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Shorter Night Splinting by a Modified Ponseti Method With Similar Foot-Function and Health-Related Quality of Life
Angela Seidel1, Severine Tinembart2, Nadine Kaiser2
1Departement of Orthopedic Surgery and Traumatology, University of Fribourg, Fribourg, CHE.
Cureus
|March 10, 2025
Summary
A modified Ponseti method with reduced night splinting duration and Achilles tendon lengthening (ATL) shows comparable clinical outcomes and recurrence rates to the original method for clubfoot treatment. This approach improves patient-reported quality of life, offering a more manageable treatment plan.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- The Ponseti method is standard for clubfoot treatment but involves a lengthy six-year night-splinting period, leading to compliance challenges.
- Idiopathic clubfoot requires effective treatment strategies that balance efficacy with patient adherence and long-term outcomes.
Purpose of the Study:
- To evaluate clinical outcomes, recurrence rates, and health-related quality of life in children with idiopathic clubfoot treated with a modified Ponseti method.
- To assess the impact of a reduced night-splinting duration on treatment success and patient-reported measures.
Main Methods:
- A cohort of 107 children (152 clubfeet) with idiopathic clubfoot treated between 1994 and 2015 was analyzed.
- Initial treatment involved long-leg casts, surgical correction (Achilles tendon lengthening and limited posterior release) for residual deformity, followed by a modified splinting regimen.
- Clinical outcomes were assessed via chart review, and functional outcomes using the Disease Specific Instrument (DSI) and the Pediatric Quality of Life Inventory (PedsQL™).
Main Results:
- Clinical follow-up was achieved in 92.7% of patients at a mean age of 7.39 years.
- Patients used splints for a mean of 7.8 months full-day and 17.3 nights.
- At a mean follow-up of 10 years, the mean DSI was 74.8 and the mean PedsQL™ was 87.8.
- Relapse rates were 9.3% bilateral and 16.8% unilateral.
Conclusions:
- Achilles tendon lengthening (ATL) combined with limited posterior release and a reduced splinting period of 2.1 years yields results comparable to the original Ponseti method.
- The modified approach demonstrates favorable clinical outcomes, acceptable recurrence rates, and positive patient-reported quality of life.
- This modified Ponseti method offers a viable alternative with potentially improved patient compliance due to decreased splinting duration.
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