Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

Abstract

Background The Ponseti method is the preferred treatment for idiopathic clubfoot. Although popularised by orthopaedic surgeons it has expanded to physiotherapists and other health practitioners. This study reviews the results of a physiotherapist-led Ponseti service for idiopathic and non-idiopathic clubfeet and compares these results with those reported by other groups. Method A prospective cohort of clubfeet (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) with a minimum 2-year follow-up after correction was reviewed. Physiotherapists treated 91 children-41 patients (69 feet) had non-idiopathic deformities and 50 children (77 feet) were idiopathic. Objective outcomes were evaluated and compared to results from other groups managing similar patient cohorts. Results The mean follow-up was 4.6 years (range 2-8.3 years) for both groups. The non-idiopathic group required a median of 7 casts to correct the clubfoot deformity with an 83 % tenotomy rate compared to a median of 5 casts for the idiopathic group with a 63 % tenotomy rate. Initial correction was achieved in 96 % of non-idiopathic feet and in 100 % of idiopathic feet. Recurrence requiring additional treatment was higher in the non-idiopathic group with 40 % of patients (36 % of feet) sustaining a relapse as opposed to 8 % (6 % feet) in the idiopathic group. Surgery was required in 26 % of relapsed non-idiopathic feet and 6 % of idiopathic. Conclusions Although Ponseti treatment was not as successful in non-idiopathic feet as in idiopathic feet, deformity correction was achieved and maintained in the midterm for the majority of feet. These results compare favourably to other specialist orthopaedic-based services for Ponseti management of non-idiopathic clubfeet. Level of evidence Prognostic Level III.

A Single-Center Evaluation of Mid-Term Results of Ponseti Management for Nonidiopathic Congenital Clubfeet in Vietnam

“…Like some recent studies [1][2][3][4][11][12][13][14], this study showed satisfactory results with nonidiopathic clubfeet treated by the Ponseti method as initial successful results 81.3%, early relapses 26.9%, and poor latest follow-up results 31.3%. However, the Ponseti method was less successful in the syndromic and neuromuscular patients when compared with the group of idiopathic clubfeet in this study (Table 2); these results were almost similar to the results of other studies over the same follow-up period despite there were different results of some variables in detail (Table 4).…”

Ponseti method compared to previous treatment of clubfoot in Norway. A multicenter study of 205 children followed for 8–11 years

“…This is also concluded in a recent review article [ 8 ]. Traditionally the treatment is medical-led, but physiotherapist-led Ponseti clinics have shown equally good results, even in non-idiopathic and complex clubfeet [ 9 ].…”

Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet

“… 16 , 27 , 28 Defining non-compliance as use of brace less than ten hours per day before four years of age is a more strict definition. 4 , 29 It is our experience that children often partly comply with the brace and that is why we differentiated brace compliance. Overall brace compliance in our study was rather good as 61% of the children used the brace as prescribed for four years, and 20% were defined as poor or non-compliant.…”