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Treatment of Clubfoot with the Ponseti Method: Should We Begin Casting in the Newborn Period or Later?
Abstract
The Ponseti method has become accepted worldwide as the treatment of choice for nonoperative management of clubfoot. However, there has been no research on whether casting should begin in the newborn period (< or = 30 days old) or later (> 30 days but < 1 year old) or on whether the length of the foot at the beginning of casting is predictive of the outcome of therapy. Therefore, we conducted an investigation to compare outcomes in patients started on casting therapy in the newborn period or later. Outcomes were based on Pirani and Diméglio scores. The study population was comprised of 40 clubfeet in 29 consecutive infants with no associated neuromuscular disease, who underwent Ponseti treatment. The median follow-up was 34 months (range, 20-47 months). Casting began in the newborn period on 26 feet of 18 patients (newborn group), and after 1 month of age on 14 feet of 11 patients (older infant group). Final Diméglio scores were significantly worse for the patients whose casts were applied in the newborn period, compared with those who had the first cast applied at a time >30 days postpartum (P = .04). Infants with feet > or =8 cm in length at the start of cast treatment had better final Diméglio scores than those with feet <8 cm. Our findings suggest that casting according to the Ponseti method should begin in infants older than 1 month of age, or with an involved foot > or =8 cm in length.
... After deformity corrections, the total Pirani scores often drop to zero. This finding is in agreement with those by other authors [11,38]. This statistic on mid-foot and hind-foot scores as recorded in this study is in agreement with the values recorded by Mejabi et al., in Ile Ife, Nigeria, and by Iltar et al., in Turkey [11,38]. ...
... This finding is in agreement with those by other authors [11,38]. This statistic on mid-foot and hind-foot scores as recorded in this study is in agreement with the values recorded by Mejabi et al., in Ile Ife, Nigeria, and by Iltar et al., in Turkey [11,38]. As stated by these authors, it means that the progress of treatment of clubfoot, even in our environment, can be assessed using the Pirani scoring system [11]. ...
... It is not clear why the right foot Pirani scores did not positively correlate with severity (p > 0.05), and this may well be a chance occurrence. This study showed more severe cases of clubfoot than the ones reviewed by Mejabi et al., and Itlar et al., [11,38]. This may be as a result of the higher age of patients in our sample population compared with the patients reviewed by these authors, whose patients were mainly in the neonatal period or in the infancy period within the first year of life. ...
Background: Congenital talipes equinovarus imposes some functional compromise on the foot, resulting in structural
adaptation or modification of the local anatomy in conformity with the direction of the structural stress that subserves
the abnormal function. The success or otherwise of treatment is a measure of the degree of reversal of these structural
adaptations and functional deficits. The aim of this study was to evaluate the early treatment outcome in the background
of late presentation among subjects in a new clubfoot program of a Nigerian university teaching hospital.
Methodology: A 6-month prospective, descriptive and health facility-based cross-sectional study of early treatment
outcome of congenital talipes equinovarus among children in a Nigerian university teaching hospital is presented.
Results: Sixty-seven children met the inclusion criteria and were recruited for this study. There was a slight
preponderance of males over the females, with a male to female ratio of 1.6: 1. The mean age of the study population
was 31.6 ± 23.64 months. In 45 (67.2%) children, the clubfoot was bilateral and unilateral in 22 (32.8%). Idiopathic
clubfoot was the commonest variant at the rate of 70.1%. Thirty-nine (58.2%) had percutaneous tenotomy (Achilles
tendon tenotomy), while 28 (41.8%) did not. The mean of the total initial Pirani score (4.61±1.18) was higher than that
of the total final Pirani score (0.81 ± 0.49), with p < 0.001. The mean Pirani score of the left foot (4.78 ± 1.08) in the
subjects who had percutaneous tenotomy was higher than that of subjects (3.83 ± 1.88) who did not have percutaneous
tenotomy (p = 0.03). The odd of subjects with callosity to achieve correction at 10 or more cast was 11.8 times that of
the subjects without callosity. On a logistic regression model, total initial Pirani score and callosity were independently
significant (p < 0.05) in being associated with ≥10 castings for correction. For a unit increase in total initial Pirani score,
the relative risk ratio of requiring ≥10 cast was 3.49 when the other variables are held constant in the logistic regression
model. The relative risk ratio of requiring ≥10 cast for correction increased by 1.03 for a unit monthly increase in the
age of the subject.
Conclusion: Late presentation of clubfoot for treatment was common in this study. The Pirani score remained a reliable
tool for assessing severity and monitoring treatment of clubfoot, and was valid across all age groups of clubfoot subjects
seen in this study. In this study, it predicted the need or otherwise for percutaneous tenotomy, and correlated positively
with the number of casting sessions required for correction.
Keywords: congenital clubfoot; late presentation; pirani score
... Our study cohort showed male to female ratio of 1.8:1, and male predominance was also observed by most other studies. [12][13][14][15][16][17] We noted slightly less than half of the babies had bilateral CTEV (42.6%). Although this was consistent with most other studies, [13][14][15]17,18 a few studies reported more bilateral involvements. ...
... [12][13][14][15][16][17] We noted slightly less than half of the babies had bilateral CTEV (42.6%). Although this was consistent with most other studies, [13][14][15]17,18 a few studies reported more bilateral involvements. 19,20 We have slightly more babies who started treatment more than one month after birth (Group 2) compared to those who were treated early (Group 1). ...
... In this study the mean number of cast changes for all babies was 5.83, and this was consistent with many other studies that reported between 5 to 6 cast changes. 10,12,13,[21][22][23][24] There was no significant difference in the rate of cast changes between those started on treatment before or after one month of age. Slightly more than half (66.2%) of the clubfeet had percutaneous heel cord tenotomis. ...
Introduction:
Most of the authors currently agree that congenital talipes equinovarus (CTEV) or idiopathic clubfoot can be effectively treated with the Ponseti method instead of extensive soft tissue surgery. This study was conducted to investigate whether there is a difference in the outcome between starting treatment before one month of age or after that age.
Methods:
This is a retrospective study on babies with CTEV treated in University Malaya Medical Centre from 2013 to 2017. The 54 babies (35 boys and 19 girls) were divided into two cohorts, Group 1 that had treatment before the age of one month, and Group 2 that had treatment after one month old. The number of cast changes, rate of full correction, and rate of relapse after treatment were compared between the two groups.
Results:
Of the 54 babies, with 77 CTEV treated during the period, our outcome showed that the mean number of cast change was 5.9 for Group 1 and 5.7 for Group 2. The difference was not statistically significant. All the affected feet (100%) achieved full correction. One foot in the Group 1 relapsed, while three feet in Group 2 relapsed, but the difference was also not statistically significant. All of the relapsed feet were successfully treated with repeated Ponseti method.
Conclusions:
Treating CTEV using Ponseti method starting after one month was not associated with more casting change of higher rate of relapse.
... Ponseti recommended starting the treatment within the first days of life due to the malleable properties of the fibroelastic connective tissue of the tendons, joint capsules, and ligaments [26]. Iltar et al. [27] proposed to start the treatment 1 month after birth or when the foot length grew to a minimum of 8 cm or more. It was reported that starting the Ponseti treatment after 20 months resulted in less degree of improvement in the varus adductus and medial rotation of the calcaneopedal block [28]. ...
Clubfoot is one of the most common congenital orthopedic disorders that is characterized by four structural deformities. The treatment of clubfoot could be conservative or surgical; however, conservative modalities should be the initial option for the management of clubfoot. The Ponseti method is a conservative modality. Thus, this review was conducted to assess the outcomes of the Ponseti method in the treatment of clubfoot by reviewing the previous studies conducted on this subject. Google Scholar and PubMed databases were explored for scientific articles using different keywords, including "clubfoot, treatment, management, outcomes , and Ponseti method." Original articles focused on the treatment of clubfoot by the Ponseti method that was in English and available full-text articles were eligible for the analysis. After refining the findings, only nine articles were found eligible as per the inclusion criteria. The 9 studies included a total number of 884 children. It was found that children were suffering from idiopathic clubfoot, neglected clubfoot, idiopathic and flexible clubfoot, complex clubfoot, or undefined clubfoot. The Ponseti method is found effective and safe for the management of clubfoot, even for neglected clubfoot in older children with few complications and decreased rate of relapse.
... Club foot is a common musculoskeletal deformity in our environment, 7 and Ponseti treatment protocol is the current standard of care globally. 8 The age range of the forty-one patients studied was 1 to 104 weeks, with a median age of 6.4 weeks. Comparable with the mean age at initial presentation of 6. 7 weeks of the study of Sharma A, et al. 9 This is rather late when compared with figures obtained by workers in developed world such as Zimmerman et al. 10 and Brewster et al. 11 Late presentation as seen in our study may be due to lack of awareness among the parents, low socioeconomic status and ignorance regarding the club foot. ...
BACKGROUND Pirani scoring system is one of the classification systems in management of club foot which is simple and easy to use. However, there is paucity of studies using Pirani system to determine the severity and monitor progress in the treatment of club foot. We therefore set out with the aim of assessing severity and monitoring the progress of treatment using the Pirani scoring system. The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. METHODS It was a hospital-based prospective study of 57 club foot in 41 patients designed to evaluate the role of Pirani score in deformity assessment and management of club foot by Ponseti method. Consecutive patients presenting at the outpatient department at SVRRGGH, Tirupati with idiopathic club foot, and in-patients department with idiopathic club foot were recruited into the study. Informed consent was obtained from parents/guardians of the patients that were recruited in the study. This was a prerequisite for obtaining the ethical approval. Data collected from the study groups was entered into a worksheet, and analysis was performed using the statistical package for social sciences (SPSS) software for windows version 21. Significant statistical inferences were drawn at p & lt ; 0.05. RESULTS The correlation between the midfoot score, hindfoot score, Pirani score and the number of casts to achieve correction was significant (P = 0.001). Also, there was correlation between the Pirani score and the need for tenotomy (P = 0.001); between the number of casts to achieve correction and the need for tenotomy (P = 0.001). Moreover, the progress of treatment can be monitored with the Pirani score (P = 0.001). CONCLUSIONS Pirani scoring system is a simple, easy, quick and reliable system to determine severity and monitor progress in the treatment of club foot with excellent interobserver variability. KEYWORDS Pirani Score, Club Foot, Ponseti Method
... Their results showed that, compared with age, the effect of initial Pirani score on the number of casts was ten times more predictable [16]. However, due to the controversial reports of the effect of age on the results of the Ponseti method, we only included neonates less than 15 days old [9,[17][18][19]. ...
Background
Congenital clubfoot is one of the common congenital orthopaedic deformities. Pirani and Dimeglio scoring systems are two classification systems for measuring the severity of the clubfoot. However, the relation between the initial amount of each of these scores and the treatment parameters is controversial.
Methods
Patients with severe and very severe idiopathic clubfoot undergoing Ponseti treatment were entered. Their initial Pirani and Dimeglio scores, the number of castings as a short-term treatment parameter, and the recurrences as a long-term parameter until the age of three were prospectively documented.
Results
One hundred patients (143 feet) with mean age of 9.51 ± 2.3 days including 68 males and 32 females and the mean initial Pirani score of 5.5 ± 0.5 and the mean initial Dimeglio score of 17.1 ± 1.6 were studied. The incidence of relapse was 8.4 %( n = 12). The mean initial Pirani score ( P < 0.001) and the mean initial Dimeglio score ( P < 0.003) of the feet with recurrence were significantly more than the non-recurrence feet. The mean number of casts in the recurrence group (7 ± 0.9) was significantly more than the feet without recurrences (6.01 ± 1.04) ( P = 0.002). The ROC curve suggested the Pirani score of 5.75 and the Dimeglio score of 17.5 as the cut-off points of these scores for recurrence prediction.
Conclusion
In our study, Pirani and Dimeglio scores are markedly related with more number of casts and recurrence in patients with severe and very severe clubfoot. Also, we have introduced new cut-off points for both classification systems for prediction of recurrence. To the best of our knowledge, this finding has not been introduced into the English literature.
Purpose
Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1 year post-correction following Ponseti management in infants who were born preterm but treated at term age.
Methods
A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37 weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs).
Results
Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8–5.6) in the idiopathic group and 5.7 (95%CI: 5.0–6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1–6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0–7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery.
Conclusion
Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to term-born infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method.
Level of evidence
Level IV.
Background
The Ponseti method is the standard of care for managing idiopathic congenital talipes equinovarus (clubfoot) in the outpatient setting, but there are no clinical guidelines for inpatient treatment. Children in the neonatal intensive care unit (NICU) with clubfoot often delay treatment initiation due for medical reasons.
Methods
We systematically reviewed literature related to the treatment of clubfoot in the NICU, non-idiopathic clubfoot, and older infants, as well as barriers to care.
Results
In a mixed NICU population of syndromic and idiopathic clubfoot, the Ponseti method has good functional outcomes with minimal interference with medical management. The Ponseti method has good functional outcomes with reduced need for extensive surgical procedures in non-idiopathic clubfoot and idiopathic clubfoot with delayed presentation (under one year of age).
Conclusions
It is possible to begin Ponseti treatment in the NICU without compromising medical management. It is not clear if this confers an advantage over waiting for outpatient casting.
Background:
The clubfoot is one of the commonly found congenital deformities in newborn. The Ponseti method is the most effective nonoperative clubfoot management method. It is based on understanding of pathoanatomy of clubfoot. For classifying severity of clubfoot, Pirani score is used. The number of cast required for clubfoot correction is dependent on its initial Pirani score. This study aimed on how the number of cast for correction of clubfoot deformity depends on starting time of casting and pretreatment Pirani score.
Materials and methods:
This study comprises of 200 patients with 297 affected foot nonoperatively managed with Ponseti technique of casting. We measured initial and final Pirani scores of patients with different age groups.
Results:
We found that initial severity was less in 0-1 month age group children but mean casting number was more while initial severity was more in 1-2 month age group, the mean number of casting was less. Tenotomy requirement was also less in 1-2 month age group.
Conclusion:
We concluded that casting according to the Ponseti method should be started in 1-2 months age group which shows better results than the other age groups in clubfoot.
The aim of this study is to evaluate the effectiveness of the Ponseti method in children presenting before 1 year of age with either untreated or complex (initially treated unsuccessfully by other conservative methods) idiopathic clubfeet.
The authors report 134 feet of 92 patients with Dimeglio grade 2, 3, or 4 deformities treated with the Ponseti method. Twenty-four percent of feet were of complex deformities at initial presentation to the authors' clinics.
At a mean follow-up of 46 months (range 24-89) we avoided joint release surgery in 97% of feet. Sixty-seven percent required a percutaneous tenotomy of the Achilles tendon. Relapse rate was 31% (41 feet). We treated 2 relapses by restarting the use of orthosis, 17 with re-casting, 18 with anterior tibial tendon transfer following a second relapse, and 4 feet with extensive joint surgery. Compliance with the use of orthosis was identified as the most important risk factor (P<0.0001) for relapses. Previous unsuccessful treatment attempts by other conservative methods did not adversely affect the results unless the cases had iatrogenic deformities. Cases with iatrogenic deformities from previous treatment had a significantly increased risk of non-compliance and relapse. Experience of the treating surgeon and cast complications were also related to relapses.
Our results show that the Ponseti technique is reproducible and effective in children at least up to 12 months of age. It can also produce good correction in children presenting with complex idiopathic deformities. Therefore, extensive joint releases should not be considered immediately in such cases. The treating surgeon should be meticulous in using the technique and ensure compliance to foot abduction brace in order to avoid recurrences.
Unlabelled:
Neglected clubfoot is common, disabling, and contributes to poverty in developing nations. The Ponseti clubfoot treatment has high efficacy in correcting the clubfoot deformity in ideal conditions but is demanding on parents and on developing nations' healthcare systems. Its effectiveness and the best method of care delivery remain unknown in this context. The 6-year Uganda Sustainable Clubfoot Care Project (USCCP) aims to build the Ugandan healthcare system's capacity to treat children with the Ponseti method and assess its effectiveness. We describe the Project and its achievements to date (March 2008). The Ugandan Ministry of Health has approved the Ponseti method as the preferred treatment for congenital clubfoot in all its hospitals. USCCP has trained 798 healthcare professionals to identify and treat foot deformities at birth. Ponseti clubfoot care is now available in 21 hospitals; in 2006-2007, 872 children with clubfeet were seen. USCCP-designed teaching modules on clubfoot and the Ponseti method are in use at two medical and three paramedical schools. 1152 students in various health disciplines have benefited. USCCP surveys have (1) determined the incidence of clubfoot in Uganda as 1.2 per 1000 live births, (2) gained knowledge surrounding attitudes, beliefs, and practices about clubfoot across different regions, and (3) identified barriers to adherence to Ponseti treatment protocols. USCCP is now following a cohort of treated children to evaluate its effectiveness in the Ugandan context.
Level of evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Unlabelled:
The Ponseti method is reportedly effective for treating clubfoot in children up to 9 years of age. However, whether age at the beginning of treatment influences the rate of successful correction and the rate of relapse is unknown. We therefore retrospectively reviewed 68 consecutive children with 102 idiopathic clubfeet treated by the Ponseti technique in four Portuguese hospitals. We followed patients a minimum of 30 months (mean, 41.4 months; range, 30-61 months). The patients were divided into two groups according to their age at the beginning of treatment; Group I was younger than 6 months and Group II was older than 6 months. All feet (100%) were initially corrected and no feet required extensive surgery regardless of age at the beginning of treatment. There were no differences between Groups I and II in the number of casts, tenotomies, success in terms of rate of initial correction, rate of recurrence, and rate of tibialis anterior transference. The rate of the Ponseti method in avoiding extensive surgery was 100% in Groups I and II; relapses occurred in 8% of the feet in younger and older children.
Level of evidence:
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Ponseti clubfoot treatment has become more popular during the last decade. We reviewed the medical records of 74 consecutive infants (117 club feet) who underwent Ponseti treatment. Minimum followup was 5 years (mean, 6.3 years; range, 5–9 years). We studied age at presentation, previous treatment, the initial severity score of the Pirani scoring system, number of casts, need for Achilles tenotomy or other surgical procedures, and brace use. We measured final ankle motion and parents’ perception of outcome. Late presentation and previous non-Ponseti treatment were associated with lower initial severity score, fewer casts, and less need for tenotomy. Forty-four percent of patients had poor brace use. We observed better brace use (75%) in babies who presented late for treatment. Good brace use predicted less need for extensive surgical procedures. Twenty-four (32%) babies underwent additional surgical procedures other than tenotomy, including 21% who underwent tibialis anterior tendon transfer. At followup, 89% of feet had adequate dorsiflexion (5° or greater). Parents indicated high satisfaction with the treatment results. Ankle motion was not associated with parents’ satisfaction. The Ponseti method is effective, even if treatment starts late or begins after failure at other centers. Brace use influenced the success of treatment.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
A child with recurrent or incompletely corrected clubfoot after previous extensive soft tissue release is treated frequently with revision surgery. This leads to further scarring, pain and limitations in range of motion. We have utilized the Ponseti method of manipulation and casting and when indicated, tibialis anterior tendon transfer, instead of revision surgery for these cases.
A retrospective review of all children treated since 2002 (n = 11) at our institution for recurrent or incompletely corrected clubfoot after previous extensive soft tissue release was done. Clinical and operative records were reviewed to determine procedure performed. Ponseti manipulation and casting were done until the clubfoot deformity was passively corrected. Based on the residual equinus and dynamic deformity, heel cord lengthening or tenotomy and tibialis anterior transfer were then done. Clinical outcomes regarding pain, function and activity were reviewed.
Eleven children (17 feet) with ages ranging from 1.1 to 8.4 years were treated with this protocol. All were correctable with the Ponseti method with one to eight casts. Casts were applied until the only deformities remaining were either or both hindfoot equinus and dynamic supination. Nine feet required a heel cord procedure for equinus and 15 required tibialis anterior transfer for dynamic supination. Seven children have follow-up greater than one year (average 27.1 months) and have had excellent results. Two patients had persistent hindfoot valgus which required hemiepiphyseodesis of the distal medial tibia.
The Ponseti method, followed by tibialis anterior transfer and/or heel cord procedure when indicated, can be successfully used to correct recurrent clubfoot deformity in children treated with previous extensive soft tissue release. Early follow-up has shown correction without revision surgery. This treatment protocol prevents complications of stiffness, pain and difficulty in ambulating associated with multiple soft tissue releases for clubfeet.
The Ponseti method has become a well-established technique for the treatment of clubfoot presenting in the neonatal period. A few reports have discussed the result of this method in older age group. The purpose of this study is to present the results and clinical experience of using the Ponseti method in the treatment of idiopathic congenital talipes equinovarus in infants presented between 4 and 13 months of age with a history of failed manipulations. Thirty-two feet in 20 infants (12 males; eight females) with idiopathic congenital clubfeet were treated using the Ponseti method with minor modifications. The average age at presentation was 7 months (range from 4 to 13 months). We used the Pirani scoring system to assess the feet. After an average follow-up of 19 months, the ultimate overall results were satisfactory in 31 feet. The Pirani score improved from an average of 4.3 (range: 3-6) at presentation to a final follow-up average of 0.5 (range: 0-1). One foot had unsatisfactory result with a pretreatment score of 5.5 and a final score of 3. The results were also presented in terms of the number of casts applied, the need for tenotomy of tendo Achillis, recurrence of the deformity and the ultimate requirement for surgical release. The use of the Ponseti method in older-aged infants with idiopathic congenital clubfoot seems to be an effective method of treatment, obviating the need for extensive surgery.
Nonoperative management of clubfoot with the Ponseti method has proven to be effective, and it is the accepted initial form of treatment. Although several studies have shown that problems with compliance with the brace protocol are principally responsible for recurrence, no distinction has been made with regard to whether the distance from the site of care affects the early recurrence rate. We compared early recurrence after Ponseti treatment between rural and urban ethnically diverse North American populations to analyze whether distance from the site of care affects compliance and whether certain patient demographic characteristics predict recurrence.
One hundred consecutive infants with a total of 138 clubfeet treated with the Ponseti method were followed prospectively for at least two years from the beginning of treatment. Early recurrence, defined as the need for subsequent cast treatment or surgical treatment, and compliance, defined as strict adherence to the brace protocol described by Ponseti, were analyzed with respect to the distance from the site of care, age at presentation, number of casts needed for the initial correction, need for tenotomy, and family demographic variables.
Of eighteen infants from a rural area who had early recurrence, fourteen were Native American. The families of these children, like those of all of the children with early recurrence, discontinued orthotic use earlier than was recommended by the physician. Discontinuation of orthotic use was related to recurrence, with an odds ratio of 120 (p < 0.0001), in patients living in a rural area. Native American ethnicity, unmarried parents, public or no insurance, parental education at the high-school level or less, and a family income of less than $20,000 were also significant risk factors for recurrence in patients living in a rural area. Intrinsic factors of the clubfoot deformity were not correlated with recurrence or discontinuation of bracing.
Compliance with the orthotic regimen after cast treatment is imperative for the Ponseti method to succeed. The striking difference in outcome in rural Native American patients as compared with the outcomes in urban Native American patients and children of other ethnicities suggests particular problems in communicating to families in this subpopulation the importance of bracing to maintain correction. An examination of communication styles suggested that these communication failures may be culturally related.
The purpose of this study was to evaluate the early results of treatment of idiopathic congenital talipes equinovarus (CTEV) by the Ponseti method and compare the results with those of other manipulation techniques and surgical treatment reported in the literature. A total of 100 patients with 156 clubfeet (80 males, 20 females), were treated for idiopathic CTEV by the Ponseti method. The average age at presentation was 4.5 months. Scoring of each foot was done according to the Pirani score. Photographs showing the deformity and podograms were taken to have an objective record against which the results were compared. The mean total Pirani score at the start of treatment was 4.26 and mean foot print angle (FPA) was 14.2 degrees. Post correction, there was a significant difference (P < .001, z = 18.638) in the mean FPA. There was also a statistically significant difference between the pre- and postcorrection Pirani scores (P < .001, z = 55.427). In 95% of the patients correction of the deformity was achieved. The Ponseti technique is based on sound understanding of the pathoanatomy of clubfoot. The good results obtained by the Ponseti technique show that posteromedial soft tissue release may no longer be required for most cases of idiopathic CTEV.
Although clubfoot is one of the most common congenital abnormalities affecting the lower limb, it remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment. This review provides an update on the etiology of clubfoot as well as current treatment strategies. Understanding the exact genetic etiology of clubfoot may eventually be helpful in determining both prognosis and the selection of appropriate treatment methods in individual patients. The primary treatment goal is to provide long-term correction with a foot that is fully functional and pain-free. To achieve this, a combination of approaches that applies the strengths of several methods (Ponseti method and French method) may be needed. Avoidance of extensive soft-tissue release operations in the primary treatment should be a priority, and the use of surgery for clubfoot correction should be limited to an “a la carte” mode and only after failed conservative methods.
Level of Evidence: Level V, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.