Treatment of idiopathic club foot using the Ponseti method

Abstract

We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients.

Ponseti Treatment for Idiopathic Clubfoot: Minimum 5-year Followup

“…Colburn and Williams [6] found only three of 57 feet treated by the Ponseti method required extensive surgical correction. This pattern of good short-term results has been replicated in many recent studies [1,2,4,6,8,9,17,19,21].…”

“…Relapses are associated with deviating from the Ponseti brace protocol [4,14,23,29]. However, strictly following the brace protocol seems to be the major challenge of the Ponseti method.…”

“…A recent questionnaire reported that 65% of the Pediatric Orthopaedic Society of North America members used the Ponseti method [16]. However, all recently published reports describe only short-term followup of 1 to 2 years [1,2,4,6,8,9,17,19,21].…”

Update on Clubfoot: Etiology and Treatment

“…Brace intolerance is the primary reason for recurrence [10,22,49], though it may also occur with successful brace wear in some patients. Most early relapses occur in the hindfoot and are clinically evident by the development of equinus and varus deformities of the heel.…”

Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review

“…If untreated, this compromised foot position can result in long-term pain and severe disability [3,9]. Conservative treatment attempts to correct the deformity such that the foot is functional, pain-free, flexible, and able to fit in regular shoes [22,23].…”