The Ponseti method of treatment for neuromuscular and syndromic (non-idiopathic) clubfeet: evaluation of a programme-based approach at a mean follow-up of 5.8 years
- PMID: 32651710
- DOI: 10.1007/s00264-020-04677-9
The Ponseti method of treatment for neuromuscular and syndromic (non-idiopathic) clubfeet: evaluation of a programme-based approach at a mean follow-up of 5.8 years
Abstract
Purpose: To analyse the results of the Ponseti method in the treatment of non-idiopathic clubfeet and compare them with idiopathic clubfeet in a programme-based setting using a standardized protocol METHODS: We reviewed two groups of 782 children treated prospectively in our programme-based Clubfoot Clinic: group I comprised of 89 patients (146 feet) with non-idiopathic clubfoot and group II comprised of 693 patients (1032 feet) with idiopathic clubfoot. Both groups were compared on the basis of patient demographics, number of casts, tenotomy rate, success rate, rate of recurrences, and the need for additional secondary procedures.
Results: Non-idiopathic clubfeet had a higher incidence of bilateral involvement (p = 0.0093) and affected both males and females equally (p = 0.002) as compared with idiopathic clubfeet. Non-idiopathic clubfeet (group I) required significantly more casts (6.75 ± 4.2) compared with idiopathic clubfeet (4.23 ± 4.14), had a higher rate of Achilles tenotomy (90.4% vs 75%, p < 0.0001), and had a lower initial correction rate compared with idiopathic clubfeet (92.5% vs 100%, p < 0.0001). There was a significant difference in the recurrence rates between the two groups, as 42.5% of non-idiopathic feet (38 patients) relapsed compared with 10.2% (71 patients) in the idiopathic group (p < 0.0001). Most recurrences in group I were amenable to re-casting, with only nine patients (14 non-idiopathic clubfeet) requiring extensive soft tissue releases. The final success rate in the non-idiopathic group at a mean follow-up of 5.8 years (2-8 years) was 87.7%.
Conclusions: We recommend the use of the Ponseti method as an effective treatment for non-idiopathic clubfeet associated with neuromuscular and syndromic conditions.
Keywords: Clubfoot; Neuromuscular; Non-idiopathic; Ponseti; Programme-based treatment; Syndromic.
References
-
- Smythe T, Kuper H, Macleod D et al (2017) Birth prevalence of congenital talipes equinovarus in low-and middle-income countries: a systematic review and meta-analysis. Tropical Med Int Health 22(3):269–285. https://doi.org/10.1111/tmi.12833
-
- Ponseti IV (1996) Congenital club foot: fundamental of treatment. Oxford University Press, Oxford
-
- Morcuende JA, Dolan LA, Dietz FR et al (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113(2):376–380 - PubMed
-
- Radler C (2013) The Ponseti method for the treatment of congenital club foot: review of the current literature and treatment recommendations. Int Orthop 37(9):1747–1753. https://doi.org/10.1007/s00264-013-2031-1 - PubMed - PMC
-
- Dobbs MB, Gurnett CA (2009) Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 467(5):1146–1153. https://doi.org/10.1007/s11999-009-0734-9 - PubMed - PMC
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