Rate and predictors of relapse and surgery in idiopathic clubfeet after successful Ponseti treatment in infancy : a single centre, retrospective, comparative study.

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Abstract

Conflict of interest statement: M. Bouchard reports consulting fees for Orthopediatrics and Orthopediatrics Specialty Bracing; payments for speaking at Washington University, Cincinnati Children's Hospital, and Columbia University; and a hotel for the annual IPOS meeting, paid for by the Pediatric Orthopaedic Society of North America; and is cofounder of Orthoflexion, all of which are unrelated to this work. 6. Ann Transl Med. 2021 Jul;9(13):1101. doi: 10.21037/atm-20-7774. Objective analysis of intermediate-term outcome of the Ponseti technique: a review of the experience from Los Angeles. Zionts LE(1), Ebramzadeh E(1), Sangiorgio SN(1). Author information: (1)The J. Vernon Luck, Sr., MD Orthopedic Research Center, Orthopaedic Institute for Children and the Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. The Ponseti method of manipulative treatment for clubfoot deformity became widely adopted by pediatric orthopaedic surgeons beginning in the mid-1990s. The technique allows correction of most idiopathic clubfeet using gentle manipulation and cast application. The treatment represents a marked advance over past efforts to gain correction of the foot through extensive release surgery. In 2006, we began a Clubfoot Clinic at the Orthopaedic Institute for Children in Los Angeles, California dedicated to managing clubfoot patients using Ponseti's method. An IRB-approved database of patient-related, treatment related, and demographic variables was assembled and used to ascertain the outcome of treatment as well as to address parental questions regarding certain aspects of treatment. Here, we present a review of our body of work, which has improved clinical decision making as well as our ability to better inform our patients' parents regarding the treatment and prognosis of the Ponseti method. Studies from our institution showed that while relapses and the need for extra-articular tibialis anterior tendon transfer (TATT) surgery remain common to the Ponseti method, these events do not adversely affect overall patient function or satisfaction. These findings were not unlike those of classic studies reported from Ponseti's institution. We conclude that the Ponseti method is not only a technique to achieve initial correction of an idiopathic clubfoot, but also how to manage relapses that will inevitably occur in many patients. While relapses and tendon transfer surgery are likely to remain common with this treatment method, these events do not adversely affect overall patient function or satisfaction. The parents of infants whose clubfeet are managed using the Ponseti method should be counselled accordingly. 2021 Annals of Translational Medicine. All rights reserved. DOI: 10.21037/atm-20-7774 PMCID: PMC8339808