RESUMEN Se realizó un estudio descriptivo observacional retrospectivo en población hospitalaria con el objetivo de identificar los factores asociados a la recidiva del pie Bot tratado con el método de Ponseti en el Hogar Clínica San Juan de Dios entre los años 2009-2012. Se encontraron datos en las historias clínicas de 128 pacientes con pie Bot que cumplieron los criterios de selección del estudio. Se presentaron los datos en tablas y gráficos con distribución porcentual y se realizó un análisis estadístico descriptivo con prueba de T de Student para las variables numéricas y Chi cuadrado para las variables cualitativas con un nivel de significancia estadística p<0.05. La edad media de los pacientes fue de 4.9+-6.7 años. La recidiva fue del 10.2%. Los factores asociados a recidiva fueron: mayor edad media (6.4+-5.6 meses), ser del sexo masculino(76.9%), proceder de Provincias(53.8%), madres con colaboración regular (23.1%), pie equino típico (76.9%), pie izquierdo afectado (46.2%), severidad grave (84.6%), valoración radiográfica grave (23.1%), abandono precoz (92.3%), no uso de férula (100%), no tenotomía amplia (30.8%) y deficiente terapia física (53.8%). Conclusiones: La frecuencia de recidiva del pie Bot fue similar a lo reportado a nivel mundial y los factores asociados a recidiva hallados por el estudio fueron: edad de 6.4+-5.6 meses al iniciar la corrección, poca colaboración de la madre, procedente de provincias, pie Bot atípico, pie Bot izquierdo, severidad grave, no uso de férula, abandono precoz del tratamiento y deficiente terapia física.

Os temas pertinentes à introdução e à difusão do Método de Ponseti para o Tratamento do pé torto congênito no Brasil são discutidos. O Método Ponseti é baseado na confecção de gessos seriados de forma específica, tenotomia do Achillis, e manutenção da correção com órtese de abdução. Este tratamento era diferente do tratamento então vigente no país, baseado em maior tempo de confecção de gessos e realização de uma cirurgia extensa do pé. A difusão do Método Ponseti é analisada de forma cronológica, com ênfase na história de sua difusão no Brasil e no mundo a partir da Universidade de Iowa, na influência da Internet, e no Programa de treinamento de ortopedistas denominado Ponseti Brasil. Dados populacionais foram utilizados como avaliação da difusão do Método Ponseti antes do Programa de Treinamento. Quatro formas de avaliação direta do impacto do Programa de Treinamento são propostas: a reação dos participantes, o questionamento dos participantes sobre sua prática clínica após um ano do Programa, a avaliação dos participantes com relação ao tratamento do pé torto em duas cidades do Programa, São Luis e Teresina, e apresentações de casuísticas de nove serviços de ortopedia brasileira em um Painel Nacional no Curso Ponseti Avançado realizado dois anos após o Programa Ponseti Brasil. Para corroborar as informações sobre difusão, as publicações em países em desenvolvimento são discutidas, como ampliações da indicação do Método Ponseti. A tendência da literatura médica sobre pé torto congênito é analisada, por bases de dados em língua inglesa e bases de dados latino-americanas, e também são revisados os anais dos congressos nacionais da Sociedade Brasileira de Ortopedia e Traumatologia (CBOT Congresso Brasileiro de Ortopedia e Traumatologia) e Congresso Brasileiro de Ortopedia Pediátrica para observar a apresentação de trabalhos sobre tratamento pelo Método Ponseti e tratamento cirúrgico do pé torto. A difusão também é discutida em outros países, organizações não governamentais, com relação à visão dos pais e com relação aos custos do tratamento. A difusão do Método no Brasil é considerada na fase de expansão, e sua discussão pode trazer elementos que auxiliem a incorporação dessa tecnologia no Sistema Único de Saúde / Introduction and diifusion of Ponseti Method for congenital clubfoot treatment in Brazil are discussed. Ponseti Method is based on specific serial casting, Achillis tenotomy and use of abduction brace to maintain correction. This was different from standard treatment in Brazil at that time, based in many more months of serial casting and an extensive foot surgery. The Ponseti Method difusion is analized in a cronologic manner, with focus in the history of its difusion in Brazil and in the world, beginning in University of Iowa. Internet influence is discussed, as well as the Program Ponseti Brasil for training orthopaedic surgeons in Ponseti clubfoot treatment. Populational data were used to evaluate Ponseti Method difusion, before the Training Program. Four manners of direct evaluation of the impact of the Training Program are presented: the participants´reaction, enquiries about clinical practice with Ponseti Method after one year, evaluation of the impact of the Training Program in two cities, São Luis and Tesesina, and case series presentations of nine Brazilian Orthopaedic Clinics in a national panel in the Advanced Ponseti Course, two years after the Training ProgramPonseti Brasil. To reinforce information about difusion, publications in developing countries are discussed, extending indications for use of the Ponseti Method. Tendencies of medical literature about clubfoot treatment were analized, through written english and latinoamerican databases, and proceedings of two national meetings Brazilian Orthopaedic Meeting and Brazilian Pediatric Orthopaedic Meeting were revised to evaluate presentations about clubfoot treatment (Ponseti and surgical). Difusion is also discussed in other countries, non governamental organizations, related to parents perspective, and related to costs of treatment. Difusion of Ponseti Method is considered in expansion phase, and its discussion can help in the incorporation of this tecnology into the SUS (Sistema Único de Saúde Brazilian Health System)

Os temas pertinentes à introdução e à difusão do Método de Ponseti para o Tratamento do pé torto congênito no Brasil são discutidos. O Método Ponseti é baseado na confecção de gessos seriados de forma específica, tenotomia do Achillis, e manutenção da correção com órtese de abdução. Este tratamento era diferente do tratamento então vigente no país, baseado em maior tempo de confecção de gessos e realização de uma cirurgia extensa do pé. A difusão do Método Ponseti é analisada de forma cronológica, com ênfase na história de sua difusão no Brasil e no mundo a partir da Universidade de Iowa, na influência da Internet, e no Programa de treinamento de ortopedistas denominado Ponseti Brasil. Dados populacionais foram utilizados como avaliação da difusão do Método Ponseti antes do Programa de Treinamento. Quatro formas de avaliação direta do impacto do Programa de Treinamento são propostas: a reação dos participantes, o questionamento dos participantes sobre sua prática clínica após um ano do Programa, a avaliação dos participantes com relação ao tratamento do pé torto em duas cidades do Programa, São Luis e Teresina, e apresentações de casuísticas de nove serviços de ortopedia brasileira em um Painel Nacional no Curso Ponseti Avançado realizado dois anos após o Programa Ponseti Brasil. Para corroborar as informações sobre difusão, as publicações em países em desenvolvimento são discutidas, como ampliações da indicação do Método Ponseti. A tendência da literatura médica sobre pé torto congênito é analisada, por bases de dados em língua inglesa e bases de dados latino-americanas, e também são revisados os anais dos congressos nacionais da Sociedade Brasileira de Ortopedia e Traumatologia (CBOT Congresso Brasileiro de Ortopedia e Traumatologia) e Congresso Brasileiro de Ortopedia Pediátrica para observar a apresentação de trabalhos sobre tratamento pelo Método Ponseti e tratamento cirúrgico do pé torto. A difusão também é discutida em outros países, organizações não governamentais, com relação à visão dos pais e com relação aos custos do tratamento. A difusão do Método no Brasil é considerada na fase de expansão, e sua discussão pode trazer elementos que auxiliem a incorporação dessa tecnologia no Sistema Único de Saúde / Introduction and diifusion of Ponseti Method for congenital clubfoot treatment in Brazil are discussed. Ponseti Method is based on specific serial casting, Achillis tenotomy and use of abduction brace to maintain correction. This was different from standard treatment in Brazil at that time, based in many more months of serial casting and an extensive foot surgery. The Ponseti Method difusion is analized in a cronologic manner, with focus in the history of its difusion in Brazil and in the world, beginning in University of Iowa. Internet influence is discussed, as well as the Program Ponseti Brasil for training orthopaedic surgeons in Ponseti clubfoot treatment. Populational data were used to evaluate Ponseti Method difusion, before the Training Program. Four manners of direct evaluation of the impact of the Training Program are presented: the participants´reaction, enquiries about clinical practice with Ponseti Method after one year, evaluation of the impact of the Training Program in two cities, São Luis and Tesesina, and case series presentations of nine Brazilian Orthopaedic Clinics in a national panel in the Advanced Ponseti Course, two years after the Training ProgramPonseti Brasil. To reinforce information about difusion, publications in developing countries are discussed, extending indications for use of the Ponseti Method. Tendencies of medical literature about clubfoot treatment were analized, through written english and latinoamerican databases, and proceedings of two national meetings Brazilian Orthopaedic Meeting and Brazilian Pediatric Orthopaedic Meeting were revised to evaluate presentations about clubfoot treatment (Ponseti and surgical). Difusion is also discussed in other countries, non governamental organizations, related to parents perspective, and related to costs of treatment. Difusion of Ponseti Method is considered in expansion phase, and its discussion can help in the incorporation of this tecnology into the SUS (Sistema Único de Saúde Brazilian Health System)

Background: Talipes equinovarus, also termed club foot, is a congenital deformity of the ankle joint. Despite its prevalence of approximately 1 per 1000 live births, fetal talipes is relatively poorly studied since the introduction of percutaneous tendo Achilles tenotomies. Objectives: To document the associations, outcomes and prognosis of patients with antenatally diagnosed fetal talipes. The study aims to examine the association between, and prevalence of, fetal talipes and other abnormalities, structural and chromosomal, as well as the outcome in relation to postnatal surgery. The accuracy of prenatal ultrasound in diagnosing fetal talipes is also examined. Methods: A retrospective observational study was made of all cases presenting to the Fetal Medicine Unit between 1 January 2009 and 31 December 2014. All the identified cases were analysed to identify isolated talipes, associated abnormalities, and chromosomal abnormalities. The pregnancy outcomes were determined using the Astraia database as well as maternity records. When the outcome resulted in a live infant, these infants were followed up using the files at the referral hospital to determine the treatment method used and the number requiring surgery. Results: There were 155 cases, all referred to the Fetal Medicine Unit. Antenatal data included 75 who had other structural abnormalities and 75 who had isolated talipes. In five of the cases were no sufficient data could be found. Twenty-five cases were lost to follow-up, and 12 cases had no clubfoot at birth. Only one was labelled as having positional clubfoot. There were 91 live births. Of the cases of talipes with associated abnormalities, 21.19% were live births (excluding ENND). All terminations of pregnancy as well as 90.9% of intrauterine fetal deaths were complex talipes, and 94.52% of the cases of isolated talipes were live births. The most common associated abnormalities were of the central nervous system. Seventeen of the live births were lost to follow-up. Of the cases of isolated talipes, 53.19% had tenotomies and Ponseti treatment. The false positive rate of detecting fetal talipes on ultrasound was 7.74%. Conclusion: The study made it evident that complex talipes is associated with a poor pregnancy outcome defined as pregnancy loss, where isolated talipes is usually associated with a good pregnancy outcome. Ultrasound is a good diagnostic tool when diagnosing talipes antenatally but cannot diagnose the severity of the clubfoot. False negatives were not studied. The introduction of tenotomy can make a difference in the outcome of clubfoot in comparison with previous studies where tenotomies were not performed. Medical professionals need to address the importance of counselling, and a multidisciplinary team should be involved in cases involving prenatal counselling.

The area of the care of a Clubfoot (pes equinovarus congenitus PEC Clubfoot) Diagnosed Child is the topic of this Paper. Currently, the PEC is the second most frequent congenital deformity within orthopaedics. The theoretical part of this Paper deals with a description of the PEC, its diagnostics, cure and a possible risk of relapse. A sub-chapter of the Paper introduces the Achilleus association, which is the only body in the Czech Republic bringing together parents of PEC diagnosed children. The Paper also focuses on nurses and their role(s) in the nursing care of PEC diagnosed children. The empirical part of this Paper covers a research with the following directions: - parental knowledge of PEC diagnosed children care at home; - specifications of the nursing care of PEC diagnosed children; - nurses and their educational role (if fulfilled) in the nursing care of PEC diagnosed children. The research presented in the empirical part of the Paper was based on a semi-structuralized interview and open coding technique. The interviews were conducted with parents of PEC diagnosed children and care providing nurses who also play an important educational role in this matter. The benefit of the Paper, based on collected research data, is to provide a complete overview on the problems relating to the care of PEC diagnosed children. The outcome is supposed to be also presented to appropriate expert public for further consideration. The research outcome presents that the level of parental knowledge of the PEC diagnosed children care at home is very high and that parents provide their children with a quality care. The Paper describes that specifications of the nursing care of PEC diagnosed children are mainly evident in appropriate and consistent education of parents as the homecare is usually a long-term process. Finally, the Paper also shows that nurses in their educational role in the nursing care of PEC diagnosed children do not fulfil their tasks to such an extent that is expected.