Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 15;5(5):CD008602.
doi: 10.1002/14651858.CD008602.pub4.

Interventions for congenital talipes equinovarus (clubfoot)

Shadi Bina  1 , Verity Pacey  2 , Elizabeth H Barnes  3 , Joshua Burns  1   4 , Kelly Gray  2
Affiliations

Interventions for congenital talipes equinovarus (clubfoot)

Shadi Bina et al. Cochrane Database Syst Rev. .

Abstract

Background: Congenital talipes equinovarus (CTEV), also known as clubfoot, is a common congenital orthopaedic condition characterised by an excessively turned-in foot (equinovarus) and high medial longitudinal arch (cavus). If left untreated it can result in long-term disability, deformity and pain. Interventions can be conservative (such as splinting or stretching) or surgical. Different treatments might be effective at different stages: at birth (initial presentation); when initial treatment does not work (resistant presentation); when the initial treatment works but the clubfoot returns (relapse/recurrent presentation); and when there has been no early treatment (neglected presentation). This is an update of a review first published in 2010 and last updated in 2014.

Objectives: To assess the effects of any intervention for any type of CTEV in people of any age.

Search methods: On 28 May 2019, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus, AMED and Physiotherapy Evidence Database. We also searched for ongoing trials in the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (to May 2019). We checked the references of included studies.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs evaluating interventions for CTEV, including interventions compared to other interventions, sham intervention or no intervention. Participants were people of all ages with CTEV of either one or both feet.

Data collection and analysis: Two review authors independently assessed the risks of bias in included trials and extracted the data. We contacted authors of included trials for missing information. We collected adverse event information from trials when it was available. When required we attempted to obtain individual patient data (IPD) from trial authors for re-analysis. If unit-of-analysis issues were present and IPD unavailable we did not report summary data, MAIN RESULTS: We identified 21 trials with 905 participants; seven trials were newly included for this update. Fourteen trials assessed initial cases of CTEV (560 participants), four trials assessed resistant cases (181 participants) and three trials assessed cases of unknown timing (153 participants). The use of different outcome measures prevented pooling of data for meta-analysis, even when interventions and participants were comparable. All trials displayed high or unclear risks of bias in three or more domains. Twenty trials provided data. Two trials reported on the primary outcome of function using a validated scale, but the data were not suitable for inclusion because of unit-of-analysis issues, as raw data were not available for re-analysis. We were able to analyse data on foot alignment (Pirani score), a secondary outcome, from three trials in participants at initial presentation. The Pirani score is a scale ranging from zero to six, where a higher score indicates a more severe foot. At initial presentation, one trial reported that the Ponseti technique significantly improved foot alignment compared to the Kite technique. After 10 weeks of serial casting, the average total Pirani score of the Ponseti group was 1.15 points lower than that of the Kite group (mean difference (MD) -1.15, 95% confidence interval (CI) -1.32 to -0.98; 60 feet; low-certainty evidence). A second trial found the Ponseti technique to be superior to a traditional technique, with mean total Pirani scores of the Ponseti participants 1.50 points lower than after serial casting and Achilles tenotomy (MD -1.50, 95% CI -2.28 to -0.72; 28 participants; very low-certainty evidence). One trial found evidence that there may be no difference between casting materials in the Ponseti technique, with semi-rigid fibreglass producing average total Pirani scores 0.46 points higher than plaster of Paris at the end of serial casting (95% CI -0.07 to 0.99; 30 participants; low-certainty evidence). We found no trials in relapsed or neglected cases of CTEV. A trial in which the type of presentation was not reported showed no evidence of a difference between an accelerated Ponseti and a standard Ponseti treatment in foot alignment. At the end of serial casting, the average total Pirani score in the accelerated group was 0.31 points higher than the standard group (95% CI -0.40 to 1.02; 40 participants; low-certainty evidence). No trial assessed gait using a validated assessment. Health-related quality of life was reported in some trials but data were not available for re-analysis. There is a lack of evidence for the addition of botulinum toxin A during the Ponseti technique, different types of major foot surgery or continuous passive motion treatment following major foot surgery. Most trials did not report on adverse events. Two trials found that further serial casting was more likely to correct relapse after Ponseti treatment than after the Kite technique, which more often required major surgery (risk differences 25% and 50%). In trials evaluating serial casting techniques, adverse events included cast slippage (needing replacement), plaster sores (pressure areas), and skin irritation. Adverse events following surgical procedures included infection and the need for skin grafting.

Authors' conclusions: From the evidence available, the Ponseti technique may produce significantly better short-term foot alignment compared to the Kite technique. The certainty of evidence is too low for us to draw conclusions about the Ponseti technique compared to a traditional technique. An accelerated Ponseti technique may be as effective as a standard technique, but results are based on a single small comparative trial. When using the Ponseti technique semi-rigid fibreglass casting may be as effective as plaster of Paris. Relapse following the Kite technique more often led to major surgery compared to relapse following the Ponseti technique. We could draw no conclusions from other included trials because of the limited use of validated outcome measures and the unavailability of raw data. Future RCTs should address these issues.

PubMed Disclaimer

Conflict of interest statement

SB: none known.

VP: has received consultancy fees, research grants and conference financial support for various activities unrelated to this study.

EHB: none known.

JB: Joshua Burns' research and clinical activities are funded by the Australian Department of Health (Medical Research Future Fund), US National Institutes of Health, Charcot‐Marie Tooth Association of Australia, Charcot‐Marie Tooth Association (USA), Diabetes Australia, Elizabeth Lottie May Rosenthal Bone Bequest, Perpetual Limited, Humpty Dumpty Foundation. Consultancies: Acceleron Pharma (Sept 2016).

KG: none known.

Figures

1
1
Flow diagram illustrating the study selection process.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Green = low risk of bias; yellow = unclear risk of bias; red = high risk of bias.
3
3
Forest plot of comparison: 1 Kite versus Ponseti technique for treatment of initial CTEV. Pirani score after 10 weeks of serial casting.
4
4
Forest plot of comparison: 2 Ponseti versus traditional treatment (plaster casting and surgery) for treatment of initial CTEV. Pirani score at end of initial Ponseti (serial plaster casting and tenotomy) and traditional treatment (serial plaster casting only).
5
5
Forest plot of comparison: 4 Comparison of plaster of paris and semi rigid casting at initial presentation, outcome: 4.1 Pirani score at end of casting in those awaiting tenotomy.
6
6
Forest plot of comparison: 3 Accelerated Ponseti technique versus standard Ponseti technique at unknown intervention timepoint, outcome: 3.1 Foot alignment: Pirani score at the end of serial plaster casting.
1.1
1.1. Analysis
Comparison 1: Ponseti versus Kite technique for treatment of initial CTEV, Outcome 1: Foot alignment: Pirani score at 10 weeks
2.1
2.1. Analysis
Comparison 2: Ponseti versus traditional treatment (plaster casting and surgery) for treatment of initial CTEV, Outcome 1: Foot alignment: Pirani score at end of serial plaster casting
3.1
3.1. Analysis
Comparison 3: Ponseti technique. Comparison of semi‐rigid fibreglass and plaster of Paris., Outcome 1: Foot alignment: Pirani score at end of casting in those awaiting tenotomy
4.1
4.1. Analysis
Comparison 4: Accelerated Ponseti technique versus standard Ponseti technique, Outcome 1: Foot alignment: Pirani score at the end of serial plaster casting
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Chen 2015 {published data only}
    1. Chen W, Pu F, Yang Y, Yao J, Wang L, Liu H, et al. Correcting congenital talipes equinovarus in children using three different corrective methods. Medicine 2015;94(28):e1004. [PMID: ] - PMC - PubMed
Chong 2014 {published data only}
    1. Chong DY, Finberg NS, Conklin MJ, Doyle JS, Khoury JG, Gilbert SR. Prospective evaluation of the use of Mitchell shoes and dynamic abduction brace for idiopathic clubfeet. Journal of Pediatric Orthopaedics Part B 2014;23(6):501-4. [PMID: ] - PubMed
Cummings 2009 {published data only}
    1. Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. Journal of Pediatric Orthopaedics 2009;29(6):564-9. [PMID: ] - PubMed
El‐Deeb 2007 {published data only (unpublished sought but not used)}
    1. El-Deeb KH, Ghoneim AS, El-Adwar KL, Khalil AA. Is it hazardous or mandatory to release the talocalcaneal interosseous ligament in clubfoot surgery?: a preliminary report. Journal of Pediatric Orthopaedics 2007;27(5):517-21. [PMID: ] - PubMed
Elgohary 2014 {published data only}
    1. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie 2015;25(5):949-53. [PMID: ] - PubMed
Gintautiene 2016 {published data only}
    1. Gintautiene J, Cekanauskas E, Barauskas V, Zalinkevicius R. Comparison of the Ponseti method versus early tibialis anterior tendon transfer for idiopathic clubfoot: A prospective randomized study. Medicina 2016;52(3):163-70. [PMID: ] - PubMed
Harnett 2011 {published and unpublished data}
    1. Harnett P, Freeman R, Harrison WJ, Brown LC, Backles V. An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. Journal of Bone and Joint Surgery. British Volume 2011;93-B(3):404-8. [DOI: 10.1302/0301-620X.93B3] [PMID: 21357965] - DOI - PubMed
Hui 2014 {published data only}
    1. Hui C, Joughin E, Nettel-Aguirre A, Goldstein S, Harder J, Kiefer G, et al. Comparison of cast materials for the treatment of congenital idiopathic clubfoot using the Ponseti method: a prospective randomized controlled trial. Canadian Journal of Surgery 2014;57(4):247-53. [PMID: ] - PMC - PubMed
Kaewpornsawan 2007 {published data only}
    1. Kaewpornsawan K, Khuntisuk S, Jatunarapit R. Comparison of modified posteromedial release and complete subtalar release in resistant congenital clubfoot: a randomized controlled trial. Journal of the Medical Association of Thailand 2007;90(5):936-41. [PMID: ] - PubMed
Lahoti 2008 {published and unpublished data}
    1. Lahoti O, Bajaj S. Is there a role for lengthening flexor hallucis and flexor digitorum longus tendons in surgery for club foot?: a preliminary report. Journal of Bone and Joint Surgery. British Volume 2008;90-B(6):801-2. [PMID: ] - PubMed
Manzone 1999 {published data only}
    1. Manzone P. Clubfoot surgical treatment: preliminary results of a prospective comparative study of two techniques. Journal of Pediatric Orthopaedics Part B 1999;8(4):246-50. [PMID: ] - PubMed
Maripuri 2013 {published data only}
    1. Maripuri SN, Gallacher PD, Bridgens J, Kuiper JH, Kiely NT. Ponseti casting for club foot-above-or below-knee?: a prospective randomised clinical trial. Bone & Joint Journal 2013;95-B(11):1570-4. [PMID: ] - PubMed
Pittner 2008 {published data only (unpublished sought but not used)}
    1. Pittner DE, Klingele KE, Beebe AC. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. Journal of Pediatric Orthopaedics 2008;28(2):250-3. [PMID: ] - PubMed
Rijal 2010 {published data only (unpublished sought but not used)}
    1. Rijal R, Shrestha BP, Singh GK, Singh M, Nepal P, Khanal GP, et al. Comparison of Ponseti and Kite's method of treatment for idiopathic clubfoot. Indian Journal of Orthopaedics 2010;44(2):202-7. [PMID: ] - PMC - PubMed
Sanghvi 2009 {published data only (unpublished sought but not used)}
    1. Sanghvi AV, Mittal VK. Conservative management of idiopathic clubfoot: Kite versus Ponseti method. Journal of Orthopaedic Surgery (Hong Kong) 2009;17(1):67-71. [PMID: ] - PubMed
Selmani 2012 {published data only (unpublished sought but not used)}
    1. Selmani E. Is Ponseti's method superior to Kite's for clubfoot treatment? European Orthopaedics and Traumatology 2012;3(3):183-7. [EMBASE: 368243939]
Siddiqui 2007 {published data only}
    1. Siddiqui MA, Pirwani MA, Bhura S, Soomro YH. Window procedure versus Turco procedure for the treatment of talipes equino varus. Pakistan Journal of Surgery 2007;23(3):212-6.
Sud 2008 {published data only}
    1. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti's vs. Kite's method in the treatment of clubfoot - a prospective randomised study. International Orthopaedics 2008;32(3):409-13. [PMID: ] - PMC - PubMed
Svehlik 2017 {published data only}
    1. Svehlik M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in club foot - long-term, randomized, prospective trial. Gait & Posture 2017;58:346-51. [DOI: 10.1016/j.gaitpost.2017.08.010] [PMID: ] - DOI - PubMed
Zeifang 2005 {published data only}
    1. Zeifang F, Carstens C, Schneider S, Thomsen M. Continuous passive motion versus immobilisation in a cast after surgical treatment of idiopathic club foot in infants: a prospective, blinded, randomised clinical study. Journal of Bone and Joint Surgery. British Volume 2005;87-B(12):1663-5. [PMID: ] - PubMed
Zwick 2009 {published data only (unpublished sought but not used)}
    1. Zwick EB, Kraus T, Maizen C, Steinwender G, Linhart WE. Comparison of Ponseti versus surgical treatment for idiopathic clubfoot: a short- term preliminary report. Clinical Orthopaedics and Related Research 2009;467(10):2668-76. [DOI: 10.1007/s11999-009-0819-5] [PMID: ] - DOI - PMC - PubMed

References to studies excluded from this review

Andriesse 2008 {published data only}
    1. Andriesse H, Hägglund G. Comparison of serial casting and stretching technique in children with congenital idiopathic clubfoot. Evaluation of a new system. Acta Orthopaedica 2008;79(1):53-61. - PubMed
Atar 1993 {published data only}
    1. Atar D, Lehman WB, Grant AD. Complete soft-tissue clubfoot release with and without internal fixation. Orthopaedic Review 1993;22(9):1015-6. - PubMed
Aurell 2005 {published data only}
    1. Aurell Y, Andriesse H, Johansson A, Jonsson K. Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method. Journal of Pediatric Orthopaedics, Part B 2005;14(5):347-57. - PubMed
Chang 1991 {published data only}
    1. Chang YL, Huang SC, Liu TK. Surgical management of resistant idiopathic congenital clubfoot. Journal of the Formosan Medical Association 1991;90(12):1186-93. - PubMed
Chhina 2013 {published data only}
    1. Chhina H, Howren A, Simmonds A, Alvarez CM. Onabotulinumtoxin A injections: A safety review of children with clubfoot under 2 years of age at BC Children's Hospital. Journal of the European Paediatric Neurology Society 2014;18(2):171-5. - PubMed
DePuy 1989 {published data only}
    1. DePuy J, Drennan JC. Correction of idiopathic clubfoot: a comparison of results of early versus delayed posteromedial release. Journal of Pediatric Orthopedics 1989;9(1):44-8. - PubMed
DeRosa 1986 {published data only}
    1. DeRosa GP, Stepro D. Results of posteromedial release for the resistant clubfoot. Journal of Pediatric Orthopedics 1986;6(5):590-5. - PubMed
Derzsi 2015 {published data only}
    1. Derzsi Z, Nagy O, Gozar H, Gurzu S, Pop TS. Kite versus Ponseti method in the treatment of 235 feet with idiopathic clubfoot. Medicine 2015;94(33):1-4. [DOI: 10.1097/MD.0000000000001379] - DOI - PMC - PubMed
Diméglio 1996 {published data only}
    1. Dimégio A, Bonnet F, Mazeau P, De Rosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot. Journal of Pediatric Orthopaedics Part B 1996;5(3):173-80. - PubMed
Dobbs 2017 {published data only}
    1. Dobbs MB, Frick SL, Mosca VS, Raney E, VanBosse HJ, Lerman JA, et al. Design and descriptive data of the randomized Clubfoot Foot Abduction Brace Length of Treatment Study (FAB24). Journal of Pediatric Orthopaedics 2017;26(2):101-7. - PubMed
Doğan 2002 {published data only}
    1. Doğan A, Bagatur AE, Zorer G. The effect of deep deltoid ligament release on dorsiflexion in congenital clubfoot treated with complete subtalar release. Acta Orthopaedica et Traumatologica Turcica 2002;36(3):248-55. - PubMed
Farsetti 2009 {published data only}
    1. Farsetti P, De Maio F, Russolillo L, Ippolito E. CT study on the effect of different treatment protocols for clubfoot pathology. Clinical Orthopaedics and Related Research 2009;467(5):1243-9. - PMC - PubMed
Faulks 2009 {published data only}
    1. Faulks S, Richards BS. Clubfoot treatment: Ponseti and French functional methods are equally effective. Clinical Orthopaedics and Related Research 2009;467(5):1278-82. - PMC - PubMed
Gupta 2014 {published data only}
    1. Gupta S, Kanojia RK, Lohia L. Comparative study of posteromedial release and complete subtalar release in resistant/recurrent congenital talipes equinovarus foot: A 5-year follow-up study. Current Orthopaedic Practice 2014;25(1):43-52. [DOI: 10.1097/BCO.0000000000000040] - DOI
Halanski 2010 {published data only}
    1. Halanski MA, Davison JE, Huang JC, Walker CG, Walsh SJ, Crawford HA. Ponseti method compared with surgical treatment of clubfoot: a prospective comparison. Journal of Bone and Joint Surgery. American Volume 2010;92(2):270-8. - PubMed
Hallaj‐Moghadam M 2015 {published data only}
    1. Hallaj-Moghadam M, Moradi A, Ebrahimzadeh MH. Clinical outcome of posteromedial versus posteromedial-lateral release for clubfoot. Journal of Pediatric Orthopaedics 2015;24(1):24-27. [DOI: 10.1097/BPB.0000000000000124] - DOI - PubMed
Howren 2015 {published data only}
    1. Howren AM, Jamieson DH, Alvarez CM. Early ultrasonographic evaluation of idiopathic clubfeet treated with manipulations, casts, and Botox: a double-blinded randomized control trial. Journal of Child Orthopaedics 2015;9(1):85-91. [DOI: 10.1007/s11832-015-0633-4] - DOI - PMC - PubMed
Ippolito 2003 {published data only}
    1. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. Journal of Bone and Joint Surgery. American Volume 2003;85-A(7):1286-94. - PubMed
Janicki 2011 {published data only}
    1. Janicki JA, Wright JG, Weir S, Narayanan UG. A comparison of ankle foot orthoses with foot abduction orthoses to prevent recurrence following correction of idiopathic clubfoot by the Ponseti method. Journal of Bone and Joint Surgery. British Volume 2011;93-B(5):700-4. - PubMed
Kesemenli 2003 {published data only}
    1. Kesemenli CC, Kapukaya A, Subaşi M, Necmioglu S, Arslan H, Ozbag D, et al. Anthropometric study of patients treated for clubfoot. Journal of Pediatric Orthopedics 2003;23(4):498-502. - PubMed
Kuo 2001 {published data only}
    1. Kuo KN, Hennigan SP, Hastings ME. Anterior tibial tendon transfer in residual dynamic clubfoot deformity. Journal of Pediatric Orthopedics 2001;21(1):35-41. - PubMed
Li 2007 {published data only}
    1. Li L, Zhang L, Wang E. Comparison of long-term results between muscle-strength balancing procedure and McKay procedure in treating congenital clubfoot. Chinese Journal of Reparative and Reconstructive Surgery 2007;21(10):1108-12. - PubMed
Lohia 2014 {published data only}
    1. Lohia LK, Meena S, Kanjia RK. Comparative study of complete subtalar release and Joshi's external stabilization system in the management of neglected and resistant idiopathic clubfoot. Foot and Ankle Surgery 2014;21(1):16-21. [DOI: 10.1016/j.fas.2014.08.007] - DOI - PubMed
Matuszewski 2012 {published data only}
    1. Matuszewski L, Gil L, Karski J. Early results of treatment for congenital clubfoot using the Ponseti method. European Journal of Surgery Traumatology 2012;22(5):403-6. [DOI: 10.1007/s00590-011-0860-4] - DOI - PMC - PubMed
Miura 2005 {published data only}
    1. Miura Y, Kamegaya M, Saisu T, Moriya H. Effect of postoperative early ankle motion exercise using hinged ankle-foot orthoses in clubfoot. Journal of Pediatric Orthopedics 2005;25(4):529-32. - PubMed
Napiontek 2000 {published data only}
    1. Napiontek M. Muscular strength after extensive operative treatment of congenital talipes equinovarus. Journal of Pediatric Orthopaedics, Part B 2000;9(2):128-36. - PubMed
Narang 2011 {published data only}
    1. Narang AS, Singh H, Sharma V, Khare S. Comparison of short term results of JESS distractor and one stage posteriomedial release for neglected, resistant and relapsed or recurrent club foot. Journal of Orthopaedics 2011;8(4):e8.
Nilgün 2011 {published data only}
    1. Nilgün B, Suat E, Engin ŞÍ, Fatma U, Yakut Y. Short-term results of intensive physiotherapy in clubfoot deformity treated with the Ponseti method. Pediatrics International 2011;53(3):381-5. - PubMed
O'Brien 2004 {published data only}
    1. O'Brien SE, Karol LA, Johnston CE 2nd. Calcaneus gait following treatment for clubfoot: preliminary results of surgical correction. Journal of Pediatric Orthopaedics, Part B 2004;13(1):43-7. - PubMed
Ponseti 2006 {published data only}
    1. Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA. Treatment of the complex idiopathic clubfoot. Clinical Orthopaedics and Related Research 2006;451:171-6. - PubMed
Richards 2008 {published data only}
    1. Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CB, Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. Journal of Bone and Joint Surgery. American Volume 2008;90(11):2313-21. - PubMed
Shingade 2014 {published data only}
    1. Shingade VU, Shingade RV, Ughade SN. Single-stage correction for clubfoot associated with myelomeningocele in older children: early results. Current Orthopaedic Practice 2014;25(1):64-70. [DOI: 10.1097/BCO.0000000000000059] - DOI
Simons 1985 {published data only}
    1. Simons GW. Complete subtalar release in club feet. Part II - Comparison with less extensive procedures. Journal of Bone and Joint Surgery. American Volume 1985;67(7):1056-65. - PubMed
Steinman 2009 {published data only}
    1. Steinman S, Richards BS, Faulks S, Kaipus K. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. Surgical technique. Journal of Bone and Joint Surgery. American Volume 2009;91(Suppl 2):299-312. - PubMed
Thompson 1982 {published data only}
    1. Thompson GH, Richardson AB, Westin GW. Surgical management of resistant congenital talipes equinovarus deformities. Journal of Bone and Joint Surgery. American Volume 1982;64(5):562-5. - PubMed
Tschopp 2002 {published data only}
    1. Tschopp O, Rombouts JJ, Rossillon R. Comparison of posteromedial and subtalar release in surgical treatment of resistant clubfoot. Orthopedics 2002;25(5):527-9. - PubMed
Uglow 2000 {published data only}
    1. Uglow MG, Clarke NM. The functional outcome of staged surgery for the correction of talipes equinovarus. Journal of Pediatric Orthopedics 2000;20(4):517-23. - PubMed
Xu 2011 {published data only}
    1. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report. Journal of Pediatric Orthopedics 2011;31(3):317-9. - PubMed

References to ongoing studies

Madhuri 2018 {published data only}
    1. Comparison of 2 different types of splints in children with corrected CTEV, Dobbs versus Denis Browne splint. Ongoing study. 1 November 2013. Contact author for more information.
NCT03249805 {unpublished data only}
    1. NCT03249805. MiracleFeet foot abduction brace sensor trial (mFAB) [Efficacy of a new design of foot abduction brace (FAB) compared to standard FAB during Ponseti treatment of idiopathic clubfoot by measuring rate of recurrence and compliance using novel touch sensors]. https://clinicaltrials.gov/ct2/show/NCT03249805 (first received 15 August 2017).

Additional references

Alvarez 2005
    1. Alvarez CM, Tredwell SJ, Keenan SP, Beauchamp RD, Choit RL, Sawatzky BJ, et al. Treatment of idiopathic clubfoot utilizing botulinum A toxin: a new method and its short-term outcomes. Journal of Pediatric Orthopaedics 2005;25(2):229-35. - PubMed
Atar 1992
    1. Atar D, Lehman WB, Grant AD, Strongwater AM. Revision surgery in clubfeet. Clinical Orthopaedics and Related Research 1992;283:223-30. - PubMed
Beatson 1966
    1. Beatson TR, Pearson JR. A method of assessing correction in club feet. Journal of Bone and Joint Surgery 1966;48(B):40-50. - PubMed
Bryant 2006
    1. Bryant D, Havey TC, Roberts R, Guyatt G. How many patients? How many limbs? Analysis of the patients or limbs in the orthopaedic literature: a systematic review. Journal of Bone and Joint Surgery 2006;88(1):41-5. [DOI: 10.2106/JBJS.E.00272] - DOI - PubMed
Cooper 1995
    1. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty year follow-up note. Journal of Bone and Joint Surgery. American Volume 1995;77-A(10):1447-89. - PubMed
Cusick 1990
    1. Cusick B. Serial Casts: Their Use in the Management of Spasticity-Induced Foot Deformity. Tuscon, Arizona: Communication Skill Builders, 1990.
De Gheldere 2008
    1. De Gheldere A, Docquier PL. Analytical radiography of clubfoot after tenotomy. Journal of Pediatric Orthopaedics 2008;28(6):691-4. - PubMed
Deeks 2017
    1. Deeks JJ, Higgins JP, Altman DG, editor(s) on behalf of the Cochrane Statistical Methods Group. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), The Cochrane Collaboration, 2017. Available from www.training.cochrane.org/handbook.
Dietz 2006
    1. Dietz FR. Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique. Instructional Course Lectures 2006;55:625-9. - PubMed
Dietz 2009
    1. Dietz FR, Tyler MC, Leary KS, Damiano PC. Evaluation of a disease-specific instrument for idiopathic clubfoot outcome. Clinical Orthopaedics and Related Research 2009;467(5):1256-62. - PMC - PubMed
Diméglio 1995
    1. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. Journal of Pediatric Orthopaedics. Part B 1995;4(2):129-36. - PubMed
Dobbs 2000
    1. Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. Iowa Orthopaedic Journal 2000;20:59-64. - PMC - PubMed
Dobbs 2006
    1. Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. Journal of Bone and Joint Surgery. American Volume 2006;88(5):986-96. - PubMed
Dobbs 2009
    1. Dobbs M, Gurnett CA. Update on clubfoot: etiology and treatment. Clinical Orthopaedics and Related Research 2009;467(5):1146-53. [DOI: 10.1007/s11999-009-0734-9] - DOI - PMC - PubMed
Farsetti 2006
    1. Farsetti P, Caterini R, Mancini F, Potenza V, Ippolito E. Anterior tibial tendon transfer in relapsing congenital clubfoot: long-term follow-up study of two series treated with a different protocol. Journal of Pediatric Orthopaedics 2006;26(1):83-90. - PubMed
Fridman 2007
    1. Fridman MW, De Almeida Fialho HS. The role of radiographic measurements in the evaluation of congenital clubfoot surgical results. Skeletal Radiology 2007;36(2):129-38. - PubMed
GRADEpro GDT 2016 [Computer program]
    1. McMaster University (developed by Evidence Prime) GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), accessed 6 August 2016.Available at gradepro.org.
Graf 2010
    1. Graf A, Hassani S, Krzak J, Long J, Caudill A, Flanagan A, et al. Long-term outcome evaluation in young adults following clubfoot surgical release. Journal of Pediatric Orthopaedics 2010;30(4):379-85. - PubMed
Gray 2014a
    1. Gray K, Barnes E, Gibbons P, Little D, Burns J. Unilateral versus bilateral clubfoot: an analysis of severity and correlation. Journal of Pediatric Orthopaedics B 2014;23(5):397-9. [DOI: 10.1097/BPB.0000000000000064] - DOI - PubMed
Gray 2014b
    1. Gray K, Burns J, Little D, Bellemore M, Gibbons P. Is tibialis anterior tendon transfer effective for recurrent clubfoot? Clinical Orthopaedics and Related Research 2014;472(2):750-8. [DOI: 10.1007/s11999-013-3287-x] - PMC - PubMed
Grimes 2016
    1. Grimes CE, Holmer H, Maraka J, Ayana B, Hansen L, Lavy CB. Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the Ponseti method. BMJ Global Health 2016;26(1):1-5. [DOI: 10.1136/bmjgh-2015-000023] - DOI - PMC - PubMed
Hackshaw 2011
    1. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Human Reproductiion Update 2011;17(5):589-604. [DOI: 10.1093/humupd/dmr022] - DOI - PMC - PubMed
Haft 2007
    1. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. Journal of Bone and Joint Surgery. American Volume 2007;89-A(3):487-93. - PubMed
Halanski 2009
    1. Halanski MA, Huang JC, Walsh SJ, Crawford HA. Resource utilization in clubfoot management. Clinical Orthopaedics and Related Research 2009;5:1171-9. Erratum in: Clinical Orthopedics and Related Research 2010 Apr;468(4):1186. - PMC - PubMed
Halanski 2010a
    1. Halanksi MA, Davison JE, Huang JC, Walker CG, Walsh SJ, Crawford HA. Ponseti method compared with surgical treatment of clubfoot: a prospective comparison. Journal of Bone and Joint Surgery. American Volume 2010;92(2):270-8. [DOI: 10.2106/JBJS.H.01560] - DOI - PubMed
Halanski 2010b
    1. Halanski MA, Maples DL, Davison JE, Huang JC, Crawford HA. Separating the chicken from the egg: an attempt to discern between clubfoot recurrences and incomplete corrections. Iowa Orthopaedic Journal 2010;20:29-34. [21045968] - PMC - PubMed
Harrold 1983
    1. Harrold AJ, Walker CJ. Treatment and prognosis in congenital clubfoot. Journal of Bone and Joint Surgery. British Volume. 1983;65-B:8-11. - PubMed
Higgins 2011
    1. Higgins JP, Deeks JJ. Chapter 7: Selecting studies and collecting data. in: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 (update March 2011). The Cochrane Collaoration, 2011. Available from www.training.cochrane.org/handbook.
Higgins 2017
    1. Higgins JP, Altman DG, Sterne JA, editor(s). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), The Cochrane Collaboration, 2017. Available from www.training.cochrane.org/handbook.
Higgins 2019
    1. Higgins JP, Eldridge S, Li T, editor(s). Chapter 23: Including variants on randomized trials. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). The Cochrane Collaboration, 2019. Available from www.training.cochrane.org/handbook.
Janicki 2009
    1. Janicki JA, Narayanan UG, Harvey B, Roy A, Ramseier LE, Wright JG. Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method. Journal of Pediatric Orthopaedics 2009;29(4):393-7. - PubMed
Keret 2002
    1. Keret D, Ezra E, Lokiec F, Hayek S, Segev E, Wientroub S. Efficacy of prenatal ultrasonography in confirmed club foot. Journal of Bone and Joint Surgery. British Volume 2002;84(7):1015-9. - PubMed
Kite 1972
    1. Kite JH. Non operative treatment of congenital clubfoot. Clinical Orthopaedics and Related Research 1972;84:29-38. - PubMed
Laaveg 1980
    1. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. Journal of Bone and Joint Surgery. American Volume 1980;62(1):23-31. - PubMed
Landgraf 1999
    1. Landgraf JM, Abetz L, Ware JE. The Child Health Questionnaire (CHQ): A User's Manual (2nd printing). Boston, MA: HealthAct, 1999.
Lesaffre 2010
    1. Lesaffre E, Philstrom B, Needleman I, Worthington H. The design and analysis of split-mouth studies: what statisticians and clinicians should know. Statistics in Medicine 2009;28(28):3470-82. [DOI: 10.1002/sim.3634] - DOI - PubMed
Lovell 1979
    1. Lovell WW, Farley D. Treatment of congenital clubfoot. ONA Journal 1979;6(11):453-6. - PubMed
Lovell 2007
    1. Lovell ME, Morcuende JA. Neuromuscular disease as the cause of late clubfoot relapses: report of 4 cases. Iowa Orthopaedic Journal 2007;27:82-4. - PMC - PubMed
Marquez 2017
    1. Marquez E, Pacey V, Chivers A, Gibbons P, Gray K. The Ponseti technique and improved ankle dorsiflexion in children with relapsed clubfoot: a retrospective data analysis. Journal of Pediatric Orthopaedics B 2017;26(2):116-21. [DOI: ] - PubMed
Masrouha 2012
    1. Masrouha KZ, Morcuende JA. Relapse after tibialis anterior tendon transfer in idiopathic clubfoot treated by the Ponseti method. Journal of Pediatric Orthopedics 2012;32(1):81-4. - PubMed
McKay 1983
    1. McKay DW. New concept of and approach to clubfoot treatment. Section III: evaluation and results. Journal of Pediatric Orthopedics 1983;3:10-21. - PubMed
Morcuende 2004
    1. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113(2):376-80. - PubMed
Nogueira 2009
    1. Nogueira MP, Ey Batlle AM, Alves CG. Is it possible to treat recurrent clubfoot with the Ponseti technique after posteromedial release? Clinical Orthopaedics and Related Research 2009;467(5):1298-305. [DOI: 10.1007/s11999-009-0718-9] - DOI - PMC - PubMed
Pavone 2018
    1. Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The eitiology of idopathic congenital talipes equinovarus: a systematic review. Journal of Orthopaedic Surgery and Research 2018;13:206. [DOI: ] - PMC - PubMed
Perera 2007
    1. Perera R, Glasziou P. A simple method to correct for the design effect in systematic review of trials using paired dichotomous data. Journal of Clinical Epidemiology 2007;60(9):975-8. [DOI: 10.1016/j.jclinepi.2006.12.004] - DOI - PubMed
Pirani 2001
    1. Pirani S, Zeznik L, Hodges D. Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. Journal of Pediatric Orthopaedics 2001;21(6):719-26. - PubMed
Pirani 2008
    1. Pirani S, Hodges D, Sekeramayi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. Journal of Bone and Joint Surgery. British Volume 2008;90-B(Supp Ⅰ):53.
Ponseti 2005
    1. Ponseti I, Morcuende J, Mosca V, Pirani S, Dietz F, Herzenberg J, et al. Clubfoot: Ponseti Management. 2nd edition. Global-HELP Organization, 2005.
Radler 2007
    1. Radler C, Manner HM, Suda R, Burghardt R, Herzenberg JE, Ganger R, et al. Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. Journal of Bone and Joint Surgery. American Volume 2007;89(6):1177-83. - PubMed
Redmond 2006
    1. Redmond AC, Crosbie J, Ourvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clinical Biomechanics 2006;21(1):89-98. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Richards 2007
    1. Richards BS, Dempsey M. Magnetic resonance imaging of the congenital clubfoot treated with the French functional (physical therapy) method. Journal of Pediatric Orthopaedics 2007;27(2):214-9. - PubMed
Schünemann 2017a
    1. Schünemann HJ, Oxman AD, Higgins JP, Vist GE, Glasziou P, Akl E, et al, on behalf of the Cochrane GRADEing Methods Group and the Cochrane Statistical Methods Group. Chapter 11: Completing ‘Summary of findings’ tables and grading the confidence in or quality of the evidence. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). The Cochrane Collaboration, 2017. Available from www.training.cochrane.org/handbook.
Schünemann 2017b
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al, on behalf of the Cochrane Applicability and Recommendations Methods Group. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). The Cochrane Collaboration, 2017. Available from www.training.cochrane.org/handbook.
Sterne 2017
    1. Sterne JA, Egger M, Moher D, Boutron I, editor(s). Chapter 10: Addressing reporting biases. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), The Cochrane Collabration, 2017. Available from www.training.cochrane.org/handbook.
Van Praag 2018
    1. Van Praag VM, Lysenko M, Harvey B, Yankanah R, Wright JG. Casting is effective for recurrence following Ponseti treatment of clubfoot. Journal of Bone and Joint Surgery. American Volume 2018;100(12):1001-8. [DOI: 10.2106/JBJS.17.01049] - DOI - PMC - PubMed
Ware 1992
    1. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Medical Care 1992;30(6):473-83. - PubMed
Zionts 2010
    1. Zionts LE, Zhao G, Hitchcock K, Maewal J, Ebramzadeh E. Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States? Journal of Bone and Joint Surgery. American Volume 2010;92(4):882-9. - PubMed

References to other published versions of this review

Gray 2010
    1. Gray K, Pacey V, Gibbons P, Little D, Burns J. Interventions for congenital talipes equinovarus. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD008602] - DOI - PMC - PubMed
Gray 2012
    1. Gray K, Pacey V, Gibbons P, Little D, Frost C, Burns J. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD008602.pub2] - DOI - PubMed
Gray 2014
    1. Gray K, Pacey V, Gibbons P, Little D, Burns J. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database of Systematic Reviews 2014, Issue 8. [DOI: 10.1002/14651858.CD008602.pub3] - DOI - PMC - PubMed

Publication types

Substances

LinkOut - more resources