Outcomes of congenital clubfoot treatment using the Ponseti method
DOI:
https://doi.org/10.1016/j.rccot.2017.09.003Keywords:
Ponseti, clubfoot, relapseAbstract
Background: Congenital clubfoot is the most common congenital deformity of the foot. The Ponseti method is currently the gold standard for the treatment of this anomaly, as it provides a complete correction of the deformities with good foot mobility and function. There are many studies from all over the world that present the functional results of the method. However, in Colombia there are no publications of this type using the Ponseti method.
Materials and methods: This is a descriptive, retrospective, case series-type study in patients between 0 and 12 years old diagnosed with clubfoot, and treated using the Ponseti method between July 2002 and December 2015, and with a minimum follow-up of at least 6 months. Severity was measured according to the Dimeglio scale, and functionality with the LaavegPonseti scale.
Results: The study included a total of 123 patients (183 feet) with a mean follow-up of 8 years. Treatment was started between 0 and 24 months. According to Dimeglio severity rating, 6.5% were mild, 74% moderate, 13% severe, and 6.5% very severe. Most (96%) of the studied feet were of idiopathic origin. There was a relapse in 17.8%. The functional results, according to the Laaveg-Ponseti scale were excellent in 71%, good in 23%, and average in 6%.
Discussion: The results with good and excellent outcomes of 94% are similar to previous studies. With a relapse rate of 17.8%, compared to the 20% and 40%, respectively, reported in the literature. This study, unlike the others, found no direct relationship between the use of the abduction apparatus and relapse. There were no over-corrections and no patient had a poor outcome according to the Laaveg-Ponseti scale.
Evidence level: IV.
Downloads
References
Tachdjian's Pediatric Orthopaedics, 3 rd edition. Volume 2. Philadelphia: WB Saunders; 2002. p. 922-58.
Morrissy, Weinstein. Lovell and Winter's Pediatric Orthopaedics. 6 th edition Philadelphia: Lippincott Williams and Wilkins; 2006. p. 1262-77.
Turco V. Clubfoot. Current problems in Orthopaedics. New York: Churchill Livingstone; 1981.
Rosselli P, Duplat J, Uribe I, Turriago C. Ortopedia infantil. Bogotá: Panamericana; 2005. p. 68.
Staheli Lynn T. Ortopedia pediátrica. Madrid: Marbán; 2006. p. 102-5.
Bohm M. The embryologic origin of clubfoot. J Bone Joint Surg. 1929;(11A):229.
Fukujara K, Schollmeier G, Uhthoff HK. The pathogenesis of clubfoot: a histomorphometric and immunohistochemical study of fetuses. J Bone Joint Surg. 1994;(76B):450. https://doi.org/10.1302/0301-620X.76B3.8175852
Zimny Ml, Willing SJ, Roberts JM, D'Ambrosia RD. An electron microscopic study of the fascia from the medial and lateral sides of clubfoot. J Pediatr Orthop. 1985;5:577. https://doi.org/10.1097/01241398-198509000-00014
Dimeo AJ Sr, Lalush DS, Grant E, Morcuende JA. Development of a surrogate biomodel for the investigation of clubfoot bracing. J Pediatr Orthop. 2012;32:e47-52. https://doi.org/10.1097/BPO.0b013e3182571656
Forriol Campos F. Manual de cirugía ortopédica y traumatología. 2.a edición Madrid: Panamericana; 2009. p. 1441-4. https://doi.org/10.1016/S1888-4415(10)70002-3
Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22:517-21. https://doi.org/10.1097/01241398-200207000-00019
Ponseti IV. Congenital clubfoot. Fundamentals of treatment. Oxford: Oxford University Press; 1996.
Cooper DM, Dietz FR. Treatment of idiopathic clubfoot: a thirty year follow-up note. J Bone Joint Surg Am. 1995;77:1477-89. https://doi.org/10.2106/00004623-199510000-00002
Turco VJ. Resistant congenital club foot: One-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Joint Surg Am. 1979;61:805-14. https://doi.org/10.2106/00004623-197961060-00002
Radler C, Mindler GT. Pediatric clubfoot: Treatment of recurrence. Orthopade. 2016;45:909-24. https://doi.org/10.1007/s00132-016-3319-9
Cooper DM, Dietz FR. Treatment of idiopathic clubfoot: a thirtyyear follow-up note. J Bone Joint Surg. 1995;(77A):1477. https://doi.org/10.2106/00004623-199510000-00002
Ponseti I. Clubfoot. Ponseti Management. Global health publication; 2003.
Ponseti I. Treatment of congenital club foot. J Bone Joint Surg. 1992;(74A):448. https://doi.org/10.2106/00004623-199274030-00021
Ponseti I. Congenital clubfoot. Fundamentals of treatment. Oxford: Oxford University Press; 1996.
Tachdjian MO. Congenital talipes equinovarus. En: Tachdjian MO, editor. Pediatric Orthopedics. 2nd edition Philadelphia: Saunders; 1990. p. 2517.
Willis RB, Al-Hunaishel M, Guerra L, Kontio K. What proportion of patients need extensive surgery after failure of the Ponseti technique for clubfoot? Clin Orthop Relat Res. 2009;467:1294-7. https://doi.org/10.1007/s11999-009-0707-z
Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85:1286-94. https://doi.org/10.2106/00004623-200307000-00015
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004;113:376-80. https://doi.org/10.1542/peds.113.2.376
Scher DM. The Ponseti method for treatment of congenital club foot. Curr Opin Pediatr. 2006;18:22-5.
Segev E, Keret D, Lokiec F, Yavor A, Wientroub S, Ezra E, et al. Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot. Isr Med Assoc J. 2005;7:307-10.
Bor N, Coplan JA, Herzenberg JE. Ponseti Treatment for idiopathic clubfoot minimum 5-year followup. Clin Orthop Relat Res. 2009;467:1263-70. https://doi.org/10.1007/s11999-008-0683-8
Ponseti IV. Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res. 2006;451:171-6. https://doi.org/10.1097/01.blo.0000224062.39990.48
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Derechos de autor
Los autores aceptar transferir a la Revista Colombiana de Ortopedia y Traumatología los derechos edición, publicación y reproducción de los artículos publicados. La editorial tiene el derecho del uso, reproducción, transmisión, distribución y publicación en cualquier forma o medio. Los autores no podrán permitir o autorizar el uso de la contribución sin el consentimiento escrito de la revista. Una vez firmada por todos los autores, la carta de Cesión de derechos debe ser cargada en el paso dos del envío.
Aquellos autores que tengan publicaciones en esta revista aceptan los siguientes términos:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web), lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
