Management of idiopathic clubfoot in toddlers by Ponseti's method

Abstract

The Ponseti method has been reported to have successful results in clubfoot patients less than 6 months of age but the literature on its efficacy in older clubfoot patients still remains sparse. In our study, we prospectively evaluated 55 clubfeet (37 patients) to determine clinically whether the Ponseti method is effective in the management of clubfoot in older children between the age of 12 and 36 months (mean: 24.8 months). All the patients belonged to moderate or severe grades of deformity as per the Pirani scoring. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 49 clubfeet. Seven patients (seven feet) developed recurrence of adduction, varus and equinus deformity whereas three patients (five feet) developed isolated recurrence of equinus deformity. These seven patients responded to repeat treatment and obtained satisfactory outcome. Four of these seven patients underwent tibialis anterior transfer to third cuneiform for dynamic supination. Three patients, those developed isolated recurrence of equinus deformity, underwent repeat tenotomy. One foot achieved satisfactory amount of dorsiflexion, three feet underwent tendoachilles lengthening whereas another foot underwent posterior release to obtain satisfactory dorsiflexion. Six to 12 numbers of casts (mean: 10) were required to obtain correction of clubfoot deformities. Mean period of immobilization in a cast was 13.9 weeks (10-15 weeks). We found that the Ponseti method is effective in children between the age of 12 and 36 months.

Clinical Experiences and Midterm Results of the Treatment of Clubfoot with the Ponseti Method

“…We therefore recommend that specialists such as radiologists, gynecologists, and pediatricians should be informed about the importance of early treatment in order to correct the deformity. They should be proactive in referring patients to orthopedists in the first day of a patient's life, if possible, despite the finding that the Ponseti method produces good results in neglected patients as well [12].…”

Modern Concepts of Conservative Treatment Methods of Clubfoot

“…Хотя метод Понсети наиболее эффективен у пациентов до 3 месяцев, им можно успешно ле-чить и детей более старшего возраста [45,46,63].…”

Ponseti method for late presentation of clubfoot

“…Some series recommend an additional split tibialis anterior transfer at the time of equinus correction to tide over the brace compliance problem, while others do not recommend it [3]. An early and higher recurrence rate is documented in several series (29 % [3]; 23 % [8]; 19 % [5]; 24 % [7]). A total failure of treatment with the Ponseti technique in late presentation is also reported by observers (33.33 % [3]; 7.27 % [8]; 14.3 % [7]).…”

“…An early and higher recurrence rate is documented in several series (29 % [3]; 23 % [8]; 19 % [5]; 24 % [7]). A total failure of treatment with the Ponseti technique in late presentation is also reported by observers (33.33 % [3]; 7.27 % [8]; 14.3 % [7]). Complications such as prolonged bleeding, erythema, swelling, redness of the skin due to excessive pressure, osteopenia, wound dehiscence, etc.…”

“…The Ponseti method has found most use in developing countries where late presentation of clubfoot is also fairly common. Several papers now routinely recommend this technique up to two years of age and depict success rates almost equivalent to infants [2][3][4][5][6][7][8][9]. We would like to broaden the review to include clubfoot treatment by Ponseti method in older children with late presentation and raise some issues related to this extended use.…”