Outcomes of the Clubfoot Treatment with the Ponseti Method: Recurrence and Prognostic Factors
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Abstract
Background: Clubfoot is a multifactorial disease with the prevalence of one in 1000 live births. The presentations of clubfoot are forefoot adductus, hindfoot varus, cavus, and equinus. Ponseti method is an efficient nonoperative clubfoot treatment containing manipulation, serial casting, and Achilles tendon tenotomy if necessary. Our prospective observational study assessed the outcome and probability of recurrence in the treated clubfoot with the Ponseti method.
Methods: This prospective observational study was performed in Akhtar Hospital in Tehran, Iran. 27 patients with 38 feet of idiopathic clubfoot in our study were treated with the Ponseti method. The patients were assessed before and after treatment and demographic characteristics, Dimeglio scores, number of recurrenes, and need for tenotomy were recorded.
Results: All patients (38 feet) successfully achieved complete deformity correction, but 13 feet had a relapse. The mean age of cases with relapse was more than cases without relapse. Cases with a higher initial Dimeglio score had a higher recurrence rate after Ponseti method treatment. Eight feet (five patients) out of 38 feet did not use Denis Browne (DB) splint as our protocol; all of them had a relapse. On the other hand, only 5 of 30 feet (16.7%) that used splint had recurrence.
Conclusion: The treatment should be started as soon as possible because it is more effective at a younger age. Severe cases at the initial visit had more recurrence rate. Besides, the recurrence rate in cases that used DB orthosis improperly, irregularly, and incorrectly was higher than others.
1. Smith PA, Kuo KN, Graf AN, Krzak J, Flanagan A, Hassani S, et al. Long-term results of comprehensive clubfoot release versus the Ponseti method: Which is better? Clin Orthop Relat Res. 2014;472(4):1281-90. doi: 10.1007/s11999-013-3386-8. [PubMed: 24249539]. [PubMed Central: PMC394075].
2. Wynne-Davies R. Family studies and the cause of congenital club foot. Talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Joint Surg Br. 1964;46:445-63. [PubMed: 14216453].
3. Lee BYP, Mazelan A, Gunalan R, Albaker MZA, Saw A. Ponseti method of treating clubfoot - Is there difference if treatment is started before or after one month of age? Med J Malaysia. 2020;75(5): 510-3. [PubMed: 32918418].
4. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004;86(1):22-7. doi: 10.2106/00004623-200401000- 00005. [PubMed: 14711941].
5. Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World J Orthop. 2013;4(3):144-53. doi: 10.5312/wjo.v4.i3.144. [PubMed: 23878784]. [PubMed Central: PMC3717249].
6. Gibbons PJ, Gray K. Update on clubfoot. J Paediatr Child Health. 2013;49(9):E434-E437. doi: 10.1111/jpc.12167. [PubMed: 23586398].
7. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77(10):1477-89. doi: 10.2106/00004623-199510000-00002. [PubMed: 7593056].
8. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23-31. [PubMed: 7351412].
9. Smythe T, Chandramohan D, Bruce J, Kuper H, Lavy C, Foster A. Results of clubfoot treatment after manipulation and casting using the Ponseti method: Experience in Harare, Zimbabwe. Trop Med Int Health. 2016;21(10):1311-8. doi: 10.1111/tmi.12750. [PubMed: 27388947].
10. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146-53. doi: 10.1007/s11999-009-0734-9. [PubMed: 19224303]. [PubMed Central: PMC2664438].
11. Zhao D, Li H, Zhao L, Liu J, Wu Z, Jin F. Results of clubfoot management using the Ponseti method: Do the details matter? A systematic review. Clin Orthop Relat Res. 2014;472(4):1329-36. doi: 10.1007/s11999-014-3463-7. [PubMed: 24435715]. [PubMed Central: PMC3940729].
12. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-6. [PubMed: 9741465].
13. Lampasi M, Abati CN, Bettuzzi C, Stilli S, Trisolino G. Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method. Int Orthop. 2018;42(10):2429-36. doi: 10.1007/s00264-018-3873-3. [PubMed: 29594373].
14. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129-36. doi: 10.1097/01202412-199504020-00002. [PubMed: 7670979].
15. Pirani S, Hodges D, Sekeramayi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. Orthop Proc. 2008;90-B(Suppl_I):53. doi: 10.1302/0301-620X.90BSUPP_I.0880053c.
16. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop. 1998;18(3):323-7. [PubMed: 9600557].
17. 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(2): 376-80. doi: 10.1542/peds.113.2.376. [PubMed: 14754952].
18. Hoque SS, Hussain MS, Sarwar G, Maksud SI, Afroz F, Sikder AL. Evaluation of the result of Congenital Talipes Equino Varus (CTEV) treated by the Ponseti method at an early age. The Journal of Bangladesh Orthopedic Society. 2017;23(1):13-21.
19. Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop. 2014;34(6):639-42. doi: 10.1097/BPO.0000000000000182. [PubMed: 24705346].
20. Zhao D, Li H, Zhao L, Kuo KN, Yang X, Wu Z, et al. Prognosticating factors of relapse in clubfoot management by Ponseti method. J Pediatr Orthop. 2018;38(10):514-20. doi: 10.1097/BPO.0000000000000870. [PubMed: 27662384].
21. Jayasomeswar N, Kumar DM, Babu B. The outcome of Ponseti technique for idiopathic clubfoot. Int J Orthop Sci. 2019; 5(2): 774-777. doi: https://doi.org/10.22271/ortho.2019.v5.i2k.88.
22. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti's vs. Kite's method in the treatment of clubfoot--a prospective randomised study.
Int Orthop. 2008;32(3):409-13. doi: 10.1007/s00264-007-0332-y.
[PubMed: 17323092]. [PubMed Central: PMC2323422].
23. Selmani E. Is Ponseti's method superior to Kite's for clubfoot treatment he? European Orthopaedics and Traumatology. 2012;3(3):183-7. doi: 10.1007/s12570-012-0116-8.
24. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74(3):448-54. [PubMed: 1548277].
25. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22(4): 517-21. [PubMed: 12131451].
26. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990;10(1):109-19. [PubMed: 2137134].
27. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: A comparative study. Eur J Orthop Surg Traumatol. 2015;25(5):949-53. doi: 10.1007/s00590-015-1594-5. [PubMed: 25633123].
28. Zhang W, Richards BS, Faulks ST, Karol LA, Rathjen KA, Browne RH. Initial severity rating of idiopathic clubfeet is an outcome predictor at age two years. J Pediatr Orthop B. 2012;21(1):16-9. doi: 10.1097/BPB.0b013e32834c31a2. [PubMed: 21934632].
29. Brazell C, Carry PM, Jones A, Baschal R, Miller N, Holmes KS, et al. Dimeglio score predicts treatment difficulty during Ponseti casting for isolated clubfoot. J Pediatr Orthop. 2019;39(5):e402-e405. doi: 10.1097/BPO.0000000000001325. [PubMed: 30608304].
30. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot--(a study of 67 clubfeet with mean five year follow- up). J Orthop Surg Res. 2011;6:3. doi: 10.1186/1749-799X-6-3. [PubMed: 21226940]. [PubMed Central: PMC3031260].
31. Zionts LE, Frost N, Kim R, Ebramzadeh E, Sangiorgio SN. Treatment of idiopathic clubfoot: experience with the Mitchell-Ponseti brace. J Pediatr Orthop. 2012;32(7):706-13. doi: 10.1097/BPO.0b013e3182694f4d. [PubMed: 22955535].
32. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg. 2003;42(5):259-67. doi: 10.1016/s1067-2516(03)00312-0. [PubMed: 14566717].
2. Wynne-Davies R. Family studies and the cause of congenital club foot. Talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Joint Surg Br. 1964;46:445-63. [PubMed: 14216453].
3. Lee BYP, Mazelan A, Gunalan R, Albaker MZA, Saw A. Ponseti method of treating clubfoot - Is there difference if treatment is started before or after one month of age? Med J Malaysia. 2020;75(5): 510-3. [PubMed: 32918418].
4. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004;86(1):22-7. doi: 10.2106/00004623-200401000- 00005. [PubMed: 14711941].
5. Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World J Orthop. 2013;4(3):144-53. doi: 10.5312/wjo.v4.i3.144. [PubMed: 23878784]. [PubMed Central: PMC3717249].
6. Gibbons PJ, Gray K. Update on clubfoot. J Paediatr Child Health. 2013;49(9):E434-E437. doi: 10.1111/jpc.12167. [PubMed: 23586398].
7. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77(10):1477-89. doi: 10.2106/00004623-199510000-00002. [PubMed: 7593056].
8. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23-31. [PubMed: 7351412].
9. Smythe T, Chandramohan D, Bruce J, Kuper H, Lavy C, Foster A. Results of clubfoot treatment after manipulation and casting using the Ponseti method: Experience in Harare, Zimbabwe. Trop Med Int Health. 2016;21(10):1311-8. doi: 10.1111/tmi.12750. [PubMed: 27388947].
10. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146-53. doi: 10.1007/s11999-009-0734-9. [PubMed: 19224303]. [PubMed Central: PMC2664438].
11. Zhao D, Li H, Zhao L, Liu J, Wu Z, Jin F. Results of clubfoot management using the Ponseti method: Do the details matter? A systematic review. Clin Orthop Relat Res. 2014;472(4):1329-36. doi: 10.1007/s11999-014-3463-7. [PubMed: 24435715]. [PubMed Central: PMC3940729].
12. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-6. [PubMed: 9741465].
13. Lampasi M, Abati CN, Bettuzzi C, Stilli S, Trisolino G. Comparison of Dimeglio and Pirani score in predicting number of casts and need for tenotomy in clubfoot correction using the Ponseti method. Int Orthop. 2018;42(10):2429-36. doi: 10.1007/s00264-018-3873-3. [PubMed: 29594373].
14. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129-36. doi: 10.1097/01202412-199504020-00002. [PubMed: 7670979].
15. Pirani S, Hodges D, Sekeramayi F. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot deformity. Orthop Proc. 2008;90-B(Suppl_I):53. doi: 10.1302/0301-620X.90BSUPP_I.0880053c.
16. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop. 1998;18(3):323-7. [PubMed: 9600557].
17. 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(2): 376-80. doi: 10.1542/peds.113.2.376. [PubMed: 14754952].
18. Hoque SS, Hussain MS, Sarwar G, Maksud SI, Afroz F, Sikder AL. Evaluation of the result of Congenital Talipes Equino Varus (CTEV) treated by the Ponseti method at an early age. The Journal of Bangladesh Orthopedic Society. 2017;23(1):13-21.
19. Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop. 2014;34(6):639-42. doi: 10.1097/BPO.0000000000000182. [PubMed: 24705346].
20. Zhao D, Li H, Zhao L, Kuo KN, Yang X, Wu Z, et al. Prognosticating factors of relapse in clubfoot management by Ponseti method. J Pediatr Orthop. 2018;38(10):514-20. doi: 10.1097/BPO.0000000000000870. [PubMed: 27662384].
21. Jayasomeswar N, Kumar DM, Babu B. The outcome of Ponseti technique for idiopathic clubfoot. Int J Orthop Sci. 2019; 5(2): 774-777. doi: https://doi.org/10.22271/ortho.2019.v5.i2k.88.
22. Sud A, Tiwari A, Sharma D, Kapoor S. Ponseti's vs. Kite's method in the treatment of clubfoot--a prospective randomised study.
Int Orthop. 2008;32(3):409-13. doi: 10.1007/s00264-007-0332-y.
[PubMed: 17323092]. [PubMed Central: PMC2323422].
23. Selmani E. Is Ponseti's method superior to Kite's for clubfoot treatment he? European Orthopaedics and Traumatology. 2012;3(3):183-7. doi: 10.1007/s12570-012-0116-8.
24. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74(3):448-54. [PubMed: 1548277].
25. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002;22(4): 517-21. [PubMed: 12131451].
26. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990;10(1):109-19. [PubMed: 2137134].
27. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: A comparative study. Eur J Orthop Surg Traumatol. 2015;25(5):949-53. doi: 10.1007/s00590-015-1594-5. [PubMed: 25633123].
28. Zhang W, Richards BS, Faulks ST, Karol LA, Rathjen KA, Browne RH. Initial severity rating of idiopathic clubfeet is an outcome predictor at age two years. J Pediatr Orthop B. 2012;21(1):16-9. doi: 10.1097/BPB.0b013e32834c31a2. [PubMed: 21934632].
29. Brazell C, Carry PM, Jones A, Baschal R, Miller N, Holmes KS, et al. Dimeglio score predicts treatment difficulty during Ponseti casting for isolated clubfoot. J Pediatr Orthop. 2019;39(5):e402-e405. doi: 10.1097/BPO.0000000000001325. [PubMed: 30608304].
30. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot--(a study of 67 clubfeet with mean five year follow- up). J Orthop Surg Res. 2011;6:3. doi: 10.1186/1749-799X-6-3. [PubMed: 21226940]. [PubMed Central: PMC3031260].
31. Zionts LE, Frost N, Kim R, Ebramzadeh E, Sangiorgio SN. Treatment of idiopathic clubfoot: experience with the Mitchell-Ponseti brace. J Pediatr Orthop. 2012;32(7):706-13. doi: 10.1097/BPO.0b013e3182694f4d. [PubMed: 22955535].
32. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg. 2003;42(5):259-67. doi: 10.1016/s1067-2516(03)00312-0. [PubMed: 14566717].
| Files | ||
| Issue | Vol 8, No 4 (2022) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v8i4.10453 | |
| Keywords | ||
| Clubfoot Congenital Talipes Equinovarus Treatment Recurrence | ||
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How to Cite
1.
Maleki A, Aghapour SR, saleh A. Outcomes of the Clubfoot Treatment with the Ponseti Method: Recurrence and Prognostic Factors. J Orthop Spine Trauma. 2022;8(4):125-9.
