Abstract
The success of the Ponseti method for treating idiopathic clubfoot deformity is dependent on the casting techniques and the adherence of the patient to the foot abduction brace protocol. Newly developed brace designs claim to be more comfortable, to be easier to use and to prevent dislodgement of the foot from the brace, making them more efficient and improving patient compliance. They are, however, more costly, and, therefore, accessible to fewer patients. We compared the compliance and treatment outcome using two brace designs, the traditional simple brace of pre-walking shoes attached to a Dennis Browne (DB) bar and the new sophisticated Mitchell brace. We compared the functional outcome and compliance with the post-corrective bracing protocol of 38 children with idiopathic clubfoot treated in our institution using two brace designs. Twenty-one chose the DB brace and 17 chose the Mitchell brace. There was no difference in the compliance rate or in the final clinical and radiological outcomes of the two groups after a minimum of 2years of follow-up. A positive correlation was found between the Pirani score at the beginning of treatment and the final functional score for both groups. Both groups were satisfied with the selected brace. Both groups were equally compliant with the brace protocol. We conclude that new and more expensive brace designs do not necessarily provide better clinical results. Fully corrected foot and a strong family-treating team partnership are crucial to adherence with the brace protocol.
Highlights
The Ponseti method for the treatment of clubfoot deformity gained worldwide popularity and became the standard of care in many medical centres, including those in thirdworld countries, due to its simplicity and high rate of success [1, 2]
Reports on failures with the Ponseti method have shown that the decisive factor that led to recurrence of the clubfoot deformity in 50% of the cases was non-compliance with the foot abduction brace protocol [2, 4,5,6,7]
We offered the families two brace options: the traditional foot abduction brace that includes pre-walking shoes attached to a Dennis Browne bar (DB group) or the Mitchell brace, in which the shoe design includes a silicone insert resembling an ankle– foot orthoses (AFO) and a detachable shoe mechanism (Mitchell group)
Summary
The Ponseti method for the treatment of clubfoot deformity gained worldwide popularity and became the standard of care in many medical centres, including those in thirdworld countries, due to its simplicity and high rate of success [1, 2]. Ponseti first introduced his non-surgical method of clubfoot correction more than 50 years ago [3] and he has reported satisfactory results in 89% of treated feet [1]. The new brace designs include different types of bars [9], shoes, ankle– foot orthoses (AFO) and hinged attachments [8]
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