Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Abstract

Background: Clubfoot is a common congenital foot deformity in children. The Ponseti method of serial casting has become the standard of care in clubfoot treatment. Clubfoot casting is performed in many centers by both orthopaedic surgeons and physical therapists (PTs); however, direct comparison of outcomes and complications of this treatment between these providers is limited. This study prospectively compared the outcomes of patients with clubfoot treated by these 2 groups of specialists. Methods: Between January 2010 and December 2014, all patients under the age of 12 months with a diagnosis of clubfoot were included. Patients were randomized to an orthopaedic surgeon (MD) group or a PT group for weekly serial casting. Main outcome measures included the number of casts required to achieve correction, clinical recurrence of the deformity, and the need for additional surgical intervention. Results: One hundred twenty-six infants were included in the study. Patient demographics and characteristics (sex, race, family history of clubfoot, laterality, and severity of deformity) were similar between treatment groups, with the only significant difference being the mean age of entry into the study (5.2 weeks in the MD group and 9.2 weeks in the PT group, P=0.01). Mean length of follow-up was 2.6 years. The number of casts required trended to a lower number in the MD group. There was no significant difference in the rates of clinical recurrence or additional surgical intervention between groups. Conclusions: Ponseti casting for treatment of clubfoot performed by orthopaedic surgeons and PTs results in equivalent outcomes without any difference in complications. Although the number of casts required trended to a lower number in the MD group, this likely did not result in any clinical significance, as the difference in cast number equaled <1 week’s difference in the overall duration of serial casting. Level of Evidence: Level I—therapeutic.

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

“…The gold standard for clubfoot treatment in Sweden is the standard Ponseti method and, to the best of our knowledge, all the centres in Sweden apply these principles. However, we have no control over the education or experience level of the orthopedic surgeons or physiotherapists treating the children [ 35 ] nor of whether some centres apply the accelerated Ponseti method [ 36 ]. To the best of our knowledge, achillotenotomies are most often performed under local anaesthesia, but this information is not available in the clubfoot register [ 5 , 32 ].…”

Children’s orthopaedics

“…The purpose of this paper from Memphis (Tennessee, USA) was to examine if there was a difference in the treatment of idiopathic club foot by surgeons versus physical therapists. 4 Over a four-year period all patients aged under 12 months with idiopathic club foot were randomized to serial casting treatment performed either by an orthopaedic surgeon or a physical therapist. A total of 126 patients were recruited into the study and, remarkably, the authors report that there were no crossovers and no discontinuation of treatment, making it a comprehensive comparison.…”

What’s New in Pediatric Orthopaedics

“…In a prospective, randomized trial, researchers found equivalent outcomes without any difference in complications between Ponseti cast treatment performed by orthopaedic surgeons and by trained physical therapists 15 . Another study with prospective data collection found that children with unilateral clubfoot had a shoe that was a mean of 1.5 sizes smaller on the involved side at follow-ups of 5, 7, and 10 years, as well as a 2-cm smaller calf girth 16 .…”