Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse

Zionts, Lewis E.; Ebramzadeh, Edward; Morgan, Rebecca D; Sangiorgio, Sophia N.

doi:10.2106/jbjs.17.01024

Cited by 43 publications

(37 citation statements)

References 29 publications

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“…This study found that the main reasons for 'drop out' were finding aspects of treatment difficult, especially casting and bracing. Difficulty during bracing has been reported elsewhere [26,27]. However, many dropped out due to wider family circumstances, which prevented returning to clinics.…”

Section: Discussionmentioning

confidence: 95%

Factors Affecting Parents to ‘Drop-Out’ from Ponseti Method and Children’s Clubfoot Relapse

Evans

Chowdhury

Karimi

et al. 2020

OPROJ

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Background: Completed treatment of congenital clubfoot deformity using the non-surgical Ponseti method yields very good results. However, many children do not complete the treatment course, potentiating relapse of the deformity, forever compromising independent gait and quality of life. If the factors precipitating 'drop out' from treatment can be averted, more children will complete the Ponseti method of treatment which has low rate of complication and is both economical and highly effective. Children depend on parents to bring them to the clinics, hence we aimed to identify factors obstructing parents and ultimately the children's outcomes. Once identified, barriers to completing treatment may be removed. Aim:To identify the factors obstructing completion of clubfoot treatment.Method: Two of the 32 Walk for Life (WFL) clubfoot clinics in Bangladesh were utilised for participants, who were parents and children (n=72) who had dropped out from completing the clubfoot treatment course four to six years earlier. Bootstrapping was used to improve statistical power (based on 1000 random sample). Validated outcome measures included a specific context drop out questionnaire, the Oxford Ankle Foot questionnaire, the Bangla clubfoot assessment, and the Foot Posture Index. Parent's insights, experiences and recommendations were canvassed both qualitatively and quantitatively.Result: Relapse occurred in 15/72 drop out cases, predicted by problems with the initial casting process. The main reasons for drop out were difficulty with the foot abduction brace (42%), family issues (31%), and other problems with the child's clubfoot treatment (15%). Despite problems and incompletion, the parents were generally satisfied (93%), although many felt sad or ashamed for not completing the treatment course and realizing clubfoot deformity recurrence (96%). Parents who had dropped out, were noted by WFL staff to be regretful, and especially so if their now older child's clubfoot had relapsed to obviously compromise independent gait and mobility. A lack of discernment of postural clubfeet from 'true' clubfeet was identified in some clinicians, indicating variable practice methods despite uniform training, and probably lowering the overall relapse rate with inclusion of 'postural' cases. Conclusion:Relapse was predicted by problems with casting and predicted worse foot posture and reduced physical functioning. Walk for Life adopted appointment reminders, parent support groups, cost sharing, and staff updates.

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Section: Discussionmentioning

confidence: 95%

Factors Affecting Parents to ‘Drop-Out’ from Ponseti Method and Children’s Clubfoot Relapse

Evans

Chowdhury

Karimi

et al. 2020

OPROJ

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“…Ponseti stated that "regardless of the mode of treatment, the clubfoot has a stubborn tendency to relapse". 3,17 The maximum follow up period in our study is 25 months. Further follow up is required to assess long term relapse rate.…”

Section: Discussionmentioning

confidence: 93%

Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Agarwal

Gupta

Sud

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Introduction: Serial Ponseti casting achieves deformity correction in early presenting idiopathic clubfoot cases normally in around 7 casts. However, there are resistant patients where correction requires more casts than usual. In such patients a modification in standard technique might be required right from the beginning. Such patients were collectively called as difficult clubfoot. The aim of this study was to assess the outcome of our modification to Ponseti technique in difficult clubfoot. Methods: All idiopathic clubfoot cases who were 75th percentile or more in WHO age for weight chart (chubby infants) or untreated clubfoot patients presenting for first time to our clinic at more than 5 months age (late presenters and neglected cases) were included in the study. Patients who had been previously surgically intervened elsewhere, patients over 7 years of age, patients with syndromic clubfoot or clubfoot associated with neurological conditions were excluded from the study. The patients were treated by early tenotomy of tendoachillis and a plantar fascia release before starting serial casting by Ponseti technique. Post correction, strict bracing protocol was followed with regular follow up. Pirani scoring was done at each stage. Measurement of Talocalcaneal angle on AP radiograph, maximum degree of abduction and dorsiflexion was noted once every year. Results: There were total 28 patients in our study. In all, 47 feet were subjected to modified Ponseti protocol. There were 21 male patients. Median age at presentation was 4 months. Mean centile of weight for age as per WHO growth chart was 64. Mean Pirani score at presentation was 5.86 (S.D. ± 0.34). Mean number of casts required for correction was 3.75 ± 1.10. Maximum followup period was 25 months. Conclusion: This modification of Ponseti casting for difficult clubfoot patients achieves correction in shorter duration with less number of casts.

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“…In a more recent study of 101 patients who had very poor compliance with the bracing protocol, resulting in a 68% relapse rate, 38% underwent a TATT. Yet despite the high relapse rate the majority reported a good functional outcome and were satisfied with the appearance of the foot (11). It should be noted, however, that approximately 15% of patients may develop a second relapse following a TATT (12).…”

Section: Tattmentioning

confidence: 91%

Narrative review of the management of a relapsed clubfoot

Masrouha

Chu²,

Lehman

2021

Ann Transl Med

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The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators). These are discussed from the least to the most invasive. Available evidence, and limitations of the literature, for the management of relapses following both the Ponseti method and initial surgical release is reviewed along with along with the reported outcomes. Future efforts should be geared towards standardizing the definition of a relapse with objective criteria for its management.

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Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 43 publications

References 29 publications

Factors Affecting Parents to ‘Drop-Out’ from Ponseti Method and Children’s Clubfoot Relapse

Factors Affecting Parents to ‘Drop-Out’ from Ponseti Method and Children’s Clubfoot Relapse

Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Narrative review of the management of a relapsed clubfoot

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