Long-term Results of Comprehensive Clubfoot Release Versus the Ponseti Method: Which Is Better?

Abstract

Background Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child. Questions/purposes We compared (1) focused physical and radiographic examinations, (2) gait analysis, and (3) quality-of-life measures at long-term followup between groups of adult patients with clubfoot treated either with the Ponseti method of nonsurgical management or a comprehensive surgical release through a Cincinnati incision, and compared these two groups with a control group without clubfoot. Methods This was a case control study of individuals treated for clubfoot at two separate institutions with different methods of treatment between 1983 to 1987. One hospital used only the Ponseti method and the other mainly used a comprehensive clubfoot release. There were 42 adults (24 treated surgically, 18 treated with Ponseti method) with isolated clubfoot along with 48 healthy control subjects who agreed to participate in a detailed analysis of physical function, foot biomechanics, and quality-of-life metrics. Results Both treatment groups had diminished strength and motion compared with the control subjects on physical examination measures; however, the Ponseti group had significantly greater ankle plantar flexion ROM (p \ 0.001), greater ankle plantar flexor (p = 0.031) and evertor (p = 0.012) strength, and a decreased incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group had reduced peak ankle plantar flexion (p = 0.002), and reduced sagittal plane hindfoot (p = 0.009) and forefoot (p = 0.008) ROM during the preswing phase compared with the Ponseti group. The surgical group had the lowest overall ankle power generation during push off compared with the control subjects (p = 0.002). Outcome tools revealed elevated pain levels in the surgical group compared with the Ponseti group (p = 0.008) and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects (p = 0.01).

Comparison of two treatment methods of congenital clubfoot in the orthopaedists’ opinion

“…This is due to the benefits that come with treatment using the Ponseti method, that is increased ROM observed in physical examination and while walking, greater endurance rates and fewer complications associated with joints straining. These studies have demonstrated the superiority of the method according to Ponseti over the comprehensive release method [29].…”

Quantitative assessment of the foot and ankle during locomotion

“…2 and 3). [21] Tarsal coalition Tarsal coalition is a union of tarsal bones that limits subtalar joint motion. Evaluation of the foot and ankle motion pre-versus post-operatively with foot and ankle gait analysis will increase our ability to understand the pathological problem and the impact of the surgery on the patient satisfaction and outcome (Fig.…”

“…[21] Tarsal koalisyon Tarsal koalisyon tarsal kemiklerin bustalar eklem hareketini önleyecek biçimde birleşmesidir. Ameliyat öncesi ve sonrası ayak ve ayak bileği hareket analizlerini incelemek, bizim patolojik problemleri ve ameliyatın hasta memnuniyeti üzerindeki etkisini daha iyi değerlendirmemizi sağlayacaktır (Şekil 4).…”

Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score

“…Several surgical and conservative methods have been proposed [1,[4][5][6]. Long-term results of extensive surgery have been reported to be poor, with a high rate of stiffness, scarring and pain [5], which has raised the interest for conservative treatment.…”

“…Ponseti method, including serial manipulation and casting, percutaneous Achilles tenotomy and foot abduction orthosis, has shown to be effective in providing initial and long-term correction and avoiding extensive soft tissue release [5,[8][9][10][11][12][13][14][15].…”