Ponseti management of clubfoot after walking age

Abstract

The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.

Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus

“…It is clear that this improvement supplies a much better basis for the surgery even when it is not sufficient to achieve a fully corrected foot. We agree with the statement of Yagmurlu et al [20] that whatever the presenting age of the patient with club foot, the Ponseti method should be applied, at least to achieve some improvement of the deformity. However, it follows from our results that it is impossible to cure all club feet with …”

“…There are a lot of studies reporting that recurrence after correction is related to patients' compliance with bracing [19,20]. When the parents of patients do not comply with the bracing protocol, many major and minor recurrences should be expected.…”

Interventions for congenital talipes equinovarus

“…11 It has been shown to predict the need for Achilles tenotomy 102 and is emerging as a popular outcome measure in studies of older children with relapsed clubfoot ( Figure 11). 11,82,85,130,131 Predictive capacity for longer term outcomes are conflicting. One study found the Dimeglio Scale at birth to be a poor predictor of quality of gait at 2 year follow-up, 82 while another study reported a good correlation with outcome at two years.…”

Ponseti method for late presentation of clubfoot

“…Manipulation time is increased, lesser foot abduction and dorsiflexion are acceptable, knee flexion in an above knee cast is decreased, cast duration is extended, different casting material is proposed, increased cast duration post tenotomy for tendo Achilles healing and an altered brace regime is suggested ( Table 1). The surgical intervention has increased beyond percutaneous tenotomy with open Achilles tendon lengthening and posterior release added as modifications of the Ponseti technique in older children [4,9]. 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].…”

“…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.…”