Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up

Abstract

One hundred and thirty-seven idiopathic clubfeet were treated by the Ponseti technique and followed for at least 2 years. Nine feet (7%) were not corrected with initial casting and required early surgery. Recurrence after correction was related to compliance with bracing. At latest follow-up, two-thirds of those noncompliant with brace had recurrences with one-third of these recurrences requiring more extensive surgery than Achilles tenotomy and anterior tibial tendon transfer while only 14% of those compliant with brace had recurrences with none requiring more than Achilles tenotomy and anterior tibial tendon transfer. Early failures and recurrences constituted about 20% of our 137 feet by 2 years of follow-up. When the Ponseti method was fully followed, including initial casting, compliance with brace and treatment of recurrences by recasting, Achilles tenotomy and/or anterior tibial tendon transfer, our success rate was 93%.

Ponseti Treatment for Idiopathic Clubfoot: Minimum 5-year Followup

“…Colburn and Williams [6] found only three of 57 feet treated by the Ponseti method required extensive surgical correction. This pattern of good short-term results has been replicated in many recent studies [1,2,4,6,8,9,17,19,21].…”

“…However, strictly following the brace protocol seems to be the major challenge of the Ponseti method. Many authors report brace intolerance rates of 30% to 49% [1,7,11,14,21]. Our brace intolerance rate was as high as 44.3%.…”

“…For example, five of 11 brace-intolerant patients in the study of Lehman et al [21] had a good result. In another study [1], 30 brace-intolerant patients required no additional surgery. In our study, 55% of the brace-intolerant patients required no additional surgery.…”

“…Abdelgawad et al [1] reported a 6.6% failure rate in patients who presented late for treatment (mean age, 36.3 weeks). Lehman et al [21] reported failure in five feet that presented late for treatment (mean age, 34 weeks).…”

“…A recent questionnaire reported that 65% of the Pediatric Orthopaedic Society of North America members used the Ponseti method [16]. However, all recently published reports describe only short-term followup of 1 to 2 years [1,2,4,6,8,9,17,19,21].…”