Multiple Serial Casting for Recurrent Clubfoot in Arthrogryposis Corrects Deformity With Diminishing Returns

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Congenital Conditions

Background:

• Arthrogryposis multiplex congenita (AMC) involves over 400 conditions characterized by severe joint contractures.
• Clubfoot in AMC patients presents unique management challenges with a high recurrence rate compared to idiopathic clubfoot.

Purpose of the Study:

• To evaluate the effectiveness of serial casting for treating clubfoot in AMC patients.
• To utilize Pirani scores as an objective measure of deformity correction.

Main Methods:

• Retrospective collection of Pirani scores from 17 AMC patients (30 clubfeet) with a minimum of three casting series.
• Analysis of pre-treatment and post-treatment Pirani scores across casting series using ANOVA.
• Two-year follow-up from treatment initiation.

Main Results:

• Significant improvement in Pirani scores after the first casting series (4.80 to 1.68, p<0.001).
• Continued significant improvements observed in subsequent casting series (second: 4.23 to 2.72, p<0.001; third: 3.87 to 2.82, p<0.001).
• The number of casting days significantly impacted score changes during the third series (p=0.038).

Conclusions:

• The Ponseti technique, applied through serial casting, demonstrates efficacy in improving clubfoot deformities in AMC patients, as indicated by Pirani score reduction.
• Early intervention is crucial for optimal outcomes, although the technique retains effectiveness over time.
• Pirani scores provide a reliable objective measure for assessing treatment progress in AMC clubfoot.