Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method

Abstract

The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. This technique can be used in children up to 2 years of age even after previous unsuccessful nonsurgical treatment.

Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review

“…Our data also suggest that the presence of a single provider coordinating care in a clubfoot program can result in a low occurrence of major surgical events-a common factor in previous studies reporting a low incidence of major clubfoot surgery after Ponseti casting [21,22,27]. Establishment of a clubfoot program requires a care coordinator, dedicated cast technicians and orthotists, a team commitment among providers, and emphasis on continuity of care.…”

“…At Institution 1, the probability (46%) of major surgery resembled surgery rates for conservative, isolated clubfoot treatment approaches, which are similar to but not committed to the Ponseti technique [5,14,32]. In contrast, the low probability (1.7%) of major surgery at Institution 2, is reflective of other similar cohorts [21,22,27] in which less than 15% of patients treated with the Ponseti method undergo major surgery. Such wide variability in the use of major surgery in the treatment of clubfoot is costly and burdensome on the patient and the healthcare system [12,13]; therefore, there is a strong need to identify factors that are driving the increased variability in surgical rates.…”

“…Bor et al [2] observed that deviations from the Ponseti bracing recommendations were associated with a near twofold increase in additional operations. Excessive weight gain [4], parental educational level [8,12], a positive family history [8,12], and bracing noncompliance [8,9,11,21,28,31] have been identified as patient-related predictors of treatment failure.…”

“…The Ponseti technique has been reported to yield successful rates without significant surgical events in upward of 95% of patients [21,27]. Although proponents of the Ponseti technique have reported it is ''easy to learn'' [29], costeffective [13], and results in better long-term function compared with surgical intervention [1,15,16,33], Ponseti noted that strict adherence to his fundamental principles were essential for success [23].…”

Preliminary evaluation of implementing the Ponseti method for correction of clubfoot in Vietnam

“…The implementation of the Ponseti technique has repeatedly demonstrated radical reductions in clubfoot surgical procedures and greatly improved longterm results [2]. Complications are relatively few, and cost savings are significant.…”