Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time

Thomas, Hannah M.; Sangiorgio, Sophia N.; Ebramzadeh, Edward; Zionts, Lewis E.

doi:10.2106/jbjs.rvw.18.00124

Cited by 51 publications

(69 citation statements)

References 64 publications

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“…The relapse rate in this study was 32%. Previous studies have reported relapse rates ranging from 3.7% up to 53% depending on the initial treatment method, bracing protocol, follow-up time, and relapse criteria [24][25][26][27][28]. Most (87%) of the relapses in this study were observed after completion of orthosis treatment.…”

Section: Discussionmentioning

confidence: 54%

“…This prospective longitudinal study included a consecutive cohort and aimed to evaluate the development of foot length and foot growth in children with clubfoot from 2 to 7 years of age. The study cohort is representative with respect to unilateral and bilateral involvement, gender distribution, and relapse rate [24][25][26][27][28][29]. We found that clubfeet were shorter than reference feet at all ages.…”

Section: Discussionmentioning

confidence: 70%

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Development of Foot Length in Children with Congenital Clubfoot up to 7 Years of Age: A Prospective Follow-Up Study

Manousaki

Esbjörnsson

Hägglund

et al. 2021

Preprint

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Background: Clubfeet are typically shorter than normal feet. This study aimed to describe the development of foot length in a consecutive series of children with congenital clubfoot and to relate foot length to development of relapse and motion quality.Methods: Foot length was measured every 6 months in 72 consecutive children with congenital clubfoot (29 bilateral) aged from 2 to 7 years. The initial treatment was nonsurgical followed by standardized orthotic treatment. Foot length growth rate was calculated every half year. In children with unilateral clubfeet, the difference in foot length between the clubfoot and the contralateral foot was calculated. Motion quality was evaluated by the Clubfoot Assessment Protocol (CAP). Student’s t test, the Mann–Whitney U test and Spearman’s correlation were used for group comparisons. Bonferroni correction was used when multiple comparisons were performed.Results: Clubfeet were smaller (P < 0.001) than reference feet at all ages but had a similar growth rate up to age 7. Unilateral clubfeet with greater difference in size compared with the contralateral foot at the first measurement, relapsed more frequently (P = 0.016) and correlated with poorer motion quality (r = 0.4; P = 0.011).Conclusions: Clubfeet were smaller than reference feet at all ages but had a similar growth rate. Children with unilateral clubfeet and greater foot length difference at 2 years of age had a higher tendency to relapse and poorer motion quality at 7 years of age.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 70%

Development of Foot Length in Children with Congenital Clubfoot up to 7 Years of Age: A Prospective Follow-Up Study

Manousaki

Esbjörnsson

Hägglund

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The relapse rate in this study was 32 %. Previous studies have reported relapse rates ranging from 3.7 % up to 53 % depending on the initial treatment method, bracing protocol, follow-up time, and relapse criteria [ 23 – 27 ]. Most (87 %) of the relapses in this study were observed after completion of orthosis treatment.…”

Section: Discussionmentioning

confidence: 99%

Development of foot length in children with congenital clubfoot up to 7 years of age: a prospective follow-up study

Manousaki

Esbjörnsson

Hägglund

et al. 2021

BMC Musculoskelet Disord

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Background Clubfeet are typically shorter than normal feet. This study aimed first to describe the development of foot length in a consecutive series of children with congenital clubfoot and second to relate foot length to development of relapse and motion quality. Methods Foot length was measured every 6 months in 72 consecutive children with congenital clubfoot (29 bilateral) aged from 2 to 7 years. The initial treatment was nonsurgical followed by standardized orthotic treatment. Foot length growth rate was calculated every half year. In children with unilateral clubfeet, the difference in foot length between the clubfoot and the contralateral foot was calculated. Motion quality was evaluated by the Clubfoot Assessment Protocol (CAP). Student’s t test, the Mann–Whitney U test and Spearman’s correlation were used for group comparisons. Bonferroni correction was used when multiple comparisons were performed. Results Clubfeet were smaller (P < 0.001) than reference feet at all ages but had a similar growth rate up to age 7. Unilateral clubfeet with greater difference in size compared with the contralateral foot at the first measurement, relapsed more frequently (P = 0.016) and correlated with poorer motion quality (r = 0.4; P = 0.011). Conclusions As previously reported, clubfeet were smaller than reference feet at all ages. The growth rate, however, was similar between clubfeet and reference feet. Children with unilateral clubfeet and greater foot length difference at 2 years of age had a higher tendency to relapse and poorer motion quality at 7 years of age, indicating that foot length could be used as a prognostic tool.

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“…A linear regression equation (relapse expressed as patient percentage ¼ 0.958 x relapse expressed as feet percentage þ 1.329; R 2 ¼ 0.974) based on above studies was derived to calculate the patient relapse percentages in studies where relapses were reported only by feet numbers (n ¼ 14). 37 There were disadvantages of this approximation but the method avoided over reporting and bias which could have occurred if analysis was made otherwise. There were 24 articles which fulfilled our inclusion criteria (Fig.…”

Section: Methodsmentioning

confidence: 99%

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

Agarwal

Rastogi

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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The analysis determined the relapses in clubfoot children treated with Ponseti technique and standard bracing protocol and their correlation with overall follow up duration using pooled data from various series. It also tested the prescribed timelines of 5 and 7 years for slow-down/cessation of relapses in clubfoot children. Methods: A systematic literature search was performed for articles published in "Pubmed (includes Medline indexed journals)" electronic databases using key words: "Clubfoot or CTEV or congenital talipes equinovarus", "Ponseti" for years 1 st January 2001 to 15 th November 2020. Included were studies that addressed treatment of idiopathic clubfoot using the standard Ponseti technique, followed a well defined brace protocol (maintenance of corrected deformity using a central bar based brace and prescribed duration mentioned), reported a minimum mean follow up of 4 years and having relapse as one of their outcome measure. Studies reporting Ponseti technique for non-idiopathic clubfoot, child's age older than 1 year at the time of primary treatment, clubfoot with previous interventions before Ponseti treatment, where relapse and residual deformities were not identified distinctly in follow up, abstract only publications, letter to the editors, case reports, technique papers and review articles were excluded. The following characteristics of clubfoot patients in the selected articles were included for analysis: Patient numbers/feet treated with Ponseti technique; follow up years (<5; 5-7 and >7 years; overall) and corresponding relapse percentages for patients. Results: There were total 2206 patients in the included 24 studies. Average follow up was 6 years. The average relapse rates for clubfoot patients in the pooled data stood at 30%. The overall relapse rates increased with a longer follow up and the curve befitted a linear regression equation with weak positive correlation (Pearson correlation coefficient ¼ 0.08). The relapse rates in follow up categories of <5 years (26.6 ± 15.6%), 5-7 years (30.8 ± 16.3%) and >7 years (28.4 ± 6.2%) were similar statistically (Analysis of variance, ANOVA). Conclusions: Approximately 1 in 3 clubfoot patients suffer relapse post Ponseti technique and standard bracing protocol. A weak positive correlation was observed for relapses when correlated with increasing follow up years. The relapses however tend to slow down after initial growth years. There is a need to educate the care receivers regarding the possibility of late relapses despite proper Ponseti treatment and accordingly to keep them under supervised follow up for longer periods.

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Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time

Cited by 51 publications

References 64 publications

Development of Foot Length in Children with Congenital Clubfoot up to 7 Years of Age: A Prospective Follow-Up Study

Development of Foot Length in Children with Congenital Clubfoot up to 7 Years of Age: A Prospective Follow-Up Study

Development of foot length in children with congenital clubfoot up to 7 years of age: a prospective follow-up study

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

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