Long-term outcomes of the Ponseti method for treatment of clubfoot: a systematic review

Rastogi, Ashu; Agarwal, Anil

doi:10.1007/s00264-021-05189-w

Cited by 22 publications

(16 citation statements)

References 36 publications

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“…Ponseti and Smoley1 reported a 56% recurrence rate in their 5 to 12-year follow-up. A recent systematic review of long-term outcomes of the Ponseti method found recurrence rates of 47% with additional surgery required in 79% of recurrences 25. Our recurrence rate gradually increased over time, approaching two-thirds of patients at final follow-up.…”

Section: Discussionmentioning

confidence: 56%

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Chen

Ragsdale

Rhodes

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Clubfoot is a common congenital foot deformity in children. The Ponseti method of serial casting has become the standard of care in clubfoot treatment. Clubfoot casting is performed in many centers by both orthopaedic surgeons and physical therapists (PTs); however, direct comparison of outcomes and complications of this treatment between these providers is limited. This study prospectively compared the outcomes of patients with clubfoot treated by these 2 groups of specialists. Methods: Between January 2010 and December 2014, all patients under the age of 12 months with a diagnosis of clubfoot were included. Patients were randomized to an orthopaedic surgeon (MD) group or a PT group for weekly serial casting. Main outcome measures included the number of casts required to achieve correction, clinical recurrence of the deformity, and the need for additional surgical intervention. Results: One hundred twenty-six infants were included in the study. Patient demographics and characteristics (sex, race, family history of clubfoot, laterality, and severity of deformity) were similar between treatment groups, with the only significant difference being the mean age of entry into the study (5.2 weeks in the MD group and 9.2 weeks in the PT group, P=0.01). Mean length of follow-up was 2.6 years. The number of casts required trended to a lower number in the MD group. There was no significant difference in the rates of clinical recurrence or additional surgical intervention between groups. Conclusions: Ponseti casting for treatment of clubfoot performed by orthopaedic surgeons and PTs results in equivalent outcomes without any difference in complications. Although the number of casts required trended to a lower number in the MD group, this likely did not result in any clinical significance, as the difference in cast number equaled <1 week’s difference in the overall duration of serial casting. Level of Evidence: Level I—therapeutic.

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Section: Discussionmentioning

confidence: 56%

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Chen

Ragsdale

Rhodes

et al. 2022

Journal of Pediatric Orthopaedics

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“…A mean of 16.8% was seen in those studies with <4 years follow-up and up to 32% in 4 years follow-up. Another systematic review by Rastogi and Agarwal 22 included the studies only with a minimum of 10 years follow-up, and they found a mean relapse rate of 47% with a mean follow-up of 14.5 years. To calculate the exact relapse rates, long-term follow-up of atypical/complex clubfeet is needed.…”

Section: Discussionmentioning

confidence: 99%

Correction results of atypical clubfeet managed with modified Ponseti technique: A meta-analysis of 354 feet

Rangasamy

Baburaj

Gopinathan

et al. 2022

Journal of Clinical Orthopaedics and Trauma

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“…Other errors include not scoring the deformity before applying the next cast or keeping the serial record using validated clubfoot scores [5,13,33]. Failure to do this diligently results in missing or unsatisfactory results.…”

Section: Errors In Castingmentioning

confidence: 99%

“…Failure to do this diligently results in missing or unsatisfactory results. Parents may not be able to recognize cast slippage or softening if inadequately educated [5,13,33]. Previous clinical and simulation experience (of >10 casts) related to the Ponseti method has been shown to correlate with improved performance [21,42,43].…”

Section: Errors In Castingmentioning

confidence: 99%

“…The bracing phase consists of using bilateral boots and a foot abduction bar full time for 3 months and part time (night and nap time) for up to 4-5 years of age to maintain correction and prevent relapse of the clubfoot deformity. There have been a multitude of studies showing its effectiveness in both developed and developing LMIC countries, with shortterm success rates of approximately 90% and long-term rates at 80% [5][6][7][8][9][10][11][12][13][14]. Despite this success, errors can be made during the treatment process, resulting in complications if there is not close attention to detail due to the intensive nature of this treatment program [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Common Errors in the Management of Idiopathic Clubfeet Using the Ponseti Method: A Review of the Literature

et al. 2023

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Congenital talipes equinovarus is one of the most prevalent birth defects, affecting approximately 0.6 to 1.5 children per 1000 live births. Currently, the Ponseti method is the gold-standard treatment for idiopathic clubfeet, with good results reported globally. This literature review focuses on common errors encountered during different stages of the management of idiopathic clubfeet, namely diagnosis, manipulation, serial casting, Achilles tenotomy, and bracing. The purpose is to update clinicians and provide broad guidelines that can be followed to avoid and manage these errors to optimize short- and long-term outcomes of treatment of idiopathic clubfeet using the Ponseti method. A literature search was performed using the following keywords: “Idiopathic Clubfoot” (All Fields) AND “Management” OR “Outcomes” (All Fields). Databases searched included PubMed, EMBASE, Cochrane Library, Google Scholar, and SCOPUS (age range: 0–12 months). A full-text review of these articles was then performed looking for “complications” or “errors” reported during the treatment process. A total of 61 articles were included in the final review: 28 from PubMed, 8 from EMBASE, 17 from Google Scholar, 2 from Cochrane Library, and 6 from SCOPUS. We then grouped the errors encountered during the treatment process under the different stages of the treatment protocol (diagnosis, manipulation and casting, tenotomy, and bracing) to facilitate discussion and highlight solutions. While the Ponseti method is currently the gold standard in clubfoot treatment, its precise and intensive nature can present clinicians, health care providers, and patients with potential problems if proper diligence and attention to detail is lacking. The purpose of this paper is to highlight common mistakes made throughout the Ponseti treatment protocol from diagnosis to bracing to optimize care for these patients.

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Long-term outcomes of the Ponseti method for treatment of clubfoot: a systematic review

Cited by 22 publications

References 36 publications

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Correction results of atypical clubfeet managed with modified Ponseti technique: A meta-analysis of 354 feet

Common Errors in the Management of Idiopathic Clubfeet Using the Ponseti Method: A Review of the Literature

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