Source:

Zionts
LE
,
Ebramzadeh
E
,
Morgan
RD
, et al
.
Sixty years on: Ponseti method for clubfoot treatment produces high satisfaction despite inherent tendency to relapse
.
J Bone Joint Surg Am
.
2018
;
100
(
9
):
721
728
; doi:
https://doi.org/10.2106/JBJS.17.01024

Investigators from the University of California Los Angeles conducted a prospective study to assess outcomes in children with idiopathic clubfoot deformity treated using the Ponseti method. For the study, consecutive children with clubfeet treated with the Ponseti method at a single center between 2006 and 2012 were enrolled. Only patients treated prior to 3 months of age and followed until at least 5 years of age were included. The Ponseti method consisted of manipulation of the clubfoot with weekly casting to obtain initial correction. A heel-cord tenotomy was performed if there was <15° of ankle dorsiflexion. Following casting, children were treated with braces, 23 hours a day for 3 months, with bracing at naptime and bedtime until 4 years of age. In addition to clinical and demographic data, parents were asked if they were non-adherent to recommendations regarding use of bracing and completed the Roye disease-specific instrument questionnaire, a validated instrument assessing overall satisfaction, appearance of the foot, pain, and physical limitation. T-tests were used to assess the relationship between severity of initial deformity (using a standardized scale), adherence to bracing recommendations, and duration of bracing and casting with whether additional surgery was needed beyond an initial Achilles tenotomy.

Data were analyzed on 101 patients (147 clubfeet) with a mean length of follow-up of 81.1 + 17.1 months; 72% of study patients were boys. An initial heel-cord tenotomy was performed in 95 patients. All study children achieved an initial correction of their clubfoot deformity, but 68 (67%) had at least one relapse. Among patients with a relapse, 30 children (45 clubfeet) were treated with manipulation and recasting and 38 (56 feet) underwent surgical tendon transfer. Among the 37 children whose parents reported being adherent to bracing recommendations, 27% required additional surgery versus 44% of those whose parents were non-adherent at least once during treatment (P=.07). Both the severity of the initial deformity (P=.04) and the age of the child when bracing was discontinued were significantly associated with a need for additional surgery (mean values: 3.7 years for those with further surgery and 4.1 years for those without, P<.01). Duration of casting was not associated with subsequent additional surgical treatment (P=.64). Overall, parents of 83.2% of study children were very satisfied with their child’s foot, 75.2% were very satisfied with the appearance of the foot, 58.4% indicated that their child did not complain of pain in their foot, and 81.2% and 75.2%, respectively, reported no limitation with walking and running in their child.

The authors conclude that despite satisfactory initial results in treating children with clubfoot using the Ponseti method, there is a high rate of subsequent relapse.

Dr Hennrikus has disclosed no financial...

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