Comparison of 2 Different Cast Configurations for Ponseti Cast: A Randomized Controlled Study

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Clubfoot Treatment

Background:

• The Ponseti method is a standard treatment for idiopathic clubfoot.
• Various cast configurations exist, leading to ambiguity in optimal application.
• Evidence comparing standard and reinforced Ponseti casts is limited.

Purpose of the Study:

• To compare the effectiveness of standard versus reinforced Ponseti casts.
• To evaluate retained ankle dorsiflexion and overall cast integrity.
• To provide evidence for optimizing clubfoot casting techniques.

Main Methods:

• A randomized trial involving 30 children with bilateral idiopathic clubfoot.
• Each child received a standard cast on one limb and a reinforced cast on the other.
• Cast integrity and clinical ankle dorsiflexion were assessed post-tenotomy and at cast removal.

Main Results:

• Both cast types achieved identical initial ankle dorsiflexion (15.5 degrees).
• The reinforced cast showed significantly lower breakage rates (7% vs. 30%).
• Reinforced casts better retained ankle dorsiflexion at follow-up (P=0.008).

Conclusions:

• Reinforced Ponseti casts demonstrate superior performance in maintaining ankle dorsiflexion.
• The standard cast configuration is associated with higher rates of breakage.
• Reinforced casting may be a more reliable method for clubfoot treatment.