Manipulation of a clubfoot prior to a Ponseti method decreases the need for tenotomy!

Abstract

The combination of the Ponseti method with functional treatment produces better results and may reduce the need for surgery. The objective of this study was to assess the impact of manipulation of a congenital equinovarus clubfoot performed before correction by the Ponseti method.This was a cohort study of children <5 years treated with the Ponseti method followed over a minimum period of 1 year. Each foot was treated according to the Ponseti method. The study parameters were as follows: age, gender, concept of previous treatment, previous treatment with manipulation, the degree of deformation according to the Pirani score, the laterality of the deformation, the number of casts required and the time needed for correction, the evolution of the Pirani score before each correction by plaster, the use or not of tenotomy and the Pirani score at the end of the correction session, the evolution of the Pirani score when wearing an abduction boot.The series comprised a total of 68 feet. The average age of the children was 15.5 months. Regarding the deformity, 29 children presented a severe or very severe deformity. Before the treatment, 16 children received regular handling massage. Feet that had received manipulation prior to correction were the least exposed to tenotomy (P = .009). For the children who did not require a tenotomy, all the feet had a Pirani score of zero after the fourth week of wearing the splint. We noted a rapidly decreasing in the Pirani score of the feet, which did not require an tenotomy compared with other feet (Kolmogorov-Smirnov test: D = 0.61; P = .01).The combination of functional treatment with the Ponseti method reduces the need for tenotomy.