Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflicts of interest. 10. Rev Esp Cir Ortop Traumatol (Engl Ed). 2021 May-Jun;65(3):180-185. doi: 10.1016/j.recot.2020.09.005. Epub 2021 Feb 26. Syndromic clubfoot beyond arthrogryposis and myelomeningocele: orthopedic treatment with Ponseti method. [Article in English, Spanish] Ferrando Meseguer E(1), Roig Sánchez S(2), Pino Almero L(1), Romano Bataller A(3), Mínguez Rey MF(4). Author information: (1)Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España. (2)Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España. (3)Pediatría, Hospital Universitario de La Ribera, Alzira, España. (4)Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España. Electronic address: mfeminguez@gmail.com. INTRODUCTION: Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. MATERIAL AND METHODS: Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. RESULTS: Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. CONCLUSIONS: The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies. Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved. DOI: 10.1016/j.recot.2020.09.005