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Long-term comparative results in patients with congenital clubfoot treated with two different protocols
E Ippolito1, P Farsetti, R Caterini
1Department of Orthopaedic Surgery, University of Rome, Italy. e.ippolito@mclink.it
Insights
Ponseti
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Congenital Foot Deformities
Background:
- Long-term follow-up data on adult congenital clubfoot treatment is scarce.
- This study compares long-term outcomes of two distinct surgical techniques for clubfoot.
- Both techniques involved early manipulation and casting, differing in surgical intervention timing and extent.
Purpose of the Study:
- To compare the long-term efficacy of two surgical approaches for congenital clubfoot.
- To evaluate the functional and radiographic outcomes in adults treated for clubfoot in infancy.
- To determine which treatment strategy yields superior results in managing congenital clubfoot.
Main Methods:
- Two groups of patients with congenital clubfoot were retrospectively analyzed.
- Treatment involved early manipulation and casting, followed by different surgical procedures at specific ages.
- Long-term outcomes were assessed via clinical examination, radiography, and CT scans, graded using the Laaveg and Ponseti system.
Main Results:
- The second group (limited posterior release) showed significantly better outcomes (85.4 points) than the first group (extensive posteromedial release, 74.7 points).
- The second group had a higher proportion of excellent and good results (38/49) compared to the first group (20/47).
- The extensive posteromedial release in the first group did not prevent relapses or fully correct cavovarus and forefoot adduction.
Conclusions:
- Ponseti's manipulation technique combined with early limited posterior ankle release and heel-cord lengthening yields superior long-term results for congenital clubfoot.
- Extensive posteromedial release in infancy, as performed in the first group, was less effective in achieving lasting correction.
- The findings support early, less invasive surgical interventions for better long-term clubfoot management.
Background:
Long-term follow-up studies of adults who had been treated for congenital clubfoot as infants are rare. The purpose of this study was to review and compare the long-term results in two groups of patients with congenital clubfoot treated with two different techniques. In both groups, treatment was started within the first three weeks of life by manipulation and application of toe-to-groin plaster casts, with a different technique in each group. At the end of the manipulative treatment, a posteromedial release was performed when the patient was between eight and twelve months of age in the first group and a limited posterior release was performed when the patient was between two and four months of age in the second group.
Methods:
At the follow-up evaluations, all patients were interviewed and examined, and standing anteroposterior and lateral radiographs and computed tomography scans of the foot were made. The results of treatment were graded according to the system of Laaveg and Ponseti. Numerous angular measurements were made on the radiographs, and the measurements in the two groups were compared.
Results:
The first group, which included thirty-two patients (forty-seven clubfeet), was followed until an average age of twenty-five years. The second group, with thirty-two patients (forty-nine clubfeet), was followed until an average age of nineteen years. In the first group, there were two excellent, eighteen good, eleven fair, and sixteen poor results. In the second group, there were eighteen excellent, twenty good, six fair, and five poor results. According to the system of Laaveg and Ponseti, the mean rating in the first group was 74.7 points and that in the second group was 85.4 points.
Conclusions:
In the second group, use of Ponseti's manipulation technique and cast immobilization followed by an open heel-cord lengthening and a limited posterior ankle release gave much better long-term results than those obtained in the first group, treated with our manipulation technique and cast immobilization followed by an extensive posteromedial release of the foot. In our hands, this operation did not prevent relapse, and neither cavovarus nor forefoot adduction was completely corrected.