Correction of neglected idiopathic club foot by the Ponseti method

Abstract

The Ponseti method of treating club foot has been shown to be effective in children up to two years of age. However, it is not known whether it is successful in older children. We retrospectively reviewed 17 children (24 feet) with congenital idiopathic club foot who presented after walking age and had undergone no previous treatment. All were treated by the method described by Ponseti, with minor modifications. The mean age at presentation was 3.9 years (1.2 to 9.0) and the mean follow-up was for 3.1 years (2.1 to 5.6). The mean time of immobilisation in a cast was 3.9 months (1.5 to 6.0). A painless plantigrade foot was obtained in 16 feet without the need for extensive soft-tissue release and/or bony procedures. Four patients (7 feet) had recurrent equinus which required a second tenotomy. Failure was observed in five patients (8 feet) who required a posterior release for full correction of the equinus deformity. We conclude that the Ponseti method is a safe, effective and low-cost treatment for neglected idiopathic club foot presenting after walking age.

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

“…We are unable to draw any conclusions regarding the most appropriate surgical technique for residual equinus after casting in these older patients. Recent studies have indicated a percutaneous release may be performed up to age 9 years [9,17,28]. If we were to consider the use of a posterior release to achieve a plantigrade foot as a treatment failure, then the Ponseti protocol failed in an additional 8% of cases (14% were treated by posterior release or posteromedial release), and the majority of patients were older than 3 years of age.…”

“…With the perception that the treatment of idiopathic clubfoot by extensive soft tissue release is often complicated by stiffness, recurrence, and the need for additional procedures, many treatment centers have adopted the minimally invasive Ponseti method, which has achieved excellent results in both economically developed [1-4, 6-8, 10, 11, 13, 14, 16, 18, 19, 21-26] and underdeveloped regions [9,12,17,28]. Although the majority of patients in these studies have been treated in infancy, recent evidence suggests the method may be appropriate for patients of walking age [9,17,28], and the upper age limit remains to be established.…”

“…Although the majority of patients in these studies have been treated in infancy, recent evidence suggests the method may be appropriate for patients of walking age [9,17,28], and the upper age limit remains to be established. In Malawi, for example, adequate correction (plantigrade foot) was achieved in 98% of feet, and 25% of patients presented between 18 and 48 months of age [28].…”

“…In Malawi, for example, adequate correction (plantigrade foot) was achieved in 98% of feet, and 25% of patients presented between 18 and 48 months of age [28]. In Brazil, the Ponseti method (with slight modifications) was successful in 16 of 24 feet (1-9 years of age), and failure was defined as the need for a posterior or an extensive soft tissue release to correct residual equinus after casting [17]. The Ponseti casting method, supplemented by a tibialis anterior tendon transfer, was also successful in correcting 17 feet (1-8 years of age) previously treated by an extensive soft tissue release [9].…”

Does Short-term Application of an Ilizarov Frame with Transfixion Pins Correct Relapsed Clubfoot in Children?

“…Midfoot deformities also may occur during recurrence [20]. Although Ponseti serial casting techniques reportedly achieve lasting correction in 62% to 98% of patients with a 10% relapse rate after initial successful treatment [22], patients with recurrent clubfoot require additional treatment [15]. The Ilizarov method is one of the options that can be used to treat recurrent clubfoot in patients as young as 4 or 5 years, and other methods including serial casting and soft tissue release are still effective.…”