The Ponseti Method for the Treatment of Clubfeet Associated with Down Syndrome

Abstract

Category: Other Introduction/Purpose: This study aims to compare treatment characteristics and outcomes of clubfoot patients with Down Syndrome (DS) to those with idiopathic clubfoot treated with the Ponseti method. Methods: A retrospective review of prospectively gathered data was performed at a single institution over an 18-year period. Patients with idiopathic clubfeet (IC) and clubfeet associated with DS who were less than one-year old and treated by the Ponseti method were included. Initial Dimeglio score, number of casts, need for tendoachilles tenotomy, recurrence, and need for further surgery were recorded. Outcomes were classified using the Richards classification system. Results: 24 clubfeet in 15 patients with DS, and 320 IC in 225 patients were identified with an average follow-up of 62 and 65 months respectively. DS patients presented for treatment at an older age (54 vs. 16 days, p=0.000) and with lower initial Dimeglio scores (11.1 vs. 13.7, p=0.000). Tendoachilles tenotomy was performed in 79% of IC and 75% of the DS clubfeet (p=0.64). Recurrence rates were not statistically different between the groups, nor was the need for later surgery. However, recurrences in the DS group were significantly less likely to require intra-articular surgery (4.2% vs. 34.4%, p=0.02). Clinical outcomes were 83% 'good', 13% 'fair', and 4% 'poor' in DS patients, and 69% 'good', 27% 'fair', and 4% 'poor' in the idiopathic cohort (p=0.1). Conclusion: Despite milder deformity and older age at presentation, DS associated clubfeet have similar recurrence rates and clinical outcomes as their idiopathic counterparts. When deformities do relapse in DS patients, significantly less intra-articular surgery is required than for idiopathic clubfeet.