Congenital Clubfoot: Early Recognition and Conservative Management for Preventing Late Disabilities

Abstract

Congenital clubfoot is one of the most common musculoskeletal deformities presenting at birth. Many high risk factors have been associated with clubfoot such as male gender, primiparous mothers and maternal smoking. Accurate understanding of clubfoot pathoanatomy is supposed to be the basis for deformity correction. Prenatal ultrasonography is of reference value in recognizing clubfoot during pregnancy. Neglected clubfoot can eventually cause a noticeable disability and severely influence the quality life in adulthood. Early recognition and treatment are presumed to be the key for prevention of late disabilities. Nowadays, Ponseti method, as one of the conservative treatment regimen, has been widely accepted because of the reported good results of long-term follow-up. However, special attention should be paid to the details in clinical practice for achieving even better correction and a lower rate of relapse. After the complete correction, brace wearing is critical for preventing deformity relapse. Non-compliance or non-adherence with the brace protocol has been considered as the predominant risk factor predisposing to the relapse of clubfoot, which is still a challenging problem. This paper was prepared to give a general introduction about clubfoot, in terms of the importance of early recognition and conservative management, especially Ponseti method, for preventing late disabilities.

The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity

“…Clubfoot is one of the most prevalent musculoskeletal congenital defects, with an incidence from 0.9 to 7 of 1000 live births 1 . The deformity is not self-healing, and if timely treatment does not occur (the age at the onset of treatment need further study 2 – 5 ), the deformity will deteriorate until adulthood and cause adverse effects for the patient. Because its aetiology is not thoroughly understood, we cannot provide aetiological treatment.…”

Comparison of different conservative treatments for idiopathic clubfoot: Ponseti’s versus non-Ponseti’s methods

“…Noncompliance with or nonadherence to the brace protocol has been considered the predominant risk factor for relapse of clubfoot, which is still a challenging problem. 9 …”

“… 7 , 8 Ponseti’s method is now widely recommended as the gold standard for treatment of idiopathic clubfoot, and it has been approved on a worldwide basis. Although some other methods are still widely applied in the clinical setting, such as Kite’s method and the French method, 9 few studies have compared the effects of these different conservative treatment methods for clubfoot, and no definitive conclusions have been reached. The purpose of this study was to determine whether Ponseti’s method is the most efficient technique in the conservative treatment of congenital idiopathic clubfoot based on a meta-analysis of the current scientific literature.…”

Editorial: Pediatric Orthopedics at the Doorstep of the Pediatrician

“…Originally described by Dr. Ignacio Ponseti from Iowa, USA in 1963 [2], the treatment could get global recognition only in the late nineties. The manipulation and casting technique needs to be started as soon after birth as possible as early treatment ensures a high success rate of around 90 % in all forms of clubfoot [3]. In fact the treatment has been found to have a success rate of around 84 % even when used in children more than 7 y of age in an Indian cohort [4].…”

“…In fact the treatment has been found to have a success rate of around 84 % even when used in children more than 7 y of age in an Indian cohort [4]. A brief pathoanatomy and the Ponseti technique has been described by Li Zaho and co-authors in their article on early recognition and management of congenital clubfoot [3]. It is imperative to note that the application of Ponseti technique is not limited to the Orthopedic surgeons alone.…”