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Does Clubfoot Treatment Need to Begin As Soon As Possible?
Lewis E Zionts1, Sophia N Sangiorgio, Shannon D Cooper
1Orthopaedic Institute for Children, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Insights
Early treatment for idiopathic clubfoot is not an emergency. While age at first visit impacted cast slippage, it did not affect other aspects of early clubfoot management.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
Background:
- Idiopathic clubfoot is often treated with urgency, a practice reflected in medical literature.
- The Ponseti method is a widely accepted, minimally invasive treatment for clubfoot.
Purpose of the Study:
- To determine the relationship between patient-related variables, early treatment factors, and the age of initial treatment for idiopathic clubfoot.
- To investigate if early intervention for clubfoot impacts treatment outcomes.
Main Methods:
- Infants with moderate to severe idiopathic clubfoot were enrolled.
- Age at first visit was correlated with cast slippage, skin issues, brace compliance, and relapse rates.
- Patient variables were also analyzed against age at first visit.
Main Results:
- Over 7 years, 176 infants were included.
- No significant differences in early management were found based on age at first visit, except for cast slippage (P=0.05).
Conclusions:
- Age at first visit affects cast slippage but not other early clubfoot treatment outcomes.
- Treatment for idiopathic clubfoot is not an orthopaedic emergency; parents should be informed.
Introduction:
Parents of an infant with an idiopathic clubfoot deformity are often urged by their primary care physician to seek treatment as soon as possible. This advice frequently appears in many general pediatric and pediatric orthopaedic textbooks and monographs on the subject. This recommendation has not changed since the wide acceptance of the minimally invasive Ponseti method to treat clubfoot. We determined the correlations among patient-related variables, early treatment variables, and the age at which the patient was first seen to begin treatment.
Methods:
Infants with moderate to very severe idiopathic clubfoot deformity were invited to participate. Age at which the patient presented to begin treatment was correlated against early treatment-related variables, including number of casts required, cast slippage, cast-related skin problems, brace-related skin problems, early noncompliance with brace wearing, and relapse before 1 year. Patient-related variables were also correlated against age at first visit.
Results:
Over 7 years, 176 infants met the inclusion criteria. There were no significant differences in the aspects of the early management as a function of age at first visit, with the exception of cast slippage (P=0.05).
Conclusions:
The age at first visit influenced the incidence of cast slippage, but otherwise did not affect the early treatment of clubfoot.
Clinical Relevance:
The treatment of idiopathic clubfoot deformity should not be considered an orthopaedic emergency, and parents whose infants are born with this deformity should be counseled accordingly.
