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Initial severity rating of idiopathic clubfeet is an outcome predictor at age two years
Wanglin Zhang1, Benjamin Stephens Richards, Shawne T Faulks
1Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, Shanghai, China.
Abstract:
This study was performed to determine if rating the severity of clubfeet before Ponseti treatment was predictive of the outcomes at age two years. Four hundred and seventy-nine idiopathic clubfeet (323 patients) were numerically rated for severity using Dimeglio classification. Eighty-six feet rated moderate, 305 feet rated severe, and 88 feet rated very severe. Outcomes were classified as Good (plantigrade foot with or without a tendoachilles lengthening), Fair (limited surgery), or Poor (posteromedial release). Significant correlation existed between initial severity of the foot and outcomes, with moderate better than severe and very severe, and severe better than very severe. Initial numerical severity rating strongly correlated with the probability of a good outcome (P<0.0001). Evaluating the severity of clubfeet before Ponseti treatment provides prognostic information for parents.
Insights
Clubfoot severity, rated before Ponseti treatment, predicts outcomes. Higher initial severity correlates with a lower chance of a good outcome, offering valuable prognostic information for parents.
Area of Science:
- Pediatric Orthopedics
- Clinical Outcomes Research
Background:
- Idiopathic clubfoot is a common congenital foot deformity.
- The Ponseti method is a widely used non-surgical treatment for clubfoot.
- Predicting treatment outcomes is crucial for managing patient expectations and guiding clinical decisions.
Purpose of the Study:
- To determine if pre-treatment clubfoot severity predicts outcomes at two years of age.
- To assess the correlation between initial clubfoot severity and the need for surgical intervention.
Main Methods:
- A cohort of 479 idiopathic clubfeet (323 patients) were retrospectively analyzed.
- Feet were classified by severity using the Dimeglio classification system.
- Outcomes were categorized as Good, Fair, or Poor at two years post-treatment.
Main Results:
- A significant correlation was found between initial clubfoot severity and treatment outcomes (P<0.0001).
- Moderate severity feet had better outcomes than severe and very severe feet.
- Severe severity feet had better outcomes than very severe feet.
Conclusions:
- Initial clubfoot severity, assessed by numerical rating before Ponseti treatment, is a significant predictor of treatment success.
- This pre-treatment evaluation provides valuable prognostic information for parents regarding their child's clubfoot outcome.
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