Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age

Abstract

Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release (n = 205 [79%]), open tendo-Achilles lengthening (n = 8 [3%]), posterior release (n = 21 [8%]), and extensive soft tissue release (posteromedial release, n = 16 [6%]). The mean dorsiflexion after removal of the last cast was 12.5 degrees for the entire group and was greater in 1 year olds compared with 3 year olds. Although all patients achieved a plantigrade foot, the importance of the mild loss of passive dorsiflexion remains to be determined. An extensive soft tissue release was avoided in 94% of patients using the Ponseti method. We intend a followup study to ascertain whether the correction is maintained.

Level of evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The foot abduction orthosis is crafted in our surgical workshop.

Fig. 2A–D

A patient with a clubfoot on the left is shown before and after Ponseti treatment. (A) This 4-year-old girl has had her first cast applied. Note the position of the patella and the large callus over the lateral aspect of her calcaneus. (B) During the casting phase, her foot was progressively abducted. (C) Her last long leg cast is shown. (D) She is now able to walk with a plantigrade foot. We initially recommended wearing high top, reverse last shoes for several months after casting, but have since abandoned this practice.

Fig. 3A–C

A patient treated by the Ponseti method for bilateral idiopathic clubfoot is shown with followup photograph (A) standing and (B–C) with maximal passive dorsiflexion. (A) This boy has just completed the Ponseti method for a bilateral clubfoot deformity and has achieved a heel-toe gait. (B) Maximum passive dorsiflexion on the right side. (C) Maximum passive dorsiflexion on the left side.