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Good results with the Ponseti method: a multicenter study of 162 clubfeet followed for 2-5 years.

Sætersdal C, Fevang JM, Fosse L, Engesæter LB - Acta Orthop (2012)

Bottom Line: We found no statistically significant differences between the two braces, except a tendency of better Pirani score in the group using the bilateral foot abduction brace, and a tendency of better compliance in patients using the unilateral brace.Better Pirani scores were found in children who were treated at the largest hospitals.Only 5 feet needed extensive surgery during the first 4 years of life.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway. christian.saetersdal@helse-bergen.no

ABSTRACT

Background and purpose: In 2002-2003, several hospitals in Norway introduced the Ponseti method for treating clubfoot. The present multicenter study was conducted to evaluate the initial results of this method, and to compare them to the good results reported in the literature.

Patients and methods: 116 children with 162 congenital idiopathic clubfeet who were born between 2004 and 2006 were treated with the Ponseti method at 8 hospitals in Norway. All children were prospectively registered at birth, and 116 feet were assessed according to Pirani before treatment was started. 63% used a standard bilateral foot abduction brace, and 32% used a unilateral above-the-knee brace. One of the authors examined all feet at a mean age of 4 years. At follow-up, all feet were assessed by Pirani's scoring system, and range of motion of the foot and ankle was measured.

Results: At follow-up, 77% of the feet had a Pirani score of 0.5 or better, good dorsiflexion and external rotation, and no forefoot adduction. An Achilles tenotomy had been performed in 79% of the feet. Compliance to any brace was good; only 7% were defined as non-compliant. Extensive soft tissue release had been performed in 3% of the feet. We found no statistically significant differences between the two braces, except a tendency of better Pirani score in the group using the bilateral foot abduction brace, and a tendency of better compliance in patients using the unilateral brace. Better Pirani scores were found in children who were treated at the largest hospitals.

Interpretation: After introducing the Ponseti method in Norway, the clinical outcome was good and in accordance with the reports from single centers. Only 5 feet needed extensive surgery during the first 4 years of life.

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Related in: MedlinePlus

Overview of children enrolled in the study, and type of brace used. No/other brace: 1 child did not use any brace; 5 children used a below-the-knee unilateral brace of different types; 1 changed to a bilateral brace. Bilateral brace: 9 changed to a unilateral brace and 2 to another type of brace. Unilateral brace: 1 changed to a bilateral brace.
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Figure 1: Overview of children enrolled in the study, and type of brace used. No/other brace: 1 child did not use any brace; 5 children used a below-the-knee unilateral brace of different types; 1 changed to a bilateral brace. Bilateral brace: 9 changed to a unilateral brace and 2 to another type of brace. Unilateral brace: 1 changed to a bilateral brace.

Mentions: Of the 134 children, 15 had either moved out of the area or failed to show up, and 3 children had initial treatment that differed too much from Ponseti’s descriptions. Accordingly, 116 individuals (72% boys) were included in this study (Figure 1). 46 children had bilateral disorder and 70 had unilateral disorder; thus, the total number of clubfeet examined was 162. Each hospital enrolled between 7 and 25 children in the study.


Good results with the Ponseti method: a multicenter study of 162 clubfeet followed for 2-5 years.

Sætersdal C, Fevang JM, Fosse L, Engesæter LB - Acta Orthop (2012)

Overview of children enrolled in the study, and type of brace used. No/other brace: 1 child did not use any brace; 5 children used a below-the-knee unilateral brace of different types; 1 changed to a bilateral brace. Bilateral brace: 9 changed to a unilateral brace and 2 to another type of brace. Unilateral brace: 1 changed to a bilateral brace.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369157&req=5

Figure 1: Overview of children enrolled in the study, and type of brace used. No/other brace: 1 child did not use any brace; 5 children used a below-the-knee unilateral brace of different types; 1 changed to a bilateral brace. Bilateral brace: 9 changed to a unilateral brace and 2 to another type of brace. Unilateral brace: 1 changed to a bilateral brace.
Mentions: Of the 134 children, 15 had either moved out of the area or failed to show up, and 3 children had initial treatment that differed too much from Ponseti’s descriptions. Accordingly, 116 individuals (72% boys) were included in this study (Figure 1). 46 children had bilateral disorder and 70 had unilateral disorder; thus, the total number of clubfeet examined was 162. Each hospital enrolled between 7 and 25 children in the study.

Bottom Line: We found no statistically significant differences between the two braces, except a tendency of better Pirani score in the group using the bilateral foot abduction brace, and a tendency of better compliance in patients using the unilateral brace.Better Pirani scores were found in children who were treated at the largest hospitals.Only 5 feet needed extensive surgery during the first 4 years of life.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway. christian.saetersdal@helse-bergen.no

ABSTRACT

Background and purpose: In 2002-2003, several hospitals in Norway introduced the Ponseti method for treating clubfoot. The present multicenter study was conducted to evaluate the initial results of this method, and to compare them to the good results reported in the literature.

Patients and methods: 116 children with 162 congenital idiopathic clubfeet who were born between 2004 and 2006 were treated with the Ponseti method at 8 hospitals in Norway. All children were prospectively registered at birth, and 116 feet were assessed according to Pirani before treatment was started. 63% used a standard bilateral foot abduction brace, and 32% used a unilateral above-the-knee brace. One of the authors examined all feet at a mean age of 4 years. At follow-up, all feet were assessed by Pirani's scoring system, and range of motion of the foot and ankle was measured.

Results: At follow-up, 77% of the feet had a Pirani score of 0.5 or better, good dorsiflexion and external rotation, and no forefoot adduction. An Achilles tenotomy had been performed in 79% of the feet. Compliance to any brace was good; only 7% were defined as non-compliant. Extensive soft tissue release had been performed in 3% of the feet. We found no statistically significant differences between the two braces, except a tendency of better Pirani score in the group using the bilateral foot abduction brace, and a tendency of better compliance in patients using the unilateral brace. Better Pirani scores were found in children who were treated at the largest hospitals.

Interpretation: After introducing the Ponseti method in Norway, the clinical outcome was good and in accordance with the reports from single centers. Only 5 feet needed extensive surgery during the first 4 years of life.

Show MeSH
Related in: MedlinePlus