A comparison of ankle foot orthoses with foot abduction orthoses to prevent recurrence following correction of idiopathic clubfoot by the Ponseti method

Abstract

The Ponseti method of clubfoot management requires a period of bracing in order to maintain correction. This study compared the effectiveness of ankle foot orthoses and Denis Browne boots and bar in the prevention of recurrence following successful initial management. Between 2001 and 2003, 45 children (69 feet) with idiopathic clubfeet achieved full correction following Ponseti casting with or without a tenotomy, of whom 17 (30 clubfeet) were braced with an ankle foot orthosis while 28 (39 clubfeet) were prescribed with Denis Browne boots and bar. The groups were similar in age, gender, number of casts and tenotomy rates. The mean follow-up was 60 months (50 to 72) in the ankle foot orthosis group and 47 months (36 to 60) in the group with boots and bars. Recurrence requiring additional treatment occurred in 25 of 30 (83%) of the ankle foot orthosis group and 12 of 39 (31%) of the group with boots and bars (p < 0.001). Additional procedures included repeat tenotomy (four in the ankle foot orthosis group and five in the group treated with boot and bars), limited posterior release with or without tendon transfers (seven in the ankle foot orthosis group and two in the group treated with boots and bars), posteromedial releases (nine in the orthosis group) and midfoot osteotomies (five in the orthosis group, p < 0.001). Following initial correction by the Ponseti method, children managed with boots and bars had far fewer recurrences than those managed with ankle foot orthoses. Foot abduction appears to be important to maintain correction of clubfeet treated by the Ponseti method, and this cannot be achieved with an ankle foot orthosis.

Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis

“…Some reports considered recurrence of clubfoot after treatment using the Ponseti method as any deformity that required additional casting and/or surgical intervention. This is almost similar to the definition of the Iowa group 3,6,14,25,26)…”

“…Many studies suggested that non-compliance with the brace treatment was closely associated with recurrence of the deformity 3,6,10,13,14,15,16,21,22,25,26,27). In addition, a few researches suggested that low educational level of parents, annual family income of < US $20,000, and Native American ethnicity were all significant risk factors for the recurrence of deformity following correction with the Ponseti method 3,14,15,21).…”

“…Then the children start using the FAO and its purpose is to maintain the correction after the final cast 2,12). A comparative research between the use of the bar-connected FAO and the ankle foot orthosis (AFO) to prevent relapse follow correction of idiopathic clubfoot with the Ponseti method suggested that the bar-connected FAO appeared to be very important in preventing recurrence of clubfeet treated with the Ponseti method and this cannot be achieved with an AFO because 60 to 70 degrees of external rotation, which is accomplished by the FAO, is necessary to stretch the medial soft tissues 26). Conversely, the AFO can only keep the foot in a neutral position without stretching the medial soft tissue.…”

Clinical Experiences and Midterm Results of the Treatment of Clubfoot with the Ponseti Method

“…In addition, using the appropriate orthosis is equally as important. A study comparing a Denis Brown orthosis with an ankle foot orthosis reveals that patients wearing the Denis Brown orthosis have significantly fewer recurrences [22]. However, Hemo et al, find no significant difference between Denis Brown and Mitchell braces after a minimum two-year follow-up period [23].…”

Percutaneous needle tenotomy for Ponseti technique in the management of Congenital Talipes Equinovarus (CTEV)

“…19 Janicki et al also reported 31%.recurrence that required additional treatment. 24 None of the foot in our study required conversion or open tenotomy. There was no skin/soft tissue infection in any of our cases.…”