Ponseti casting for severe club foot deformity: are clinical outcomes promising?

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Podiatry

Background:

• Idiopathic clubfoot is a common congenital foot deformity.
• The Ponseti method, involving manipulation and serial casting, is a widely used treatment.
• Severe cases often require additional interventions like tenotomy.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of the Ponseti method for severe idiopathic nonsyndromic clubfoot.
• To assess deformity correction, complication rates, and patient satisfaction.
• To compare outcomes between unilateral and bilateral cases and the impact of tenotomy.

Main Methods:

• Prospective study of 85 patients with severe idiopathic nonsyndromic clubfoot.
• Serial casting using the Ponseti technique, with tenotomy performed as needed.
• Deformity assessment using the Diméglio classification before and after treatment.
• Follow-up to assess relapse rates, walking ability, and parent satisfaction.

Main Results:

• Plantigrade foot achieved in all patients.
• Average of 5.7 casts required; 89.4% underwent tenotomy.
• Relapse rate was 27.1% at a mean follow-up of 26 months.
• Bilateral clubfoot cases had poorer outcomes than unilateral.
• Parent satisfaction with gait and appearance was high (80-94.1%).

Conclusions:

• The Ponseti method is a valuable technique for treating severe idiopathic nonsyndromic clubfoot.
• Achieving a plantigrade foot is possible, though relapse remains a concern.
• While tenotomy may delay walking slightly, overall outcomes and patient satisfaction are positive.