Initiating Ponseti management in preterm infants with clubfoot at term age

Abstract

Purpose: Currently, the optimal time to initiate treatment among preterm infants with clubfoot is unknown. The aim of this study was to describe treatment outcomes up to 1 year post-correction following Ponseti management in infants who were born preterm but treated at term age. Methods: A retrospective chart audit was conducted at a major pediatric hospital on preterm infants with clubfoot who commenced Ponseti management at term age (≥37 weeks of gestation). Data are expressed as mean values (±standard deviation) or 95% confidence intervals (95% CIs). Results: Twenty-six participants (40 feet) born at 32.6/40 (±3.1) weeks of gestation were identified. Thirteen (50%) were male, 14 (54%) presented bilaterally, and 7 (27%) presented with syndromic clubfoot. Ponseti management was initiated at 41.4/40 (±2.8) weeks gestation. Baseline Pirani scores were 5.2 (95%CI: 4.8–5.6) in the idiopathic group and 5.7 (95%CI: 5.0–6.4) in the syndromic group. The number of casts to correction was 5.9 (95% CI: 5.1–6.6) for those with idiopathic clubfoot and 6.1 (95%CI: 5.0–7.3) for those with syndromic clubfoot. Achilles tenotomies were required in 13 (21 feet) with idiopathic clubfoot and five (7 feet) with syndromic clubfoot. Recurrence occurred in four infants (5 feet): 4 feet required further casting and bracing, and 1 foot required additional surgery. Conclusion: Ponseti management at term age in preterm-born infants yields comparable 1-year outcomes to term-born infants. Further research is required to determine whether outcomes beyond 1 year of age align with growth and development demonstrated by term-born infants who are managed with the Ponseti method. Level of evidence: Level IV.

What’s New in Pediatric Orthopaedics

“…Scanlan et al reported that Ponseti treatment for clubfoot may be delayed until term age in premature infants (<37-week gestation) without an increased risk of recurrence. Both idiopathic and syndromic clubfeet were included; on average, 5.9 casts were needed for idiopathic clubfeet and 6.1 were needed for syndromic clubfeet 55 .…”

News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020–2023)

“…Scalan et al retrospectively reviewed 26 preterm infants (46 feet) born at < 37 weeks of gestation with clubfoot who were treated at term. They found that at one year follow-up they had comparable outcome, number of casts, tenotomy, and recurrence rates to those born at term [ 35 ].…”