Treatment of Idiopathic Clubfoot

Abstract

The Mitchell-Ponseti (MP) foot abduction orthosis was introduced to provide a more user-friendly alternative to the traditional Denis-Browne (DB) brace in the treatment of idiopathic clubfoot. We describe our experience with the effectiveness of the MP brace to maintain correction of clubfeet corrected using the Ponseti method. We evaluated 57 consecutive infants with 84 idiopathic clubfeet who were treated using the Ponseti method. After initial correction of the deformity was obtained, all infants were placed in the MP brace. The patients were followed for a minimum of 2 years (mean, 37.9 mo; range, 24 to 56 mo). Seventy-nine feet (94%) had heel-cord tenotomy or lengthening. The families of 34 (60%) patients were adherent with the postcorrective brace protocol. Skin problems were observed in 8 patients (14%), 6 of which were superficial dorsal skin abrasion, and none of the sandals required customization by an orthotist. A recurrence occurred in 40 feet (48%). Correction was regained with manipulation and cast application in all cases. Nineteen feet (23%) in 14 patients have had, or are scheduled for, an anterior tibial tendon transfer. At latest follow-up, all feet were plantigrade and had at least 10 degrees of dorsiflexion. None of the patients required surgical releases. Of 31 patients followed for at least 3 years, 26 (84%) used the brace for a minimum of 3 years. Using the MP foot abduction orthosis, we were able to achieve compliance rates that were at least comparable with those of earlier reports using the DB brace. Families found the brace easy to use. The MP brace may be considered a useful alternative to the DB brace. Level II--prospective.