Talk:Clubfoot

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What does club in club foot mean?[edit]

I think there should be a part somewhere in this article explaining this. Is it because the legs are shaped like a golf club? — Preceding unsigned comment added by 49.50.207.90 (talk) 08:01, 26 March 2012 (UTC)

General comment[edit]

It would be interesting to know the history of surgery in this area, because historically, e.g. Lord Byron, there were people who suffered throughout their lives from this contdition. Matt Stan 12:57, 27 Mar 2004 (UTC)

I don't understand the last "penis" line. Either more detail about this disclaimer, or dropping it entirely, seems obvious here. - Doug

That's very interesting about Lord Byron. I'm interested in the history of it also. The Nazi Party's Propaganda Minister, Joseph Goebbels had a club foot (ironic?). Also, one of the legends surrounding Chinese "foot binding" is that the last Empress of the Shang dynasty "had a clubbed foot and did not want to be known as having this condition. She asked her husband to make binding feet mandatory for all girls. By doing so, her deformed foot could now be considered beautiful." - Jennifer

hello im nona and i want to ice skate. Nona —Preceding unsigned comment added by 65.65.53.178 (talk) 23:03, 21 February 2008 (UTC)

club foot has also been associated with amniotic banding - maybe this should be included?

Ponseti method page[edit]

Is it worth creating a separate page for this technique, or should a link just be provided to the quite detailed information in this article? Any comments would be welcome before I do anything. Dr Aaron 22:54, 30 August 2006 (UTC)

I think it would be beneficial. You can see information here (with the menu bar at the right) [2]. There's also an article about the method here [3]. --aishel 01:02, 31 August 2006 (UTC)

Photos[edit]

Would it be possible to obtain a photo of an adult with a club foot? I don't really know what baby feet are supposed to look like. --UNHchabo 03:35, 11 September 2006 (UTC)

I have a club foot and I have photos of my foot that I wouldn't mind wikipedia using. InvalidZod (talk) 04:37, 7 July 2008 (UTC)

I went ahead and changed the picture but it was changed back. Please state here what "angle" you would like. Otherwise the picture of a babies foot gives no insight to what it may future look like. Also how does my foot not look like a club foot do you even know what an adult foot looks like?InvalidZod (talk) 19:23, 16 July 2008 (UTC)

Goebbels[edit]

In this article, it says "Josef Goebbels also had club foot, a fact which was obscured from the German public by censorship campaigns." - however on the page for Goebbels, it says "Although he has been frequently described as having a club foot, this was not the case." Anyone know which is true? —The preceding unsigned comment was added by 68.80.22.212 (talk) 06:59, 19 December 2006 (UTC).

clubfoot or club foot[edit]

This article has no consistency between the two, can someone find the correct (or most popular) method and standardize? Vicarious 04:28, 10 March 2007 (UTC)

Paul McCartney[edit]

No reference to Paul McCartney's club foot, and there is no indication from the cover of Abbey Road that he has or every had the condition....

Status of Denis Brown bar[edit]

"Maintenance of correction may require the full time use (23 hours a day) of a splint, however, the 'Denis Browne Bar', also known as a foot abduction brace (FAB), has fallen out of favor for treatment of this condition. Part time use of a brace(generally at night, usually 12 hours/day) is frequently prescribed up to 3-4 years of age"

This doesn't make much sense and is not consistent with what I know of the Ponseti method. This is the essence of the Ponseti method:

1. A series of manipulations and casts. The frequency varies according to the child's specific condition and the doctor's judgement, but is usually 6-10 castings, at 1 to 2 week intervals.

2. Once the foot receives a the appropriate degree of over correction, the doctor evaluates the flexibility of the achilles tendon (aka "heel cord") and the position of the child's heel. Depending on this, the doctor may end the casting, or do a percutaneous tenotomy. This is a small cut to the achilles tendon made through the skin (rather than as an open surgical incision), that causes the tendon to be longer and more flexible when it heals. This is done in about 80% of cases. After the tenotomy, there is one more cast, which is removed 2-3 weeks later, when the cord has healed.

3. After this last cast, the child is placed in a foot abduction brace for 23 hours a day, for 2-3 months. This generally is a "Denis Brown" bar, or similar variant, attached to a pair of shoes. Even if it's not literally a DBB, it's something that is functionally equivalent, but possibly with different adjustments. Originally, these shoes were straight-lasted "Markell" shoes. While many children tolerate the FAB/Markell shoe combination well, some children find these uncomfortable and/or are able to slip their feet out of them. To address this some "Ponseti" doctors prescribe "Mitchell" shoes, which are essentially sandals that conform somewhat better to a child's feet. [it's possible that the author of the quoted passage meant to refer to the shoe issue, rather than the FAB itself.]

4. Typically after 2-3 months (per the judgement of the doctor), the child is shifted from wearing the FAB 23 hours a day to wearing the brace only while sleeping. This can be done gradually, or immediately, depending on the doctor's judgement. Dr. Ponseti had originally recommended that the child continue to wear the brace until about 2 years of age, but over time has increased this recommendation to about 4 years of age, based on research suggesting that the longer a child wears the brace, the less chance there is of the foot relapsing.

I know of no source that says that a foot abduction brace has fallen out of favor with doctors using the Ponseti method. My source for the above is the materials on the ponseti links at the bottom of the page, my own experience as the parent of a child with clubfoot (19 months old and still wearing a FAB at night), and as a participant in the Yahoo! groups related to clubfoot.

Strange...my club foot wasn't corrected with either of the methods mentioned on this page[edit]

I was born with a club foot, but it wasn't corrected with either of the methods mentioned on this page. Instead it was (over the course of several months) gently twisting it into the correct direction.--*Kat* 08:14, 22 June 2007 (UTC)

how can a babies who suffered club foot get brain injury. —Preceding unsigned comment added by 60.48.13.218 (talk) 07:05, 24 September 2007 (UTC)

"Anterior Tibial Tendon Transfer (needed in 20% of cases) - *where the tendon is moved from the toe to the third finger*" <-- this makes no sense anatomically, I think its moved to the calcaneus or other part of the foot.. —Preceding unsigned comment added by 86.145.126.100 (talk) 17:29, 12 January 2008 (UTC)

Illogical passage...[edit]

"Anterior Tibial Tendon Transfer (needed in 20% of cases) - *where the tendon is moved from the toe to the third finger*" <-- this makes no sense anatomically, I think its moved to the calcaneus or other part of the foot.. —Preceding unsigned comment added by 86.145.126.100 (talk) 17:31, 12 January 2008 (UTC)

External links[edit]

External links on Wikipedia are supposed to be "encyclopedic in nature" and useful to a worldwide audience. Please read the external links policy (and perhaps the specific rules for medicine-related articles) before adding more external links.

The following kinds of links are inappropriate:

  • Online discussion groups or chat forums
  • Personal webpages and blogs
  • Multiple links to the same website
  • Fundraising events or groups
  • Websites that are recruiting for clinical trials
  • Websites that are selling things (e.g., books or memberships)

I realize that some links are helpful to certain users, but they still do not comply with Wikipedia policy, and therefore must not be included in the article. It might be appropriate for the regular editors of this page to carefully review ALL of the external links after reading the relevant policies. WP:NOT:Wikipedia is not a collection of links, after all. WhatamIdoing (talk) 07:04, 17 January 2008 (UTC)


It seems it may be necessary to review that specific policy, as it serves, in the instance of this specific topic, to further a basic and long-lasting lie about club feet, namely, the fallacy told to parents of children with club feet, that their child will have "normal" feet as an adult. By preventing links that take the public to see what others with club feet continue to suffer throughout their lives, you would have this lie continue? All of the material on this wiki may be based on scientific fact, but not this particular issue.

There is a glaring failure of the medical community - there has never been any substantial long-term followup research to show how all of the various surgeries and therapies fair in the long-term. By preventing such links, people with post-club feet often spend most of their lives feeling they are the only person experiencing the results of these poorly researched techniques, when the fact is, they are very far from alone. The links to club foot discussion groups and blogs where these issues are addressed and shared has as much value to the medical community as any other link. Such links may, in fact, present more data to clinicians as they make critical medical decisions that will affect the child's entire life, well beyond their 18th birthdays. See [1] this blog for further discussion on this issue. —Preceding unsigned comment added by Notumbo (talkcontribs) 03:38, 13 June 2010 (UTC)

References

  1. ^ [1]

I would argue for the inclusion of links in the top-right box to HPO (Human Phenotype Ontology). This initiative has gained widespread use in classification of dysmorphic and other features. The HPO code for club foot is HP:0001762. Opinions? — Preceding unsigned comment added by Svanvoor (talkcontribs) 09:55, 24 December 2010 (UTC)

Peter Forsberg[edit]

Someone has listed Peter Forsberg as having been born with clubfoot. While he has foot problems, they are not related to clubfoot. See the following link: http://www.usatoday.com/sports/hockey/nhl/flyers/2006-05-10-forsberg_x.htm?POE=SPOISVA —Preceding unsigned comment added by 99.238.3.174 (talk) 22:02, 21 February 2008 (UTC)

Club foot article grammar[edit]

There are significant grammatical and syntax errors on this page. So many that the article's accuracy and usefulness is questionable. 75.157.225.94 (talk) 00:17, 9 April 2008 (UTC)Hacoah

Wikipedia in a nutshell! 38.115.185.13 (talk) 17:01, 27 February 2009 (UTC)HelenChicago

Better Description[edit]

The article at present doesn't actually describe what a club foot is. Are there the same bones, but pointing the wrong way? Do the bones grow the wrong way, or are they that way from birth? Is it the bones at all, or something with the ligaments and tendons? More information would be helpful. wanderingstan (talk) 07:11, 3 December 2008 (UTC)

Surgery used to be used, way back in the day[edit]

Extensive surgery of the soft tissue or bone is not usually necessary to treat clubfoot. Hmmm. That may be true today, but certainly hasn't always been. I was born with TEV in 1960 and had numerous surgical interventions, from Achillotenotomy aged about 24 months through (at age 16) a triple arthrodesis (fusion of subtalar, calcaneocuboid, and talonavicular joints). Following that my foot was unrecognisable (it looked like a foot, rather than its previous twiested self) and I could buy shoes off-the-shelf for the first time in my life, so I'm not complaining. It's stood me in good stead since.

At age 12 I was offered the option of a partial amputation (removing, as I remember, the metatarsals and toes). Though I didn't take up the option this was not unknown among my peer group and a course of surgery was certainly not uncommon. Perhaps someone with knowledge of orthopædic surgery in the UK 40 years ago could comment. Obviously, any contributions I made to the article here would be OR! Tonywalton Talk 17:22, 19 March 2009 (UTC)

If anyone is interested - I have medical records of a case of equinovarus of a 2-year old that was actually due to mercury poisoning, and successfully treated with chelation. If you are interested to read the record of the treatment, let me know. —Preceding unsigned comment added by Ilona1501 (talkcontribs) 20:02, 10 October 2009 (UTC)


I was born with a club foot, but not from any disease, I apparently got my foot stuck in my mothers rib cage while forming. When i was born my left foot was backwards and upsidedown, surgery at 2mths old corrected my foot. My issues do not stop at my foot, My left leg had developed at a slower rate than the right, then at the age of 15 doctors recommended staples in my right leg to allow the left to catch up in length, which was successful. Then a few years ago i put my back out, after xrays were taken I found out my L3, L4 and L5 were all partially fused together with my tailbone, I have been told that that is all linked in with my club foot and i will be prone to back aches in the future. If there is any questions or someone has a similar case, I'd be happy to hear from you. MY shoe sizes are L 10 R 12.

             Mic Brisbane Qld Australia 2nd june 2012.

In non-human animals[edit]

Would it be within the scope of this article to add a couple paragraphs on club feet in other animals, specifically horses? In horses, it's quite common. Occurs due to a somewhat different process, I think (I'll have to do some research before adding anything) but I'd like to either create a new article or add on to this one. Basically I don't want to create a new article/content fork if it isn't appropriate, but I'd also not want to add stuff to this article that's beyond its scope if it's confined to the human condition only. Opinions? Montanabw(talk) 18:56, 13 December 2010 (UTC)

No one complained, so I added a couple of paragraphs and tagged the article for WPEQ. If anyone feels this material is beyond the scope and wants to move it to a new article on clubfeet in non-humans, let me know. I don't have the intent to expand the section much at present, but maybe later. Eventually we may want to create a new article just for horses, but would prefer to have a lot more material to add first. Montanabw(talk) 21:43, 4 February 2011 (UTC)

A touch of the crystal balls?[edit]

The article states "World Clubfood [sic] Day was introduced in 2013 by Ponseti International Association and is celebrated on June 3rd every year." This was added in April by this edit and is obviously a complete piece of illogic. If the edit was added in April saying the alleged "Day" was introduced in June 2013 is senseless, and as this "Day" was (or rather, "shall be") first marked in 2013 it can hardly, from the perspective of April 2013, be "celebrated" every year. (As a small piece of original research a club foot is hardly something to celebrate; mine is more something to decry). As this section is completely uncited I propose deleting it unless it's a) reworded and b) referenced by Monday 20th May. At the least it's promotional, at the worst it's a copyvio from somewhere. Tonywalton Talk 23:43, 17 May 2013 (UTC)

Deleted, per the above. No dissenting voices (correcting "Clubfood" to "Clubfoot" doesn't count). If this is to be reinstated it must be cited per WP:V and WP:RS, correctly worded per WP:BALL and must not read like an advertisement. Tonywalton Talk 22:48, 22 May 2013 (UTC)

I read the edit, and it didn't seem particularly problematic to me. I mean, it's hardly "predicting" something, is was just badly phrased. It says

  "World Clubfood Day was introduced in 2013 by Ponseti International Association and is celebrated on June 3rd every year. This date was chosen following the signing of the Iowa Clubfoot Declaration during the 2nd International Clubfoot Symposium held in Iowa City, Iowa, USA, on October 4 – 5, 2012."

So it doesn't say it "was introduced in June". It says it "was introduced in 2013", i.e. it was introduced in 2013, before June, so people would be aware that June 3rd is the date. "Celebrated on" is obviously just a way of phrasing that it is GOING to be celebrated on June 3rd. Why say "is going to be first celebrated on June 3rd"? That just means that the phrasing will be automatically obsolete on June 4th, and the person would have to come back and re-edit it to reflect that it HAD been celebrated on June 3rd. Is it a "crystal ball" if I say that "Christmas is celebrated on December 25th" during November, simply because we MAY not actually celebrate Christmas this year? Technically then, I ought to phrase it "Christmas HAS BEEN celebrated on December 25th, and may be celebrated on the 25th again this year, barring unforeseen circumstances"? There could be a nuclear holocaust within the next two weeks or something, right? Can't go around predicting the future like that! And the phrasing hardly "reads like an advertisement". Perhaps it could be somewhat more neutral sounding, but I think that you are exaggerating greatly. Are you sure that your neutrality isn't just being influenced by the fact that you have a club foot and think the whole idea of a "Clubfoot Day" is ridiculous?. As for "MUST be referenced", I always find it funny when some people insist on that, while there are whole articles out there without any references at all which are simply flagged "this article requires references...". I guess "MUST" depends on the person doing the editing and how much they dislike what is being said. And of course, I've found whole articles "referenced" to sources that clearly can't cover all the information on the page. For example the page on "Muzzleloader" references two news articles, one apparently about how "Hunting is driving the black powder market", and one about how a company that makes muzzleloaders is going out of business, neither of which is likely to cover the entire history of muzzleloading weapons and artillery..45Colt 20:50, 22 September 2015 (UTC)

Photos of horse hooves?[edit]

I'm obviously no expert on horses, but to my untrained eye, those images of hooves look totally normal. I especially noted the one comparing the "normal" hoof with the "Stage 1 club foot"...I studied it for a minute or two, and they appear identical to me. I thought it said that the club foot "gives the appearance of walking en pointe". Why do the hooves shown all appear to be flat on the ground?.45Colt 20:54, 22 September 2015 (UTC)

I agree that the images are very poor, and the text unclear. The image of the pony hooves at least show something abnormal. I think it would be helpful to rewrite the text, and replace the second and third images with a diagram that makes it clear what is happening. --Ronz (talk) 22:06, 22 September 2015 (UTC)

Some sources on talipes equinovarus[edit]

https://drive.google.com/folderview?id=0B6sh4eLSj14NWUdIN0FBQ09zbWM&usp=sharing — Preceding unsigned comment added by Sabrina.ponsi (talkcontribs) 15:40, 8 March 2016 (UTC)

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Article evaluation and general considerations to improve the page[edit]

The third paragraph on the page has little relevance to club foot and is distracting. This section� should be moved to the other animals section at the bottom of the page because it is not a necessary topic for this page. Information should read medically based rather than general talk because it is a medical condition. The third sentence under French Method category has little relevance and is difficult to understand�. Is the History section necessary on this page? One sentence does not seem pertinent to this medical condition. Further Physical Therapy Interventions and other interventions for later on in life including adequate resources should be added to build the reputation of the page. GR3GP1K3 (talk) 18:19, 14 September 2017 (UTC)

Suggestions[edit]

A Management section should be included in the article to provide useful and reliable information for readers to cope with the condition. Besides that, it will be a beneficial to the readers if a section about the available helps and resources where they could get support from included in the article. Yieng (talk) 18:03, 12 October 2017 (UTC)Yieng

Suggestions[edit]

I think there is a lot of information in this article however, there is a lot of information that I feel does not need to focused on such as the history section. I think the article should be more clear and concise with the information. I also think that the Ponseti method could be subdivided as well with focus on maintenance and interventions for management.

Waterhouset (talk) 13:23, 13 October 2017 (UTC)

Sources[edit]

These are some good sources

Doc James (talk · contribs · email) 15:11, 14 October 2017 (UTC)

Inconsistent terminology[edit]

The article currently uses a mix of "clubfoot" and "club foot". However, <OR> I was born with "clubbed feet" secondary to lumbar myelomeningocele. During my whole childhood when dealing with orthopeadic surgeons, physiotherapists, etc. it was always referred to by the adjectival form "clubbed".</OR> I'm a 50 year old South African. We really should get this sorted so that the article can be consistent. Roger (Dodger67) (talk) 17:26, 15 October 2017 (UTC)

Both these reviews use "clubfoot"[6][7]
So does the ICD10 and MeSH[8][9]
Moved to that. Doc James (talk · contribs · email) 07:30, 16 October 2017 (UTC)

Wording[edit]

  • Saying the achilles is cut is clearer than saying it is "released"
yes, but for a concerned parent of newborn affected by this condition who may be looking for information, the term "cut" is more intimidating. It is important to be accurate, but it seems better if the article could start with some reassuring comments about the condition and the value of treatment and avoid scaring them in the first few lines. Nwaan (talk) 03:39, 26 October 2017 (UTC)
  • Cutting the achilles is surgery. So we thus need to say 20% require "further surgery"
Ponseti viewed his method as "non-surgical" and and his method was popularized in the early days of the internet in a grassroots movement initiated by his appreciative patient families on a listserv called "nosurgeryforclubfoot". Ponseti's recommendation in his book [1] that some clubfoot patients have an office procedure for "a simple subcutaneous tenotomy of the tendo Achilles under local anesthesia", is not necessarily a "surgery". Many procedures are done under local anesthesia (suturing of lacerations, joint aspirations, some fracture reductions, etc) and they are not considered "surgery". Also, not all patients have a tenotomy as part of treatment. It seems a disservice to Ponseti and the many families who supported him to equate his tenotomy with historical forms of clubfoot surgery. Again, in the introductory comments, it seems seems intimidating to emphasize the challenges that occur for some patients, when 80% of patients do not require anything more than casting, bracing, and a "subcutaneous tenotomy under local anesthesia" Nwaan (talk) 03:39, 26 October 2017 (UTC)

Restored this. Doc James (talk · contribs · email) 01:13, 26 October 2017 (UTC)

With respect to the wearing of the brace the ref says:

"The usual type of brace is a foot abduction brace (Fig. 3) that holds both feet abducted and dorsiflexed and is worn 23 h per day for the first 3 months and then at sleep times, aiming for 12–14 h of brace wear each day, until the age of 4 years. " No initially it is nearly continuously. Have added that wording. Doc James (talk · contribs · email) 01:17, 26 October 2017 (UTC)

"Bending" is not an accurate term and seems harsh and more dramatic relative to the terminology used by Ponseti to describe the molding or manipulation done as part of the Ponseti method. In his book, Ponseti described describes his process of correcting clubfoot deformity as "gentle manipulation" with "molding" of the cast. Again, for the introductory comments, it seems less intimidating to parents of a newborn with this condition as a description of what the doctor is going to do to their baby's foot. It seems better to use "manipulate" as Ponseti did, or "stretch" or "massage" rather than "bending" an infant's foot to correct deformity. Nwaan (talk) 03:39, 26 October 2017 (UTC)
User:Nwaan How about "moving" as a simple term which is not intimidating? Doc James (talk · contribs · email) 17:06, 26 October 2017 (UTC)

There are few locations that use the French Method and I am not aware of any sites or reports that describe or advocate any combination of Ponseti and French Methods. A survey of the Pediatric Orthopedic Society of North America published in 2013 reported that 96% were using the Ponseti Method Nwaan (talk) 03:39, 26 October 2017 (UTC)

We do not mention the French method in the lead. Did you ref the source attached to the statement? The US is fairly US centric. The NA Ortho Society look at any place other than the USA? Doc James (talk · contribs · email) 17:06, 26 October 2017 (UTC)

There are peer-reviewed articles that discuss combinations of French and Ponseti Methods. I think we should add the French functional or physiotherapy method back into the page. Without the French method described in the article, viewers will not know of its potential benefits. GR3GP1K3 (talk) 17:37, 29 October 2017 (UTC)

Sure but please base it on high quality secondary sources rather than primary sources. Doc James (talk · contribs · email) 18:50, 29 October 2017 (UTC)

References

  1. ^ "Publications & Resources". Ponseti International. 

Notable cases[edit]

I have removed the section because they are not actually notable cases. A notable case of a medical condition is something that is written about in medical journals. The people who were mentioned in the section are notable for a wide variety of reasons ranging from arts to politics - none were listed/discussed because there is something particularly interesting about their clubbed feet. Roger (Dodger67) (talk) 07:19, 30 October 2017 (UTC)

Sounds good. These sorts of details can be mentioned on the article about the person. Doc James (talk · contribs · email) 17:39, 30 October 2017 (UTC)
Subject to WP:EGRS of course. Roger (Dodger67) (talk) 05:08, 31 October 2017 (UTC)
Mentioned on the article about the person if their is consensus and policy supports doing so I guess I should have said. Doc James (talk · contribs · email) 23:29, 31 October 2017 (UTC)

French Method[edit]

No one delete the French Method. Please stop deleting it. GR3GP1K3 (talk) 18:09, 10 November 2017 (UTC)

You have been provided a bunch of guidance on your talk page. Moving this back to your sandbox so you can adjust it based on the advice their. Why do you write "Therapists" with a capital letter? Why not use secondary sources? Doc James (talk · contribs · email) 06:47, 11 November 2017 (UTC)

Peer Review 1[edit]

The lead of this article appears to be from about 1 or 2 sources only. It reads more like a summary of those sources more than a general idea of what clubfoot is. For example, the specifics held within the lead intro could be condensed or included elsewhere with more detail, like describing the Ponseti method only in the Ponseti section. I think it would make this information less redundant, and encourage readers to scroll down the article to read about the procedure rather than only read a brief statement about it. The article does not have a strong "encyclopedic" tone at a lot of points, which can be improved by staying more on topic in each section. For example, the "Cause" overview ends with, "Effected individuals have smaller than normal legs even after corrected." Although it is relevant to clubfoot, this has nothing to do with the cause of clubfoot, and would be best to only be included in Diagnosis, where the physical findings are mentioned and described. Having a smaller leg is not a cause of clubfoot deformity, it is an exam finding, like the other CAVE findings. There are other instances where wording is excessive in this piece. This has to do with improving the grammar and tone, but the wordiness becomes confusing at times. For example, the bulletpoint under Ponseti method about "The final stage of casting..." reads like a textbook and not an encyclopedia entry. — Preceding unsigned comment added by Rsnorton3 (talkcontribs) 22:11, 11 November 2017 (UTC)

The lead is supposed to be a summary of the condition in question.
The details in the lead are to be expanded into more detail in the body of the text.
Agree the body should be arranged so the appropriate stuff is in the appropriate section. Doc James (talk · contribs · email) 18:22, 12 November 2017 (UTC)

Ref gib2013[edit]

@Doc James:

I am not sure that my explanation in my second edit is exhaustive enough, so I bring this here, so to spend a few more words about it.

According to the help page, references can be "full" or "short". A full reference gives the whole information to the citation, a short reference redirects to the full, so to make it easier to work it out in the text. Apparently, WP's software can parse both full and short references wherever they're placed in the article; however, I've had problems when the full ref is not the _very first_ instance of them and the short ones follow. I've therefore moved the full Gib2013 ref at the top of the article. It also makes easier on the editor to work on references when it's the first instance.

Second point. Whoever put the gib2013 ref in, was of the opinion that every sentence based on it should have its own reference. On the basis of wp:Inline citation#Citation density it is enough to place _one_ ref at the end of the text supported by it, plus a few ones where things might get ambiguous because more references are used. That's why I removed so many of them.

79.13.120.159 (talk) 20:19, 12 January 2018 (UTC)

I have keep the full details in the first occurrence.
I have restored the ref to every sentence per Wikipedia:Citation_overkill
It is perfectly fine to have a ref for every sentence. And we do this routinely for medical content. Doc James (talk · contribs · email) 20:49, 12 January 2018 (UTC)