Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles

Abstract

The Ponseti method of manipulative treatment for clubfoot deformity became widely adopted by pediatric orthopaedic surgeons beginning in the mid-1990s. The technique allows correction of most idiopathic clubfeet using gentle manipulation and cast application. The treatment represents a marked advance over past efforts to gain correction of the foot through extensive release surgery. In 2006, we began a Clubfoot Clinic at the Orthopaedic Institute for Children in Los Angeles, California dedicated to managing clubfoot patients using Ponseti's method. An IRB-approved database of patient-related, treatment related, and demographic variables was assembled and used to ascertain the outcome of treatment as well as to address parental questions regarding certain aspects of treatment. Here, we present a review of our body of work, which has improved clinical decision making as well as our ability to better inform our patients' parents regarding the treatment and prognosis of the Ponseti method. Studies from our institution showed that while relapses and the need for extra-articular tibialis anterior tendon transfer (TATT) surgery remain common to the Ponseti method, these events do not adversely affect overall patient function or satisfaction. These findings were not unlike those of classic studies reported from Ponseti's institution. We conclude that the Ponseti method is not only a technique to achieve initial correction of an idiopathic clubfoot, but also how to manage relapses that will inevitably occur in many patients. While relapses and tendon transfer surgery are likely to remain common with this treatment method, these events do not adversely affect overall patient function or satisfaction. The parents of infants whose clubfeet are managed using the Ponseti method should be counselled accordingly.

Duration and outcome of orthotic treatment in children with clubfoot – a four-year follow-up national register study of Swedish children born between 2015 and 2017

“…The Ponseti method has improved clubfoot treatment, with a described drop in need for surgical interventions, during and following initial treatment and maintenance phase [8,13,14]. Despite successful treatment, recurrence of the initial foot deformity is common, particularly among those non-compliant to orthotic treatment [15][16][17][18][19][20][21][22]. Therefore, a systematic analysis of the treatment provided, and how the recommended treatment is being followed may provide insights to further improve orthotic treatment in children with clubfoot.…”

Initial clubfoot treatment in Sweden from 2016 to 2019: A national register study

“…The Ponseti protocol has improved clubfoot treatment, with a described drop in surgical interventions, above achillotenotomy, within initial treatment [12,14,15]. However, a large number of the children treated according to the Ponseti method will experience a relapse to some degree [16][17][18][19][20].…”

The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review

“…17 , 18 This confirms the necessity for continued follow-up during the brace-wearing phase, while also creating new challenges for treatment. 17 , 19 Relapses are quite heterogeneous. If they are subtle, they can be treated with a new casting cycle.…”