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The functional method: experience from the Robert Debré Hospital.
Philippe Souchet1, Jean-Pierre Delaby2, Matthieu Campana1
1Department of Pediatric Orthopaedic Surgery, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris University, Paris, France.
Annals of Translational Medicine
|August 23, 2021
Summary
Conservative treatment for clubfoot using the French functional method (FFM) yields excellent or good outcomes in 86% of cases. The introduction of percutaneous Achilles tenotomy significantly reduced the need for surgery in clubfoot patients.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Rehabilitative Medicine
Background:
- The French functional method (FFM) is a conservative physiotherapy approach for clubfoot deformity developed in the 1970s.
- Over time, the FFM has undergone improvements and incorporated additional therapeutic measures.
Purpose of the Study:
- To evaluate the mid-term and long-term outcomes of clubfeet treated conservatively from birth using the FFM.
- To assess the effectiveness of FFM modifications, including percutaneous Achilles tenotomy (PAT).
Main Methods:
- Prospective inclusion of patients treated with FFM between 1993 and 2010.
- Initial clubfoot severity assessed using the Dimeglio classification.
- Follow-up by a single surgeon until skeletal maturity, with final evaluation using the International Clubfoot Study Group (ICFSG) system.
Main Results:
- A total of 779 clubfeet were analyzed.
- Surgery was required in 41% of cases, with a significant decrease from 63.4% to 29.6% after PAT introduction in 2000.
- At a mean follow-up of 12 years, 86% of patients achieved excellent or good outcomes (mean ICFSG score 1.83).
Conclusions:
- The FFM, with modifications like PAT, demonstrates high success rates for conservative clubfoot treatment.
- Excellent or good outcomes were observed in 86% of cases, with minimal residual deformities.
- The study confirms the efficacy of the FFM in achieving favorable long-term results for clubfoot.