Use of the Foot Abduction Orthosis Following Ponseti Casts

Abstract

The purpose of this study was to evaluate the need for the use of a foot abduction orthosis (FAO) in the treatment of idiopathic clubfeet using the Ponseti technique. Forty-four idiopathic clubfeet were treated with casting using the Ponseti method followed by FAO application. Compliance was defined as full-time FAO use for 3 months and part-time use subsequently. Noncompliance was failure to fulfill the criteria during the first 9 months after casting. Feet were rated according to the Dimeglio and Pirani scoring systems at initial presentation, at the time of FAO application, and at 6 to 9 months of follow-up. At the time of application, no significant differences in scores were found between the groups. At follow-up, the compliant group's scores were significantly (P < 0.01) better than those of the noncompliant group. From the time of application to follow-up, for the compliant group, the Dimeglio scores improved significantly (P = 0.005). For the noncompliant group, the Dimeglio scores deteriorated significantly (P = 0.001). The feet of patients compliant with FAO use remained better corrected than the feet of those patients who were not compliant. Proper use of FAO is essential for successful application of the Ponseti technique.

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

“…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.…”

Ponseti Method for Untreated Idiopathic Clubfeet in Nepalese Patients From 1 to 6 Years of Age

“…Abduction splinting is an essential component of the Ponseti method, and relapse rates of up to 70% may be expected when the abduction splint is not worn [6,10,11,27]. Reasons for a lack of adherence to the splinting program may include noncompliance (patient or family chooses not to wear the splint) and brace intolerance (discomfort from skin irritation or other cause).…”

“…The economic and social consequences of time away from home must be recognized in a society where subsistence agriculture is the principle means of support. Realistically, this will involve the training of health professionals other than orthopaedic surgeons, and our experience suggests paraprofessionals may effectively administer the casting as shown in the United Kingdom (physiotherapists) [25] and Malawi (orthopaedic clinical officers) [27]. Such nonconventional models must be explored if clubfoot care is to be delivered at the population level in low-income countries.…”

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

“…Figure 3 displays the ranked difficulties with each component of the Ponseti method as indicated by 24/27 An overall response rate of 63% was achieved Of the 27 responses received, 24 (89%) indicated that the results achieved using the Ponseti method to correct clubfoot were either excellent [8] or moderate [9]. The respondents commented on the barriers to treatment, such as distance [5], poor follow-up [5], poor parent compliance, especially with the FAB [10], no FAB available [1], and older children [3].…”