Conservative Management of Idiopathic Clubfoot: Kite versus Ponseti Method

Abstract

Purpose.To compare the long-term results of the Kite and Ponseti methods of manipulation and casting for clubfoot. Methods. 42 patients (with 64 idiopathic clubfeet) were equally randomised to Kite or Ponseti treatments in the early weeks of life. 14 males and 7 females (34 clubfeet) were treated by the Kite method, whereas 13 males and 8 females (30 clubfeet) were treated by the Ponseti method. All the clubfeet were manipulated, casted, and followed up (for a mean of 3 years) by one experienced orthopaedic surgeon. The final results were compared. Results. The success rates for the Kite and Ponseti treatments were similar (79% vs 87%). With the Ponseti method, the number of casts was significantly fewer (7 vs 10); the duration of casting required to achieve full correction was significantly shorter (10 vs 13 weeks); the maximum ankle dorsiflexion achieved was significantly greater (12 vs 6 degrees); and the incidence of residual deformity and recurrence was slightly lower. Conclusion. The Ponseti method can achieve more rapid correction and ankle dorsiflexion with fewer casts, without weakening the Achilles tendon.

Validation of Ponseti method for clubfoot deformity correction

“…Very good results (>85%) have been reported by most authors. [4][5][6][7][8][9]11,12,25 Excellent results (>95%) have been also reported with this technique by some authors. [26][27][28] In 21 feet (10%) there was residual equinus and adduction deformity.…”

“…9 But, after reemergence of Ponseti technique of correction, there many published reports in literature citing the superiority of Ponseti's method over Kite's method. [10][11][12] The Ponseti technique is an easy, effective and economical method of clubfoot correction when it is applied in idiopathic clubfoot, and patients have better ankle range of motion, both in dorsi-flexion and planter-flexion. 13 The management of clubfoot deformity is the best if started at very early age as the feet are pliable and response is better as much better remodelling of the small bones of foot occur since they are in cartilaginous phase.…”

“…This reason has been widely reported to be the main factor causing failure of the technique. 1,3,9,11,12,14,27 These children were again corrected by casting and strict bracing protocol was advised and correction remained sustained thereafter.…”

Causes of Non-Optimal Conservative Treatment of Congenital Clubfoot in Children

“…Разнообразие методик и подходов в настоящее время в значительной степени имеет истори-ческое значение благодаря внедрению метода понсети: большинство ортопедов мира призна-ют его «золотым стандартом» лечения врож-денной косолапости у детей [1]. Не подвергая принципиальному сомнению возможности других методик, сравнительный анализ эффек-тивности метода понсети по отношению как к иным методам консервативного лечения [9,10], так и к хирургическому лечению [11,12] по-зволяют считать его оптимальным, а остальные методики, даже учитывая их относительную эффективность, на сегодняшний день относить к неоптимальным. Существенную роль метод понсети играет в лечении пациентов с реци-дивами деформаций, а также неэффективным предшествовавшим лечением [13][14][15].…”

Doğuştan çarpık ayak tedavisinde Ponseti yöntemi uygulama prensipleri

“…Erken dönemde uygulanan cerrahi sonrasında gelişebilen skar dokunun fazla olduğu ve eklem sertliğinin daha sık görüldüğünü bildiren çalış-malar mevcuttur. [8] Ponseti metodunun kullanılmaya başlamasından ön-ceki dönemde; Kite, 1924-1960 yılları arasında, manipülasyon ve alçılama ile tedavi ettiği 800 çocukta elde ettiği başarılı sonuçları bildirerek, cerrahi dışı tedaviyi önermiştir.1940'lı yıllarda ise, Dr. Ignacio Ponseti, PEV hastaları için uyguladığı kendi tekniğini geliştirmiştir. [9] PONSETİ YÖNTEMİ Ponseti de Kite gibi, cerrahi yöntemlerle görülme oranı artan skar ve eklem sertliği gibi komplikasyonları azaltmaya yönelik, daha az agresif davranma yolları-nı araştırmış ve yenidoğanlarda yaptığı anatomik disseksiyon çalışmaları, PEV pato-anatomisini anlamada çok önemli katkılar sağlamıştır.…”