Prolonged use of foot abduction brace reduces the rate of surgery in Ponseti-treated idiopathic club feet

Abstract

Purpose There is conflicting evidence related to factors affecting the rates of recurrence of idiopathic club feet using the Ponseti method. We attempt to evaluate the predictors of success and failure in our physiotherapy-led Ponseti club foot clinic. Methods We evaluated 189 children with 279 club feet with a mean follow-up of 6.3 years for the following: Pirani score at presentation, number of casts for correction, indication for Achilles tenotomy, and the duration of foot abduction brace (FAB) use, in relation to outcome. Outcome measures were the need for additional surgery and functional scores. Based on the pattern and rate of ossification of the tarsal bones in idiopathic club foot, a much longer FAB weaning protocol was designed and practiced since 2000. The objective of this study was to answer the question of whether a prolonged period of FAB use reduces the need for surgery in Ponseti-treated idiopathic club foot. Results Thirty-six feet (12.9 %) underwent additional surgery. The Pirani score and the number of cast changes had no influence on the rate of surgery. The duration of FAB use had a significant effect on the outcome, i.e., the rate of surgery and functional scoring. Operated children used the FAB for 28 months versus 33 months in the nonoperated group (p \ 0.05). Only a minor delay in the attainment of walking age was noted (average 15 months). ConclusionsThe duration of FAB treatment was found to be the most influential on the functional results and on rate of surgery. Close follow-up and longer FAB weaning program reduced the rates of recurrence.

Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

“…Better brace use has been repeatedly found to reduce relapse [18, 23–25] and has been reported in a 6-years follow up study of 189 cases (279 ft) [26]. This study found that surgery was more likely if brace use stopped before 28 months of use, versus cases wearing the brace for 33 months or more were less likely to have required surgery [26]. Brace use to ‘school age’ (approximating ages 5 to 6 years) is usually advised as part of the Ponseti maintenance phase.…”

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

“…When introducing the Ponseti method, the bracing protocol was changed, and it was recommended to use the brace for 4 years. The importance of brace compliance in Ponseti treatment is described in a recent study [ 30 ] and a systematic review [ 31 ]. Brace compliance was good in the Ponseti group in our study.…”

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

“…Most authors find a relation between recurrences and brace compliance. 16 , 18 , 25 Even if Ponseti recommended using the brace for four years, the definition of compliance/ non-compliance varies greatly. Some report non-compliance as complete discontinuation of the use of the brace, 25 , 26 while others have defined good compliance as night time bracing until 12 months of age, and poor compliance as termination before that.…”

“… 15 Poor compliance with the brace is a common problem in the treatment of clubfeet 4 , 16 , 17 and prolonged use of the brace improves the results. 18 Both brace compliance and type of brace might explain the increased rate of surgery over time in our patient cohort, and the aim of the present study was to search for potential differences between children treated with a bilateral foot abduction brace and children treated with a unilateral brace at follow-up of 8 to 11 years of age.…”