Clubfoot treatment through the ages

Abstract

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.

Kite versus Ponseti Method in the Treatment of 235 Feet With Idiopathic Clubfoot

“…It is worthy noticing that, in infants, not only the Dimeglio score was most significantly improved but also the 6 months’ rate of relapses was also lower in the Ponseti group, this observation being in line to other researches. 3 , 4 Ponseti method superiority was also proved for the correction rate and functional outcome. 3 , 4 The median success rate is 58% to 79% for Kite and 78% to 98% for Ponseti method.…”

“… 3 , 4 Ponseti method superiority was also proved for the correction rate and functional outcome. 3 , 4 The median success rate is 58% to 79% for Kite and 78% to 98% for Ponseti method. 14 , 15 Median time of therapy is also higher using the Kite method (20 vs 10–15 weeks).…”

“… 14 , 15 Median time of therapy is also higher using the Kite method (20 vs 10–15 weeks). 14 , 17 In several studies, the superiority of Ponseti method was agreed, for both primary correction and uncorrected plus relapsed feet, 3 , 13 but the risk for over-correction and stiff scar healing was higher after Ponseti than Kite method. 3 Its superiority is also related on the lower cost and higher effectiveness 16 and can also improve significantly the Kite recurrent clubfeet.…”

“…Although Ponseti method was extensively explored in the last time, in a meta-analysis performed by Matos and de Oliveira, it was mentioned that only 4 articles that compared the 2 methods have been published till 2010; 5 , 13 , 14 another 3 were added during 2010 to May 2015. 3 , 15 , 16 To best of our knowledge, this is the eighth study from English literature that compare the efficacy of Ponseti versus Kite method and comprises the largest number of cases.…”