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Complex Clubfoot Treatment With Ponseti Method: A Latin American Multicentric Study.

Victoria Allende1, Miguel Paz2, Sergio Sanchez3

  • 1Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba.

Journal of Pediatric Orthopedics
|November 6, 2019
PubMed
Summary

The Ponseti method effectively treats complex clubfoot, achieving high initial correction rates. However, complex clubfoot cases require frequent follow-up due to a significant recurrence rate.

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Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Surgical Innovation

Background:

  • Complex clubfoot presents unique challenges post-treatment, including short first metatarsals and rigid equinus.
  • The Ponseti method offers a modified technique for treating this challenging deformity.
  • Limited data exists on the mid-term outcomes for complex clubfoot treated with the Ponseti method.

Purpose of the Study:

  • To analyze the mid-term results and complications of treating complex clubfoot using a modified Ponseti technique.
  • To evaluate the effectiveness and safety of the Ponseti method in a large, multicenter cohort of complex clubfoot patients.

Main Methods:

  • Retrospective analysis of 124 complex clubfeet across 6 institutions with minimum 1-year follow-up.
  • Data collected included demographics, prior treatments, casting, Achilles tenotomy, recurrences, and complications.
  • Clinical outcomes were assessed using the Pirani score at presentation, post-treatment, and final follow-up.

Main Results:

  • 98% of feet achieved initial correction with a median of 5 casts and 96% undergoing Achilles tenotomy.
  • Significant Pirani score improvement was observed from 6 pre-treatment to 0.5 at final follow-up (P <0.001).
  • Relapse occurred in 29.8% of cases, associated with more initial casts and longer follow-up.

Conclusions:

  • The Ponseti method is a safe and effective treatment for complex clubfoot.
  • Early diagnosis and strict adherence to Ponseti principles are crucial for successful correction.
  • Complex clubfoot necessitates vigilant, frequent follow-up due to a higher propensity for recurrence.