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. 2015 Jun;9(3):183-9.
doi: 10.1007/s11832-015-0658-8. Epub 2015 Jun 14.

Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

Mia Dunkley  1 , Yael Gelfer, Debbie Jackson, Evette Parnell, Jennifer Armstong, Cristina Rafter, Deborah M Eastwood
Affiliations

Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

Mia Dunkley et al. J Child Orthop. 2015 Jun.

Abstract

Background: The Ponseti method is the preferred treatment for idiopathic clubfoot. Although popularised by orthopaedic surgeons it has expanded to physiotherapists and other health practitioners. This study reviews the results of a physiotherapist-led Ponseti service for idiopathic and non-idiopathic clubfeet and compares these results with those reported by other groups.

Method: A prospective cohort of clubfeet (2005-2012) with a minimum 2-year follow-up after correction was reviewed. Physiotherapists treated 91 children-41 patients (69 feet) had non-idiopathic deformities and 50 children (77 feet) were idiopathic. Objective outcomes were evaluated and compared to results from other groups managing similar patient cohorts.

Results: The mean follow-up was 4.6 years (range 2-8.3 years) for both groups. The non-idiopathic group required a median of 7 casts to correct the clubfoot deformity with an 83 % tenotomy rate compared to a median of 5 casts for the idiopathic group with a 63 % tenotomy rate. Initial correction was achieved in 96 % of non-idiopathic feet and in 100 % of idiopathic feet. Recurrence requiring additional treatment was higher in the non-idiopathic group with 40 % of patients (36 % of feet) sustaining a relapse as opposed to 8 % (6 % feet) in the idiopathic group. Surgery was required in 26 % of relapsed non-idiopathic feet and 6 % of idiopathic.

Conclusions: Although Ponseti treatment was not as successful in non-idiopathic feet as in idiopathic feet, deformity correction was achieved and maintained in the mid-term for the majority of feet. These results compare favourably to other specialist orthopaedic-based services for Ponseti management of non-idiopathic clubfeet.

Level of evidence: Prognostic Level III.

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Figures

Fig. 1
Fig. 1
Position of hands to correct the hyperflexion and equinus simultaneously in the complex feet
Fig. 2
Fig. 2
Position of felt applied to calf to help prevent cast slippage in cases of severe equinus and/or limited knee flexion
See this image and copyright information in PMC

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