Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method

Background: The Ponseti method is the preferred technique to manage idiopathic clubfoot deformity; however, there is no consensus on the expected relapse rate or the percentage of patients who will ultimately require a corrective surgical procedure. The objective of the present systematic review was to determine how reported rates of relapsed deformity and rates of a secondary surgical procedure are influenced by each study's length of follow-up.Methods: A comprehensive literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed to identify relevant articles. The definition of relapse, the percentage of patients who relapsed, the percentage of feet that required a surgical procedure, and the mean duration of follow-up of each study were extracted. Pearson correlations were performed to determine associations among the following variables: mean follow-up duration, percentage of patients who relapsed, percentage of feet that required a joint-sparing surgical procedure, and percentage of feet that required a joint-invasive surgical procedure. Logarithmic curve fit regressions were used to model the relapse rate, the rate of joint-sparing surgical procedures, and the rate of joint-invasive surgical procedures as a function of follow-up time.Results: Forty-six studies met the inclusion criteria. Four distinct definitions of relapse were identified. The reported relapse rates varied from 3.7% to 67.3% of patients. The mean duration of follow-up was strongly correlated with the relapse rate (Pearson correlation coefficient 5 0.44; p , 0.01) and the percentage of feet that required a joint-sparing surgical procedure (Pearson correlation coefficient 5 0.59; p , 0.01). Studies with longer follow-up showed significantly larger percentages of relapse and joint-sparing surgical procedures than studies with shorter follow-up (p , 0.05). Conclusions:Relapses have been reported to occur at as late as 10 years of age; however, very few studies follow patients for at least 8 years. Notwithstanding that, the results indicated that the rate of relapse and percentage of feet requiring a joint-sparing surgical procedure increased as the duration of follow-up increased. Longer-term followup studies are required to accurately predict the ultimate risk of relapsed deformity. Patients and their parents should be aware of the possibility of relapse during middle and late childhood, and, thus, Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A462).

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Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time

Thomas

Sangiorgio

Ebramzadeh

et al. 2019

JBJS Rev

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Outcomes of clubfoot conservative treatment using the Ponseti technique in an academic hospital in Saudi Arabia

Bakarman,

Zamzam,

Addweesh

et al. 2024

JMSR

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Objectives: Congenital talipes equinovarus (CTEV), commonly known as clubfoot, affects 1–4/1000 births, predominantly males. Without intervention, children face mobility limitations and deformities. Conservative treatment, particularly the Ponseti technique, which boasts a success rate exceeding 90%, is favored despite potential complications. Methods: This study aimed to assess the efficacy of the Ponseti technique through a retrospective analysis of idiopathic CTEV cases. Data on pre- and post-treatment Pirani scores were analyzed across variables including age, sex, number of casts, Achilles tenotomy, surgical intervention, and complications. Participants were categorized based on treatment outcomes to identify contributing factors. Results: Among 42 participants (69 feet), 62% were male, presenting at an average age of 9 weeks and receiving an average of 5.26 casts per patient. Pre-treatment Pirani scores averaged 4.52, significantly decreasing to 0.88 post-treatment. Feet managed without surgery demonstrated greater improvement in Pirani scores (mean change 3.888) compared to those requiring surgery (mean change 2.364), a statistically significant difference (P < 0.001). Acceptable outcomes were observed in 84.06% of feet. Percutaneous Achilles tenotomy was performed in 84% of cases. Surgical intervention was necessary in 15.94% of feet. Casting complications occurred in 14.49% of feet. Conclusion: This study confirms the Ponseti technique’s effectiveness in managing idiopathic CTEV, emphasizing early detection and initiation of conservative treatment. The early findings establish the Ponseti technique as the preferred initial approach for CTEV management.

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Incidence of Congenital Clubfoot: Preliminary Data from Italian CeDAP Registry

Dibello

Torelli

Carlo

et al. 2022

IJERPH

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(1) Background: We find the incidence of clubfoot in Italy from “Certificate of Delivery Care Registry (CeDAP)”, a database of the Italian Ministry of Health, the most comprehensive public data available for this purpose. (2) Methods: The CeDAP registry is a web system that provides epidemiological and sociodemographic information about newborns. It started on 1 January 2002, following the ministerial Decree no. 349 of 16 July 2001. The certificate is structured into six sections; each collects specific information referring to the birthplace, parents, pregnancy, childbirth, newborn, and the possible presence of congenital malformations or the causes of neonatal mortality. The midwife or the doctor draws up the certificate no later than ten days after birth. Each region transmits the data every six months to the Ministry of Health. The period between 2013 and 2017 has been selected for the study, with every Italian region’s data. We conducted a retrospective descriptive study. (3) Results: The overall rate in northern Italy is 1.09 (with some exceptions described), but we think it is essential to reevaluate this number again, given more accurate data collections by every Italian hospital. (4) Conclusions: This study intends to build a framework for future epidemiologic studies about clubfoot in Italy.

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Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot / CTEV with Ponseti Method

Cited by 4 publications

References 17 publications

Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time

Relapse Rates in Patients with Clubfoot Treated Using the Ponseti Method Increase with Time

Outcomes of clubfoot conservative treatment using the Ponseti technique in an academic hospital in Saudi Arabia

Incidence of Congenital Clubfoot: Preliminary Data from Italian CeDAP Registry

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