SLR - October 2018 - Amara Abid
Berger, N., Lewens, D., Salzmann, M., Hapfelmeier, A., Döderlein, L. Prodinger, P.M. Is Unilateral Lower-Leg Orthosis with a Circular Foot Unit in the Treatment of Idiopathic Clubfeet a Reasonable Bracing Alternative in the Ponseti Method? Five-Year Results of a Supraregional Pediatric-Orthopaedic Center. BMC musculoskeletal disorders, 2018 Dec; 19(1), 229.Scientific Literature Review
Reviewed By: Amara Abid, DPM
Residency Program: SUNY Downstate Medical Center, Brooklyn, NY
Podiatric Relevance: Pediatric talipes equinovarus (clubfoot) is a developmental disorder that fixates the foot in supinated, varus and adducted position. Management of clubfoot is a challenging task and requires management through clinical experiences and new developmental methods postoperatively. Ponseti casting is used universally along with Achilles tenotomy, and this technique has demonstrated high success rates in pediatric patients. Following the Ponseti method, foot orthoses are used to prevent recurrence. This study reviews a total of 45 patients treated with Ponseti casting along with a standard foot abduction orthosis or unilateral lower-leg orthosis to evaluate outcomes measured through relapse and increased complications.
Methods: A retrospective cohort study was performed on a total of 45 pediatric patients who were diagnosed with idiopathic clubfoot and received three years of bracing after Ponseti casting. After casting, patients were provided with standard foot abduction orthosis, and if complications occurred, the patient was switched to unilateral lower-leg orthosis, which was composed of a circular foot unit, lower-leg unit and an inner liner, which functions as a shock absorber. The groups were defined based on treatment: usage of foot abduction orthosis throughout or starting with foot abduction orthosis and switching to lower-limb orthosis during the treatment. Compliance with using the brace was measured by the number of hours the brace was applied to the patient per day. Outcome was measured in recurrence of clubfoot and reoperative techniques performed on the patient.
Results: Noncompliance of the treatment bracing protocol with foot abduction orthosis included a total of 22 patients (54 percent) due to skin problems (45 percent), sleep disturbance (50 percent) and other reasons (5 percent). Noncompliance with lower-leg orthosis included a total of two patients (5 percent) due to sleep disturbance (9 percent). The patients who were switched over to lower-limb orthosis from foot abduction orthosis did not have an elevated recurrence rate.
Conclusion: As the patients were changed from foot abduction orthosis over to lower-limb orthosis, it did not demonstrate a higher rate of clubfoot recurrence or the requirement to reoperate on the patient. There were several limitations of this retrospective study, including limited statistical analysis, diagnosis of relapse based on clinical appearance only, absence of objective measurements to diagnose relapse and cost of lower-limb orthosis being significantly higher than foot abduction orthosis. This study demonstrates that lower-limb orthosis is a beneficial option to switch from foot abduction orthosis if the patient has complications but additional investigations are needed to examine lower-limb orthosis efficacy.