SLR - August 2023 - Niral A. Patel, DPM, MS
Title:A 5-years Results of the Ponseti Method in the Treatment of Congenital Clubfoot: A Retrospective Study
Reference
Bitew A, Melesse DY, Admass BA. A 5-years results of the Ponseti method in the treatment of congenital clubfoot: a retrospective study. Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1781-1787. doi: 10.1007/s00590-022-03353-5. Epub 2022 Aug 13. PMID: 35963923; PMCID: PMC10275805.
Level of Evidence: 3
Scientific Literature Review
Reviewed By
Niral A. Patel, DPM, MS
Residency Program
Ascension St. Vincent Indianapolis, IN
Podiatric Relevance:
A pediatric condition evaluated & managed by foot & ankle physicians is congenital clubfoot. The Ponseti method is a nonsurgical approach for clubfoot that is commonly performed by podiatric physicians to treat clubfoot. Therefore, this study aimed to retrospectively assess the 5-year results of the Ponseti method in the treatment of congenital clubfoot performed for children under 2 years of age as well as a descriptive analysis of factors affecting the outcome of the treatment.
Methods:
The study population included all children under 2 years old with a diagnosis of congenital clubfeet from May 2015 to April 2019 who were treated with the Ponseti treatment method at one Hospital. Inclusion criteria included children whose idiopathic clubfeet were treated with the Ponseti method a the age of 2 weeks. Patients who were not seen by physiotherapy, discontinued their follow-up, with neurologic complications, & syndrome clubfoot were excluded from the study. Out of 265 study participants, 200 were included in the study with a response rate of 76%. The Pirani Score was used throughout the study to determine the severity & monitor progress in the assessment & treatment of clubfoot. Treated clubfoot was defined as cured if the patient obtains cosmetically acceptable, pliable, functional, painless, plantigrade foot with a Pirani score of 1 & 0.
Intervention: Casting was performed once a week until there was a need for tenotomy or bracing. Casting was used to correct cavus, adductus, & varus. Each patient had a variable number of casts depending on deformity severity. Equinus was the last component of the deformity to be corrected with tenotomy or casting only. Post tenotomy cast was applied for 3 weeks to ensure healing. Once casting was finished, the patients were transferred to the maintenance/bracing phase. Parents were appointed to come 2 weeks after the first brace to check for compliance. The follow-up continued until the child started to walk & skeletal maturation occurred. The treatment timeline varied from 3 months to 1 year.
Results:
The overall success rate of the Ponseti method in the treatment of congenital clubfoot in this cohort of 200 children was 187 or 93.5%. The secondary outcomes evaluated were sociodemographic, behavioral characteristics of parents, birth-related characteristics, deformity severity, & treatment factors. 77% of parents of the study participants had no formal education, 41.5% were born at home, & 2% had poor bracing compliance. These factors might have a negative role in the success rate of the treatment method. Males were two times affected by clubfoot. The reason for this discrepancy is unclear but may represent an inherent difference in the susceptibility to the deformity
Conclusions:
The results from 5-years of data showed that the Ponseti method in the treatment of congenital clubfoot had a success rate of 93.5%. Children with congenital clubfeet be managed with the Ponseti treatment method in a timely manner.
Though the Ponseti method has been well documented & researched several enhancements can be considered to improve the study. Firstly, adopting a prospective study design with randomization & a control group would minimize biases. Increasing the sample size would enhance statistical power & generalizability. Standardized outcome measures should be employed, including functional assessments. Implementing blinding procedures & collaborating with multiple centers would further strengthen the study. This was a descriptive study that did not indicate the association of factors to outcome with appropriate analysis methods. Incorporating these improvements would enhance the study's validity, credibility, & overall quality.