Abstract
BackgroundThe prevalence of untreated congenital clubfoot among children older than walking age is higher in developing countries due to limited resources for early care after birth. The Ponseti method represents an intervention option for older, untreated children.MethodsA metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017. A pooling analysis of proportions with 95% confidence intervals (CIs) and a publication bias assessment were performed as routine. Estimates of success, recurrence, and complication rates were weighted and pooled using the random effects model.ResultsTwelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age (older than 1 year old), were included for analysis. The rate of satisfactory outcomes found via a cluster metanalysis of proportions using the random effects model was 89% (95% CI = 0.82–0.94, p < 0.01), relative to the total analysed. The recurrence rate was 18% (95% CI = 0.14–0.24, p = 0.015), and the rate of casting complications was 7% (95% CI = 0.03–0.15, p = 0.19).ConclusionApplication of the Ponseti method in children with untreated idiopathic clubfoot older than walking age leads to satisfactory outcomes, has a low cost, and avoids surgical procedures likely to cause complications. The results obtained exhibited considerable heterogeneity.
Highlights
Congenital clubfoot (CC) is a complex deformity
A metanalysis was conducted of observational studies selected through a systematic review of articles included in electronic databases (Medline, Scopus, Embase, Lilacs, and the Cochrane Library) until June 2017
Twelve studies, including 654 feet diagnosed with congenital clubfoot in children older than walking age, were included for analysis
Summary
Congenital clubfoot (CC) is a complex deformity. Conservative treatment, involving serial cast changes, is a consensus in the literature, with the Ponseti method considered to be the first choice [1]. For treatment of patients diagnosed with CC after walking age, most studies indicate extensive surgical release of the foot tissues with or without osteotomy [2] In such cases, surgery is complex and often associated with serious complications and difficulty obtaining satisfactory outcomes [3]. Surgery does not prevent recurrence, the rate of which is approximately 25%, and reoperation is frequently required, with a consequent increase in complications and limitations in functional outcomes [4,5] Given this scenario and considering its success among younger children, the Ponseti method was indicated as a therapeutic option for older children with CC, i.e., older than 1 year old, being associated with low complication rates and lower cost [6]. The Ponseti method represents an intervention option for older, untreated children
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