SLR - July 2018 - Sara R. Millar
Reference: Lewis E. Zionts, Edward Ebramzadeh, Rebecca D. Morgan, Sophia N. Sangiorgio. Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse. The Journal of Bone and Joint Surgery, 2018.Scientific Literature Review
Reviewed By: Sara R. Millar, DPM
Residency Program: Larkin Community Hospital, South Miami FL
Podiatric Relevance: Despite the low prevalence of idiopathic clubfoot in America, this article is still relevant to all practitioners of podiatric medicine because it aims to look at longer-term outcomes for a conservative care treatment for a debilitating condition. If not treated correctly, idiopathic clubfoot can result in permanent deformity and/or require further reconstructive surgery. The goal of this article is to show that not only is the method still relevant in today's practice, but it has favorable longer-term outcomes, even at five years.
Methods: This study aimed to assess the efficacy of the Ponseti Method, application of weekly casts with semi-rigid fiberglass casting on correcting clubfoot deformity in children under three months of age with no prior treatment. An important aspect was that there is a required follow-up period of five years to assess the longer-term results. All followed a strict protocol of casting weekly and thereafter bracing 23 hours a day for three months and thereafter only during periods of rest for four years. The Dallas criteria was used to assess the latest outcome, and the Roye DSI was completed by the parents, which consists of 10 items designed to measure overall satisfaction, appearance, pain and physical limitations annually after the age of three. It is a therapeutic prospective study.
Results: In this study, 101 patients with 147 clubfeet were followed until they were five years old with the mean age being 6.8 years. All of the patients achieved initial correction. Only 37 percent of the parents stated they were adherent to the course of treatment. Of the 101 patients, 68 reported >1 relapse event, which was corrected with casting and bracing. The outcome criteria of the Dallas criteria showed that 62 percent had a good outcome, 38 percent had a fair outcome and no patients had a poor outcome. The outcome criteria of the Roye DSI were 83.2 percent of parents were very satisfied with the foot, and 75.2 percent were very satisfied with the appearance.
Conclusions: The authors found that there was a substantial rate of relapse compared to historical research, but they also determined that satisfactory outcomes were achieved in a majority of the patients. They found that initial severity of the deformity is a factor in the rate of relapse up to 44 percent.
The results of this study show that this method is effective in correcting clubfoot, and even if there is presence of a relapse, it can be managed with recasting and bracing. This study has reaffirmed the relevance and clinical effectiveness of the Ponseti method. This information is important when treating a patient with clubfoot in allowing the practitioner to be effective in communicating the prognosis to a family as well as in identifying potential complications in the initial assessment that could lead to adverse outcomes or relapse, such as nonadherence or initial severity of deformity leading to poorer outcomes.