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Children's Orthopaedics

TREATMENT OF IDIOPATHIC CLUBFOOT USING THE PONSETI METHOD: TEN-YEAR UK OUTCOME

British Society for Children's Orthopaedic Surgery (BSCOS)



Abstract

Aim

10 years after the introduction of the Ponseti casting regimen as standard treatment for idiopathic clubfoot at Alder Hey Children's Hospital, we reviewed the mid-term outcomes of the initial 2-year cohort (treated from 2002–2004)

Method

100 feet were treated in 66 patients. 61 of the 100 feet have been prospectively reviewed on an annual/ bi-annual basis since successful correction, with outcomes of the remaining feet obtained by retrospective analysis.

Results

96 feet responded to initial casting; of these, 31 had a recurrence within the first 2 years (16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior, the remaining 15 requiring extensive soft tissue release). 12 feet developed recurrence after 2 years (9 of whom were successfully treated with transfer of tibialis anterior tendon and 3 of whom required extensive soft tissue release) Mean dorsiflexion at average follow-up of 9 years is 15 degrees (95% CI 12.96 to 17.04) and mean abduction 41 degrees. (95%CI 37.65 to 45.07).

Conclusion

The Ponseti regimen is a successful treatment option for the management of idiopathic clubfoot. The majority of recurrences occur in the first two years and so close follow-up should be undertaken during this period. The importance of strict compliance with boots and bars must be emphasised to parents at this treatment stage. These mid-term outcomes have highlighted that, although fewer recurrences occur after the first two years, it is difficult to predict which feet might recur; consequently, we recommend following children up in an annual/bi-annual fashion until their skeletal maturity.