Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

Abstract

Congenital clubfoot, or congenital talipes equinovarus (CTEV), is one of the most common congenital deformities. 1) It most likely represents congenital dysplasia of all musculoskeletal tissues (musculotendinous, ligamentous, osteoarticular, and neurovascular structures) distal to the knee. This conclusion is based on multiple investigators' observations of a myriad of different abnormal anatomic findings and on the functional outcome of patients who were believed to have received optimal non-operative or operative treatment but nevertheless subsequently always had some degree of impairment. 2) Congenital clubfoot is a complex three-dimensional deformity consisting of four components: cavus, adductus, varus, and equinus. The incidence of congenital clubfoot is approximately 1.2 per 1,000 live births. 3) If a clubfoot is allowed to remain deformed, many other late adaptive changes occur in the bones. These changes depend on the severity of soft-tissue contractures and the effects of walking. In untreated adults, some joints may spontaneously fuse or degenerative changes secondary to the contractures may develop. On the basis of a proper understanding of the

Effectiveness of the Ponseti Method in the Treatment of Clubfoot: A Systematic Review

“…In the study by Islam et al, they compared the scores of groups using both the Pirani and Dimeglio classifications. On the other hand, in the study by Aydin et al, figures are shown comparing the Pirani results at beginning of the Ponseti method and after Achilles tendon tenotomy, showing that there was an improvement in the patients [ 3 , 5 , 6 , 8 , 13 ].…”

“…It is approximately three times more frequent in males than in females. Clubfoot is present unilaterally or bilaterally in 50% of cases [ 2 , 5 , 6 , 7 , 8 ]. Its etiology may be associated with myelodysplasia, arthrogryposis or multiple congenital deformities, but the most common presentation is in isolation, which is considered the idiopathic type [ 2 ].…”

“…These changes will depend on the severity of the soft tissue contracture and the effects it would have on walking. Lack of treatment or improper treatment can cause psychological or functional damage [ 6 , 7 ].…”

“…One of the advantages of this method is the degree of mobility that it grants at the end of treatment. As a disadvantage, the success of the method depends on variables such as age, sex, early diagnosis, if the patient has associated deformities and the number of casts used [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…The Pirani classification system is a valid and reproducible technique for evaluating clubfoot. It is used to measure the severity of the foot before starting, at check-ups and at the end of the treatment [ 3 , 5 , 6 , 13 ] ( Table 1 ).…”