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Ponseti management of clubfoot after walking age
Mehmet Firat Yagmurlu1, Mehmet Nurullah Ermis, Huseyin Emre Akdeniz
1Department of Orthopedics and Traumatology, Baltalimani Bone Diseases Hospital, Istanbul, Turkey. fyagmurlu@gmail.com
Insights
The Ponseti method effectively corrects clubfoot deformities in children past walking age. However, treatment effectiveness for components like varus and adductus may decrease with increasing patient age.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Congenital Deformity Correction
Background:
- Clubfoot is a common congenital deformity affecting 1-2 per 1000 live births, characterized by equinus, hindfoot varus, forefoot adductus, and cavus.
- The Ponseti method is a well-established treatment for infant clubfoot, but its efficacy in late-presenting cases (after walking age) remains a subject of investigation.
Purpose of the Study:
- To evaluate the effectiveness of the Ponseti method in correcting the individual components of clubfoot deformity in children beyond the typical infant treatment age.
- To determine the relationship between patient age at the start of treatment and the degree of correction achieved for each clubfoot component.
Main Methods:
- A cohort of 27 patients (31 feet) with a mean age of 21 months (range: 12-72 months) were treated using the Ponseti method between 2003 and 2005.
- Patients were divided into two groups (under 20 months and over 20 months) and assessed using Dimeglio scores before and after treatment, with separate analysis of correction for each deformity component.
Main Results:
- The Ponseti method demonstrated statistically significant correction across all evaluated components of clubfoot deformity.
- Patients older than 20 months showed less improvement in hindfoot varus, medial rotation of the calcaneopedal block, and forefoot adductus compared to younger patients.
Conclusions:
- The Ponseti method remains effective for correcting clubfoot deformities even in children who have started walking.
- Treatment outcomes may be influenced by patient age, with potentially reduced efficacy for certain deformity components in older children.
Background:
With an incidence of 1-2 per 1000 live births, clubfoot is one of the commonest congenital deformities. Deformity has four components: equinus, hindfoot varus, forefoot adductus, and cavus. The Ponseti method for the treatment of clubfoot has been shown to be effective in children up to one year of age. Even with this effective method, late-presenting cases are still challenging. The aim of this study is to evaluate the corrective effect of the Ponseti method on different components of clubfoot after walking age and to find how the patient's age relates to this correction.
Methods:
From 2003 to 2005 we treated 31 feet of 27 patients with clubfoot with a mean age of 21 months (12-72 months) with the Ponseti method. Average follow up was 42 months. All of the patients were evaluated before and after treatment for Dimeglio scores. Patients in the first group, aged less than 20 months, were compared with those in the second group, who were older than 20 months. The corrections for each component of the deformity were analyzed separately.
Results:
All deformities showed significant correction. Improvements for each separate component were found to be statistically significant. Patients older than 20 months improved less for the components of varus, medial rotation of calcaneopedal block and adductus compared to younger patients.
Conclusions:
The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.
