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Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials

Ying-Yu Wang1,2, Yu-Cheng Su1,2, Yu-Kang Tu3,4

  • 1Chang Gung Memorial Hospital at Linkuo, Taoyuan City, Taiwan.

The Journal of Bone and Joint Surgery. American Volume
|November 28, 2023
PubMed

Insights

The Ponseti method offers the best overall outcomes for treating infant clubfoot, balancing effectiveness with potential drawbacks. Individualized treatment plans are recommended for optimal results in congenital talipes equinovarus deformity.

Area of Science:

  • Orthopedics
  • Pediatric Surgery
  • Biomechanical Engineering

Background:

  • Clubfoot (congenital talipes equinovarus) is a common infant foot anomaly.
  • Clinical consensus on optimal interventions, particularly those based on the Ponseti method, is lacking.
  • This study systematically evaluates various treatments for idiopathic clubfoot.

Purpose of the Study:

  • To compare the clinical outcomes of different interventions for treating idiopathic clubfoot.
  • To identify the most effective treatment strategies based on current evidence.
  • To inform clinical decision-making for clubfoot management.

Main Methods:

  • A systematic literature search was performed across major databases (CENTRAL, MEDLINE, Embase, Scopus, CINAHL).
  • Included were randomized controlled trials comparing interventions like the Ponseti method, accelerated Ponseti, Ponseti with Botox, Ponseti with TATT, Kite method, and surgery.
  • Network meta-analyses (NMAs) were conducted following PRISMA guidelines, focusing on Pirani score changes and ankle dorsiflexion.

Main Results:

  • The Ponseti method demonstrated superior outcomes in Pirani score changes, ankle dorsiflexion, cast number, adverse events, and total complications.
  • The accelerated Ponseti method showed advantages in reduced time in casts and lower tenotomy rates.
  • Early tibialis anterior tendon transfer (TATT) was associated with the lowest relapse rate, while Ponseti with Botox injection minimized the need for additional major surgery.

Conclusions:

  • The Ponseti method is generally the optimal treatment for idiopathic clubfoot, despite potential for longer casting times and higher rates of tenotomy, relapse, and revision surgery.
  • Modified approaches offer specific advantages, such as reduced casting time or lower relapse rates.
  • Individualized tailoring of clubfoot treatments is crucial for achieving the best patient outcomes.
Abstract

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