health problem in most low and middle-income countries.
UNASSIGNED: To conduct an observational analysis of the community approach to the correction of neglected clubfoot by corrective rehabilitation surgery camps.
UNASSIGNED: The study included the retrospective data of all the neglected clubfoot children who had undergone clubfoot corrective surgery in 13 different remote districts of Odisha, held every year between February 2014 to October 2022 except during covid 19 pandemic period (2020 and 2021). A total of 993 clubfeet of 731 children were corrected through community approach-based corrective camp surgery. Follow-up was done for all the operated children with post-op plaster and orthosis till they returned back to the community.
UNASSIGNED: About 46.78% of study participants were within the age group of 5 years. Male presentation [454 males (62.10%)] was reportedly found 1.6 times higher than the female [277 females (37.89%)]. Most of them belonged to minor communities, socially and economically backward classes from various rural districts of eastern India. The Association of different socially backward categories of clubfoot children with the district they belonged to, was found significant statistically (p value < 0.001). When gender distribution was compared among the district where surgical camps were conducted, the association was statistically not significant (p value = 0.676).
UNASSIGNED: Neglected clubfoot in rural areas can be managed by camp approach. The establishment of a robust standard operating procedure for the conduction of community-based surgical camps may be required to reduce the morbidity level in children with neglected clubfoot.

BACKGROUND: Congenital talipes equinovarus (CTEV) is one of the common congenital disorders in pediatric orthopedic practice that affects a large group of children.It is a combination of four parts of deformity that affect either a single foot or both feet. Our aim in this study is to estimate the prevalence and incidence of CTEV and to evaluate the risk factors that lead to relapse in some children to avoid relapse in future and complex surgical interventions, as well as to improve the final outcome.
METHODS: A retrospective cohort study for the cases of CTEV was conducted to estimate the prevalence of relapse in children with CTEV after management by the Ponseti method and to evaluate the risk factors that lead to recurrence.
RESULTS: The study includes 103 patients with CTEV, and only 22 patients had relapse. The prevalence rate of relapsed cases was 20.4%, and the incidence was 42 per thousand. The average number of casts applied was 4.05 ± 1.37. The average severity of the deformity that was measured by the Pirani score was 4.97 ± 1.21. The most common atypical presentation of CTEV was associated with developmental dysplasia of the hip (DDH), followed by myelomeningocele (MMC).
CONCLUSIONS: The only significant factors in the study were the Pirani score and non-compliance of the brace with p < 0.05. There was not any significance in the correction of the deformity by Ponseti between idiopathic and non-idiopathic CTEV based on the number of casts and the Pirani score. The dynamic foot brace can be the solution for the high recurrence rate, yet more studies are needed in the future.

BACKGROUND: This study prospectively investigated the pain response and physiological parameters [heart rate (HR) and oxygen saturation (SpO2)] during sequential casting in bilateral clubfoot. Additionally, it explored the role of non-nutritive sucking and human care contact on the observed responses during casting.
METHODS: Subjects were allotted to control group (Group A with no intervention) and two intervention groups (Group B: non-nutritive sucking intervention, Group C: human care contact intervention). Neonatal Infant Pain Score (NIPS), heart rate (HR), and oxygen saturation (SpO2) were used to assess the response.
RESULTS: The three groups matched in age and gender characteristics of the participants. Pain response was noted across all groups. The left foot demonstrated a statistically significant preexisting tachycardia which rose further during casting (p < 0.01). Intergroup comparisons revealed that the alteration for NIPS during casting was in following sequence (Group A > C > B, p < 0.00001). The effect of interventions offered in Group B and C lasted in the post-cast period as well (B > C).
CONCLUSIONS: The clubfoot child exhibited moderate pain response during casting of both feet. A tachycardia was noted prior to initiation of second cast which further exaggerated with subsequent cast. Pacifier (non-nutritive sucking) intervention produced better control of pain response than human care contact during casting for both feet.

UNASSIGNED: The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India.
UNASSIGNED: A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded.
UNASSIGNED: The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents\' income level is also strongly associated with regularity of follow-up and child discomfort during treatment.
UNASSIGNED: The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents.

Percutaneous scalpel tenotomy is frequently performed as part of congenital talipes equinovarus (CTEV) to correct the equinus deformity. The use of a scalpel is associated with complications such as neurovascular bundle damage and pseudoaneurysms. In the literature, a percutaneous large-bore needle has been found to be a safer alternative to a scalpel for performing tenotomies. The goal of this study was to conduct a systematic review and report a single-center case series on the use of percutaneous needle tenotomy in the treatment of CTEV. A Preferred Reporting Items of Systematic Review and Meta-analysis (PRISMA)-compliant literature search was conducted to identify studies describing the use of a percutaneous needle tenotomy in the treatment of idiopathic CTEV. A retrospective case series of patients with idiopathic CTEV treated with percutaneous needle tenotomy over a seven-year period from a single center were also conducted. The patients\' demographics, the location of the clubfoot, and the Pirani score were all recorded. An analysis of descriptive statistics was carried out. Continuous data were expressed as mean and SD, whereas categorical variables were expressed as absolute numbers and percentages (%). The systematic review included eight papers with a total of 1026 feet and a mean age of 10.4 weeks (SD 5.9). There were 47 (0.04%) complications across all studies, with a pooled success rate of 95%. Eleven patients (16 feet) were included in the single-center case study. The patients\' initial Pirani score was 4.8 (SD 1.5), with a final score of 0. (SD 0). Four complications occurred in the patient\'s cohort - one minor bleeding and three recurrences as a result of poor compliance with the post-tenotomy foot abduction brace. In conclusion, the percutaneous Achilles tenotomy of a CTEV foot with a large bore needle is a safe and effective alternative.

BACKGROUND: Congenital talipes equinovarus (CTEV) or clubfoot is known as a deformity characterized by excessively turned-in feet and high medial longitudinal arches. It is one of the most common musculoskeletal abnormalities. It is estimated that approximately 20% of CTEV cases are caused by another congenital disease or syndromic condition.
OBJECTIVE: The aim of this study was to assess the knowledge about CTEV among the general population in the Makkah region of the kingdom.  Methods: This study was a community-based cross-sectional descriptive study carried on by an online questionnaire, previously validated in published studies, among residents in the Makkah region of Saudi Arabia who successfully fulfilled the inclusion and exclusion criteria.  Results: Out of the total number of respondents (n=1,987), gender was found to be significantly associated with awareness about CTEV (p-value=0.007) as females tend to have higher awareness levels than males. Having a child with CTEV was found to be significantly associated with awareness level (p-value˂0.001). In addition, university and secondary levels of education are more aware of CTEV than other levels of education (p-value=0.023).
CONCLUSIONS: According to the results, the lack of awareness campaigns may contribute to the low public awareness of CTEV. It is recommended that social media platforms and public campaigns be utilized to increase awareness of CTEV in key locations such as malls. These initiatives may motivate people to seek treatment for their disease as early as possible. In addition, early management of CTEV is less invasive and leads to better patient outcomes when followed up regularly.

Congenital talipes equinovarus (CTEV) is a congenital disability characterized by leg deformities in the cavus, adducts, varus, and equinus. The etiology of CTEV is poorly understood, despite its incidence ranging from 0.76 to 3.49 cases per 1000 live births in Indonesia. CTEV involves the fixation of the foot in the adducts, varus, and equinus with concurrent soft tissue anomalies. Despite advances in treatment, disability often persists. Theoretical models have been proposed for neurological, vascular, connective tissue, bone, and muscular causes; however, the currently available data suggests that mild cases are associated with intrauterine position. CTEV\'s etiology appears to involve a hereditary component, as its prevalence varies by ethnic group. Genetic factors have been identified in 24-50% of cases, depending on the community studied. Based on a complex segregation analysis, the most plausible inheritance pattern is a single large-effect gene interacting with a polygenic background.