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הינה קטע מעמוד 15 בחוברת PDF המהוללת. כדאי לכולם לקרא ובעיקר למי שלא מטפל בשיטת פונזטי:
הינה קטע מעמוד 15 בחוברת PDF המהוללת. כדאי לכולם לקרא ובעיקר למי שלא מטפל בשיטת פונזטי:
Importance of bracing The Ponseti manipulations combined with the percutaneous tenotomy regularly achieve an excellent result. However, without a diligent follow-up bracing program, recurrence and relapse occur in more than 80% of cases. This is in contrast to a relapse rate of only 6% in compliant families (Morcuende et al.) Alternatives to foot abduction brace Some surgeons have tried to “improve” Ponseti management by modifying the brace protocol or by using different braces. They think that the child will be more comfortable without the bar and so advise use of straight last shoes alone. This strategy always fails. The straight last shoes by themselves do nothing. They function only as an attachment point for the bar. Some braces are no better than the shoes by themselves and, therefore, have no place in the bracing protocol. If well fitted, the knee-ankle-foot braces, such as the Wheaton brace, maintain the foot abducted and externally rotated. However, the knee-ankle-foot braces keep the knee bent in 90 degrees of flexion. This position causes the gastrocnemius muscle and Achilles tendon to atrophy and shorten, leading to recurrence of the equinus deformity. This is particularly a problem if a knee-ankle-foot brace is used during the initial 3 months of bracing, when the braces are worn full time. In summary, only the brace as described by Ponseti is an acceptable brace for Ponseti management and should be worn at night until the child is 3 to 4 years of age.
