Treatment of non-idiopathic clubfeet with the Ponseti method: A systematic review

Abstract

PurposeAlthough non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method.MethodsPubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Data on average number of casts, Achilles tendon tenotomy (ATT), initial correction, recurrence, successful treatment at final follow-up and complications were pooled. The Methodological Index for Non-Randomized Studies was used to assess the methodological quality of the selected studies.ResultsIn all, 11 studies were included, yielding a total of 374 non-idiopathic and 801 idiopathic clubfeet. Non-idiopathic clubfeet required more casts (7.2 versus 5.4) and had a higher rate of ATT (89.4% versus 75.7%). Furthermore, these feet had a higher recurrence rate (43.3% versus 11.5%) and a lower rate of successful treatment at final follow-up (69.3% versus 95.0%). Complications were found in 20.3% of the non-­idiopathic cohort. When comparing results between clubfeet associated with myelomeningocele and arthrogryposis, the first group presented with a lower number of casts (5.4 ­versus 7.2) and a higher rate of successful treatment at final follow-up (81.8% versus 58.2%).ConclusionThe Ponseti method is a valuable and non-invasive option in the primary treatment of non-idiopathic clubfeet in young children. Studies with longer follow-up are necessary to evaluate its long-term effect.Level of EvidenceLevel III – systematic review of Level-III studies.This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and ­Meta-Analyses).

The Ponseti method of treatment for neuromuscular and syndromic (non-idiopathic) clubfeet: evaluation of a programme-based approach at a mean follow-up of 5.8 years

“…Our initial correction rate of 92.4% in non-idiopathic clubfeet is comparable with other studies in literature (ranging from 90 to 100%) [12-14, 16, 18-20, 22, 23, 25] and our average number of casts of 6.75 ± 4.2 also correlates well with other studies [12-14, 16, 25]. The mean age of patients in our series (9.3 ± 1.5 months) is higher than other studies [26], which may be due to the fact that our hospital is a tertiary referral centre with some patients having attempted treatment unsuccessfully elsewhere. Rather than separating out nonidiopathic clubfeet by aetiology, we preferred to report on the entire non-idiopathic clubfoot cohort together.…”

“…The conventional practice has been to perform extensive soft tissue and bony surgeries to correct the deformity, which often resulted in stiff and painful feet, high relapse rates, and unsatisfactory outcomes [6][7][8][9][10][11]. Considering the poor outcomes of radical surgery and parallel with the surge of interest in conservative methods of clubfoot treatment over the past few decades, several researchers have reported on the use of the Ponseti method for these difficult feet [12][13][14][16][17][18][19][20][21][22][23][24][25][26].…”

“…Both studies were of a small series of 12-16 patients with amyoplasia or distal arthrogryposis and showed a variable success rate of 70-92% at a mean short-term follow-up of 3 years [12,13]. Subsequently, a few more articles in literature [14,[16][17][18][19][20][21][22][23][24][25][26] have reported on the successful short-term outcomes of the Ponseti method in non-idiopathic clubfeet. However, some of these articles have focused on a particular aetiology (Arthrogryposis, Myelomeningocele, etc.)…”

Ponseti Casting vs. Soft Tissue Release for the Initial Treatment of Non-idiopathic Clubfoot

“…Recurrent deformity was subsequently treated with further casting and secondary operative procedures (18). These findings have been observed in other studies supporting the notion that STR treatment of non-idiopathic clubfoot leads to additional more invasive secondary operations (3,4,7,10,(17)(18)(19)(20). Kowalczyk and Felus observed an average of 1.4 procedures per foot following primary STR in their recurrent and uncorrected non-idiopathic clubfoot patients.…”

“…Unlike idiopathic clubfoot, non-idiopathic clubfoot has yet to accept a standard approach in treatment. Non-idiopathic clubfoot refers to patients who develop clubfoot secondary to an underlying condition with the most common being spina bifida and arthrogryposis (3). These deformities are more rigid and resistant to treatment compared to idiopathic clubfoot.…”