A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report

Abstract

Background: The regular Ponseti method for the treatment of idiopathic clubfoot requires a series of manipulations and castings at weekly intervals. It is not known whether the correction could be achieved in a shorter period of time with multiple manipulations and castings per week. This study was designed to evaluate the outcome of a modified treatment program with manipulation and casting offered twice a week.

Methods: The study included the modified group (26 patients with 40 idiopathic clubfeet treated with the Ponseti method twice a week) and the regular group (20 patients with 32 idiopathic clubfeet treated once a week). The average age of the patients at the time of treatment was 63.05 days in the regular group and 92.7 days in the modified group.

Results: All aspects of the deformity with the exception of the equinus were corrected in 20.61 days in the modified group and in 35.35 days in the regular group (P=0.0001). There were no differences between the 2 groups in the average number of casts (P=0.61). Percutaneous Achilles tenotomy was performed in 87.5% (35 of 40) of those in the modified group and 87.5% (28 of 32) of those in the regular group (P=0.47). A corrective surgery for a complete correction of the deformity was performed in 4 feet in the modified group (10%; 2 posteromedial releases; 2 posterior releases) and 3 feet in the regular group (10%; 2 posteromedial releases; 1 posterior release).

Conclusions: The modified Ponseti method with the treatment program twice a week is safe and effective. It significantly shortens the timeframe for the treatment.

Level of evidence: The study of therapeutic studies investigating the results of the treatment is level II.