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Ponseti method compared with surgical treatment of clubfoot: a prospective comparison
Matthew A Halanski1, Jan E Davison, Jen-Chen Huang
1Starship Children's Health, Auckland, New Zealand. matthew.halanski@devoschildrens.org
Insights
The Ponseti method for idiopathic clubfoot requires fewer casts and significantly less surgery than traditional surgical release. This conservative approach is effective in managing clubfoot deformity with fewer complications.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Foot and Ankle Surgery
Background:
- Idiopathic clubfoot treatment trends favor conservative methods over extensive surgical release.
- The study addresses the shift towards less invasive techniques for clubfoot correction.
Purpose of the Study:
- To prospectively compare the outcomes of the Ponseti method versus surgical release for idiopathic clubfoot.
- To evaluate the efficacy and intervention rates of two distinct clubfoot treatment modalities.
Main Methods:
- Prospective comparison of idiopathic clubfoot patients treated with the Ponseti method or surgical release.
- Review of clinical records with a minimum two-year follow-up, documenting all interventions and complications.
Main Results:
- The Ponseti group received an average of six casts, while the surgical group averaged thirteen casts.
- Surgical release involved major procedures in 42 of 43 cases; the Ponseti method required 15 operative interventions for recurrences in 14 feet.
- Both groups experienced two postoperative complications, but the Ponseti cohort had significantly less operative intervention and revision surgery.
Conclusions:
- The Ponseti method demonstrates a lower rate of operative intervention and revision surgery compared to traditional surgical release for clubfoot.
- Despite similar recurrence rates, the Ponseti method offers a less invasive treatment pathway for idiopathic clubfoot.
- The Ponseti method has been adopted as the primary treatment for clubfoot at the institution due to its effectiveness and reduced surgical burden.
Background:
Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The purpose of the present study was to prospectively compare the results of the Ponseti method with those of surgical releases for the correction of clubfoot deformity.
Methods:
We prospectively compared patients who had idiopathic clubfoot deformities that were treated at a single institution either with the Ponseti method or with below-the-knee casting followed by surgical release. The clinical records of the patients with a minimum duration of follow-up of two years were reviewed. All scheduled and completed operative interventions and associated complications were recorded.
Results:
Fifty-five patients with eighty-six clubfeet were treated; forty feet were included in the group that was treated with the Ponseti method, and forty-six feet were included in the group that was treated with below-the-knee casts followed by surgery (with three of these feet requiring casting only). There was no difference between the groups in terms of sex, ethnicity, age at the time of first casting, pretreatment Pirani score (average, 5.2 in both groups), or family history. The average number of casts was six in the Ponseti group and thirteen in the surgical group. Of the feet that were treated with below-the-knee casts, forty-three underwent surgery, with forty-two undergoing major surgery (posterior release [eleven] or posteromedial release [thirty-one]). In the Ponseti group, fourteen feet required fifteen operative interventions for recurrences, with only one foot requiring revision surgery. Four of these fifteen were major (necessitating posterior [one] or posteromedial release [three]) while eleven were minor. Thirteen feet in the surgical group required fourteen surgical revisions. Two postoperative complications were seen in each group.
Conclusions:
While both cohorts had a relatively high recurrence rate, the Ponseti cohort was managed with significantly less operative intervention and required less revision surgery. The Ponseti method has now been adopted as the primary treatment for clubfoot at our institution.