<p>Posteromedial Release versus Ponseti Treatment of Congenital Idiopathic Clubfoot: A Long-Term Retrospective Follow-Up Study into Adolescence</p>

Abstract

Purpose Although many short-term studies have shown the superiority of Ponseti treatment to surgical treatment, studies with long-term follow-up of patients into adolescence are lacking. The aim of this study was to compare the morphological, functional and radiological results of the two methods into and during adolescent age, when both soft tissue and bony procedures can be performed to correct residual deformities. Patients and Methods We retrospectively evaluated two groups of patients diagnosed with congenital idiopathic clubfoot and treated with either the Ponseti method (34 clubfeet) and surgery in the form of posteromedial release (31 clubfeet). All included clubfeet were clinically fully corrected after initial treatment and final plaster removal. Evaluation was performed with the International Clubfoot Study Group (ICFSG) score. Results The age at follow-up was 12.8±1.6 years in the Ponseti group and 13.5±1.7 years in the surgical group. Excellent or good results were obtained in 26 feet (76%) of the Ponseti group and in 14 feet (45%) in the surgical group. The Ponseti treatment was significantly superior to posteromedial release in terms of the final score (10.58±6.49 versus 17.26±8.83, p<0.001), functional score (p<0.001) and radiological score (p<0.001). Residual deformities were clinically present in both groups but were less frequent and less severe in Ponseti-treated patients. Flat-top talus was found to be present in both groups, but the Ponseti method was more protective than surgical treatment against this outcome (relative risk=0.494, p=0.002). The overall foot and ankle mobility was significantly better in the Ponseti group (p<0.001). Conclusion The Ponseti method was superior to surgery for treatment of clubfoot and achieved better long-term morphological, functional and radiological results. It preserves better mobility of the foot and ankle, and results in less frequent and less severe residual deformities than surgical treatment.

Factors associated with the relapse in Ponseti treated congenital clubfoot

“…There is a consensus that the initial treatment of congenital clubfoot should be nonoperative [ 3 , 4 ]. The Ponseti method was superior to surgery for treatment of clubfoot and achieved better long-term morphological, functional and radiological results [ 5 ]. The Ponseti method, which offers the safest, most effective, and least expensive correction of the majority of clubfeet, is now known as the golden standard to correct congenital clubfoot [ 6 , 7 ].…”

Flat-top talus after clubfoot treatment: a literature review

“…Iatrogenic talar necrosis is also proposed as a causative mechanism by Corbu et al . [24] but as a consequence of surgical devascularisation rather than manipulation. They found a two-fold greater rate of FTT following surgical posteromedial release than following the Ponseti method.…”

Development and Test of a Serious Game for Dorsiflexion and Plantarflexion Exercises of the Feet

“…Therefore, a congenital injury or malformation in any of the structures of this area of the body, as in the case of Congenital Clubfoot (CTE), can compromise the mechanical relationship and body balance and significantly impair the performance, causing early fatigue, pain, an overload of other segments, in addition to compromising gait and other motor functions related to the individual's daily life (Hamill;Knutzen, 2006;Soares et al, 2016). To prevent this, the treatment of the lower limbs must start as early as possible (Corbu et al, 2020). It is usually intense and repetitive, especially in the first months, and must be carried out by a qualified professional team, with a physiotherapist and medical monitoring, through daily sessions, with fifty minutes or weekly, depending mainly on the severity of the feet.…”