Treatment of congenital clubfoot with the Ponseti method

Abstract

This study aimed to present the author's early experience with the Ponseti technique in correcting clubfoot and to evaluate the need for aggressive surgery in the first year of life. The study included 44 feet of 31 patients (25 boys, 6 girls; mean age 3 months; range 4 days to 8 months) with idiopathic clubfoot deformities of grade II, III, or IV. Twenty-seven feet (19 patients) had not received any treatment before. Twelve patients (17 feet) had had unsuccessful prior conservative treatment elsewhere. All patients had manipulation casting in accordance with the Ponseti technique, and percutaneous Achilles tenotomy was performed in the presence of persistent equinus. Maintenance of correction was obtained with the use of a foot abduction brace. The mean follow-up period was 18 months (range 6.5 to 40 months). Forty-two feet (95%, 29 patients) were treated successfully using the Ponseti method. In terms of compliance with the foot abduction brace, a significant difference was noted between patients without previous treatment and those with deformities considered resistant to prior conservative treatment. The latter manifested more compliance with brace application. Ponseti method proved efficient in correcting idiopathic congenital clubfoot deformities irrespective of initial deformity grades, provided that the details of the technique are strictly adhered to. The results also suggest the role of brace application in order to avoid relapses along with the importance of increasing patients' compliance through family education and experienced orthotists.