Modified Ponseti method of treatment for correction of neglected clubfoot in older children and adolescents – a preliminary report

Abstract

Congenital talipes equinovarus may be the most common congenital orthopedic condition requiring treatment. Nonoperative treatment including different methods is generally accepted as the first step in the deformity correction. Ignacio Ponseti introduced his nonsurgical approach to the treatment of clubfoot in the early 1940s. The method is reportedly successful in treating clubfoot in patients up to 9 years of age. However, whether age at the beginning of treatment affects the rate of effective correction and relapse is unknown. We have applied the Ponseti method successfully with some modifications for 11 patients with a mean age of 11.2 years (range, 6 to 19 years) with neglected and untreated clubbed feet. The mean follow-up was 15 months (12 to 36 months). Correction was achieved with a mean of nine casts (six to 13). Clinically, 17 out of 18 feet (94.4%) were considered to achieve a good result with no need for further surgery. The application of this method of treatment is very simple and also cheap in developing countries with limited financial and social resources for health service. To the best of the authors' knowledge, such a modified method as a correction method for clubfoot in older children and adolescents has not been applied previously for neglected clubfeet in older children in the literature.

The Ponseti method in children with clubfoot after walking age – Systematic review and metanalysis of observational studies

“…Most cases of untreated CC occur in developing countries, due to deficiencies in the local public health systems, whereby children are not adequately treated [ 24 ]. The deformity becomes worse when walking because the body weight falls on the lateral side of the foot, causing contracture of the medial tissues and plastic deformity of the bones [ 25 ].…”

“…Other options include tarsectomy, midfoot osteotomy, arthrodesis, and correction with a circular external fixator, among others [ 27 – 29 ]. This type of treatment demands commitment, the postoperative period is long [ 24 ], and the rate of complications and cost are high [ 30 ]. In addition, the result is often a painful foot in childhood [ 31 ].…”

Ponseti method treatment of neglected idiopathic clubfoot: Preliminary results of a multi-center study in Nigeria

“…There are few studies on the effectiveness of the Ponseti method for patients over age 1, but the early evidence has been promising. Studies in Brazil, Nepal, India and Ethiopia reported that use of the Ponseti method allowed for avoidance of soft tissue release in 66%-92% of cases above one year of age[ 8 - 16 ].…”

Pedobarographic Analysis following Ponseti Treatment for Unilateral Neglected Congenital Clubfoot

“…The initial deformities of clubfoot are worsened by secondary changes due to weight-bearing and walking of the children as the side or dorsum of the affected foot begins to bear the weight, causing local skin ulcers, callosities and bursae formation, medial soft tissue contracture, and plastic deformation of bones 4 . The NCF can impose a heavy physical, psychological, social, and economic burden on the patients, families, communities, and countries 5 , 6 .…”