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Ponseti management of clubfoot in older infants
Noam Bor1, John E Herzenberg, Steven L Frick
1Pediatric Orthopedic Unit, Central Emek Hospital, Afula, Israel.
Insights
The Ponseti method effectively treats clubfoot in infants older than three months, with a low rate of surgical intervention. This study shows successful outcomes for older infants, challenging the notion that early treatment is always necessary.
Area of Science:
- Pediatric Orthopedics
- Pediatric Surgery
- Medical Treatment
Background:
- The Ponseti method is a common treatment for clubfoot, typically initiated shortly after birth.
- There is a prevailing belief that successful clubfoot treatment hinges on early intervention, ideally immediately after birth.
- This study investigates the efficacy of the Ponseti method in infants presenting later for treatment.
Purpose of the Study:
- To evaluate the success of the Ponseti method in treating clubfoot in infants older than three months.
- To determine the rate of surgical intervention required for clubfoot in older infants treated with the Ponseti method.
- To compare outcomes in older infants with those previously observed in younger infants.
Main Methods:
- A case series (Level IV evidence) of 23 infants (36 feet) treated for clubfoot.
- Patients presented after three months of age or after failed initial casting elsewhere.
- Treatment involved serial Ponseti casting followed by percutaneous Achilles tenotomy as needed.
Main Results:
- Only one foot (2.8%) required open surgical release (posterior only) after Ponseti casting and percutaneous Achilles tenotomy.
- Thirty-five feet underwent percutaneous Achilles tenotomy, with an average of six casts applied prior to tenotomy.
- Relapse occurred in a small number of feet, requiring repeat casting or anterior tibialis transfer.
Conclusions:
- The Ponseti method, including serial casting and percutaneous Achilles tenotomy, is highly effective for treating clubfoot in infants older than three months.
- Delayed treatment of clubfoot in older infants can achieve successful outcomes without extensive surgery.
- These findings support the use of the Ponseti method for clubfoot regardless of the age of presentation.
Unlabelled:
Treatment of clubfoot with the Ponseti method is successful when performed immediately after birth. We treated 23 infants (36 feet) who presented to us after casting, applied at other institutions, failed or after 3 months of age. Twenty-two infants had serial casting started during the first 2 months, and one infant who was 6 months old at presentation had not received previous treatment. The original orthopaedists of 18 patients advised posteromedial release. The parameter studied was the need for posteromedial release (ie, failure of Ponseti casting and percutaneous Achilles tenotomy to obtain satisfactory clinical appearance). Only one (2.8%) of 36 feet required open surgical release (posterior only). Thirty-five feet required percutaneous Achilles tenotomy. A mean of six Ponseti casts were applied before tenotomy. Two feet (two infants) required anterior tibialis transfer for mild relapse; three other feet (two infants) required repeat casting for mild relapse. Most pediatric orthopaedists think that successful clubfoot casting depends on treatment started immediately after birth. Our data suggest that older infants with clubfoot can be treated successfully without extensive surgery. Our results in older infants are similar to the results of a previous study we conducted with younger infants. In that study, one (2.9%) of 34 feet required posteromedial release surgery.
Level Of Evidence:
Therapeutic study, Level IV (Case series). See the Guidelines for Authors for a complete description of levels of evidence.
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