Predicting the Need for Surgical Intervention in Patients With Idiopathic Clubfoot

Purpose There is conflicting evidence related to factors affecting the rates of recurrence of idiopathic club feet using the Ponseti method. We attempt to evaluate the predictors of success and failure in our physiotherapy-led Ponseti club foot clinic. Methods We evaluated 189 children with 279 club feet with a mean follow-up of 6.3 years for the following: Pirani score at presentation, number of casts for correction, indication for Achilles tenotomy, and the duration of foot abduction brace (FAB) use, in relation to outcome. Outcome measures were the need for additional surgery and functional scores. Based on the pattern and rate of ossification of the tarsal bones in idiopathic club foot, a much longer FAB weaning protocol was designed and practiced since 2000. The objective of this study was to answer the question of whether a prolonged period of FAB use reduces the need for surgery in Ponseti-treated idiopathic club foot. Results Thirty-six feet (12.9 %) underwent additional surgery. The Pirani score and the number of cast changes had no influence on the rate of surgery. The duration of FAB use had a significant effect on the outcome, i.e., the rate of surgery and functional scoring. Operated children used the FAB for 28 months versus 33 months in the nonoperated group (p \ 0.05). Only a minor delay in the attainment of walking age was noted (average 15 months). ConclusionsThe duration of FAB treatment was found to be the most influential on the functional results and on rate of surgery. Close follow-up and longer FAB weaning program reduced the rates of recurrence.

Section: Discussionmentioning

confidence: 99%

Prolonged use of foot abduction brace reduces the rate of surgery in Ponseti-treated idiopathic club feet

Shabtai

Segev

Yavor

et al. 2015

“… 1 While most patients with clubfeet can achieve satisfactory initial correction, maintaining that correction during early childhood can be challenging in some. 4 , 13 , 16 Adherence with the foot-abduction brace has been shown in multiple studies to decrease likelihood of recurrence, however, adherence with bracing does not guarantee successful long-term correction. 3 , 6 , 10 , 13 , 17 Despite adherent bracing, some feet seem almost destined to relapse, whereas poorly braced feet sometimes maintain correction over the long term.…”

Section: Methodsmentioning

confidence: 99%

“… 4 , 13 , 16 Adherence with the foot-abduction brace has been shown in multiple studies to decrease likelihood of recurrence, however, adherence with bracing does not guarantee successful long-term correction. 3 , 6 , 10 , 13 , 17 Despite adherent bracing, some feet seem almost destined to relapse, whereas poorly braced feet sometimes maintain correction over the long term. 18 The age of relapse as it relates to predictors of relapse or recurrence has not been previously studied; this is the first study assessing different patterns of recurrence of idiopathic clubfoot based on age.…”

Section: Methodsmentioning

confidence: 99%

Clubfoot relapse: Does presentation differ based on age at initial relapse?

Mahan

Spencer

May

et al. 2017

PurposeTreatment of idiopathic clubfoot with the Ponseti method is now standard, but predicting relapse can be difficult. Most experts recommend bracing to the age of four years, but this can be challenging for families, and may not be necessary in all patients. The purpose of this study is to compare patterns of bracing and age of relapse to help determine if predictable patterns exist.MethodsThe 70 patients with idiopathic clubfoot treated initially with the Ponseti technique who had relapse of their clubfoot were identified. Relapse was defined as a return to casting or surgery due to recurrent deformity. Data collected included demographics, treatment and brace adherence. Patients who sustained initial relapse before the age of two years were compared with those who sustained initial relapse after the age of two years.ResultsIn total 56% (39/70) had their initial relapse prior to age two years while 44% (31/70) were after age two years. Of the patients who relapsed prior to the age of two years, 28% (11/39) were adherent with bracing while 72% were non-adherent. For patients who initially relapsed after age two, 74% (23/31) were adherent with bracing while 26% were non-adherent (p < 0.001). Of those who had initial relapse prior to age two, a subsequent relapse was seen in 69% (27/39).ConclusionPatients with idiopathic clubfoot who experienced recurrence prior to age two years are significantly more likely to be non-adherent with bracing than those who sustain recurrence after age two. After initial relapse prior to age two, bracing adherence does not affect likelihood of subsequent recurrence.

“…In the current study, >70 % of patients had a severe deformity (grade III and IV) at birth and were therefore more resistant to well-conducted non-surgical treatment. Goldstein et al recently demonstrated that a high Dimeglio score at birth is a predictive variable for surgery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The current institution has been a pioneer in the development of the FFM and has trained physiotherapists for >40 years [ 2 , 10 ]. Despite this expertise, some severe deformities remain resistant and require further treatment [ 11 , 12 ]. As reported, a non-plantigrade and misaligned foot causes pain, sprains, and difficulties wearing shoes and results in long-term degenerative lower limb osteoarthritis in adulthood [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Medial to posterior release procedure after failure of functional treatment in clubfoot: A prospective study

Bocahut

Simon

Mazda

et al. 2016

PurposeTwo conservative techniques for clubfoot treatment are still being debated and depend upon the institution’s expertise. For >40 years, the current institution has been a pioneer in the development of the physiotherapy method; however, some severe deformities remain resistant to this method which causes pain, sprains, and difficulties wearing shoes. Therefore, a surgical approach was developed simultaneously for the treatment of these residual or recurring clubfeet. The procedure reproduces the same chronological steps by performing forefoot derotation before correcting hindfoot equinus. The aim of the current study was to assess the results of this surgical technique.MethodsAll clubfeet undergoing surgery between October 1995 and February 2009 were prospectively included. Initial severity was based on Dimeglio’s classification and final outcomes on the International Clubfoot Study Group (ICFSG) outcome evaluation system. Last follow-up results were assessed by physical examination and radiographs.ResultsA total of 137 patients with severe clubfeet (mean Dimeglio score 12.0) underwent surgery. At the mean follow-up of 10.8 years, mean ICFSG score was 4.3 (range 0–23), and 12 % required revision surgery. The rate of undercorrection and overcorrection was low (17 pes-plano-valgus ft and 11 ft with undercorrection). Eight feet had a fixed deformity.ConclusionsSevere deformities are more resistant to conservative techniques even for institutions with large experience. These deformities require further treatment, including surgery if necessary. The medial to posterior soft-tissue release is a valuable technique with stable results.Level of evidenceLevel IV.