Assessment of success of the Ponseti method of clubfoot management in sub-Saharan Africa: a systematic review

Abstract

BackgroundClubfoot is one of the most common congenital deformities affecting mobility. It leads to pain and disability if untreated. The Ponseti method is widely used for the correction of clubfoot. There is variation in how the result of clubfoot management is measured and reported. This review aims to determine and evaluate how success with the Ponseti method is reported in sub-Saharan Africa.MethodsFive databases were examined in August 2017 for studies that met the inclusion criteria of: (1) evaluation of the effect of clubfoot management; (2) use of the Ponseti method; (3) original study undertaken in sub-Saharan Africa; (4) published between 2000 and 2017. We used the PRISMA statement to report the scope of studies. The included studies were categorised according to a hierarchy of study methodologies and a 27-item quality measure identified methodological strengths and weaknesses. The definition of success was based on the primary outcome reported.ResultsSeventy-seven articles were identified by the search. Twenty-two articles met the inclusion criteria, of which 14 (64%) reported a primary outcome. Outcomes were predominantly reported though case series and the quality of evidence was low. Clinical assessment was the most commonly reported outcome measure and few studies reported long-term outcome. The literature available to assess success of clubfoot management is characterised by a lack of standardisation of outcomes, with different measures reporting success in 68% to 98% of cases.ConclusionWe found variation in the criteria used to define success resulting in a wide range of results. There is need for an agreed definition of good outcome (successful management) following both the correction and the bracing phases of the Ponseti method to establish standards to monitor and evaluate service delivery.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1814-8) contains supplementary material, which is available to authorized users.

A comparison of outcome measures used to report clubfoot treatment with the Ponseti method: results from a cohort in Harare, Zimbabwe

“…This is followed by long term use of a foot abduction brace at night to maintain the foot position [2]. Despite the global trend toward increased use of the Ponseti method, there remains variation in how success of clubfoot treatment is measured [3, 4].…”

“…The most frequently used approach to measuring whether the Ponseti method has been successful (or not) is clinical assessment. In sub-Saharan Africa 68 to 98% of cases are reported to have a successful outcome with the Ponseti method [4]. This study aims to compare the results of the Ponseti method of clubfoot management at three to five years from initial correction using five different outcome measures.…”

Eficacia del método Ponseti en el tratamiento del pie equinovaro

“…El pie equinovaro no tratado produce dolor, deterioro físico y discapacidad, de ahí la importancia de su tratamiento desde temprana edad, preferiblemente después del nacimiento del niño. Además, dado que la tasa de corrección se sitúa entre un 92-100%, se debe priorizar el tratamiento conservador, de manera que se disminuyan las molestias y se favorezca una mejora en la calidad de vida tanto para el niño como para los padres (15).…”

Role of Talectomy in Severe Resistant Clubfoot in Children

“…The Ponseti method necessitates long-term follow-up periods that might not be available for all patients particularly in the developing countries. 2 Moreover, such conservative methods are often futile for rigid foot deformity. Despite the early serial casting, most of cases of clubfoot especially in patients of age between 3 months and 1 year mostly end in surgical releases.…”