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

Abstract

Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release

Update on Clubfoot: Etiology and Treatment

“…In addition, his method is being used with a high rate of success in very stiff clubfeet associated with distal arthrogryposis [8], myelomeningocele [12], and a host of different genetic syndromes and genetic disorders [30]. Success has also been reported in treating older children with neglected clubfoot [45,61] and clubfeet that have relapsed after initial treatment with extensive soft-tissue release surgery [26]. There is a report combining the principles of stretching emphasized in the French method [6] with the casting and bracing method of Ponseti [22].…”

“…Regardless of the casting material used, the casts are changed every 5 to 7 days [48]. As the Ponseti method has spread around the world there is increasing experience and success with the use of this method in children older than 1 year of age with neglected clubfoot [22,45,61,64]. The upper age limit to which this method can be applied remains a moving target.…”

Pé torto congênito

“…94 The Ponseti method 1,4,53 , composed basically of manipulations and serial plaster cast changes, percutaneous sectioning of the calcaneal tendon and use of abduction orthosis, has become the preferential method for the treatment of idiopathic CC in many countries, in the last ten years (Bor; Bor, 2002). With widespread acceptance, it was extended for use on older children [95][96][97][98] ; complex and resistant feet 99 ; relapsed feet 100 , including relapses after extensive surgical release 101 , and also, in non-idiopathic cases, such as in myelomeningocele 102,103 and distal arthrogryposis 104,105 . The grounds of the manipulation technique consist of correcting deformities by means of the plastic change of the contractured and shortened elements, which have a high elastic capacity in the younger child.…”

“…The Ponseti method has been used in older children 100 , including above two years 96,98 of age, as an initial treatment method, with satisfactory results. In older children modifications were suggested in the method, such as the obtainment of ~40º of abduction and not ~70º like in the younger children.…”

Ponseti method for late presentation of clubfoot

“…The Ponseti method has found most use in developing countries where late presentation of clubfoot is also fairly common. Several papers now routinely recommend this technique up to two years of age and depict success rates almost equivalent to infants [2][3][4][5][6][7][8][9]. We would like to broaden the review to include clubfoot treatment by Ponseti method in older children with late presentation and raise some issues related to this extended use.…”