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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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A. Bilateral foot abduction brace. B. Unilateral foot abduction brace, side and frontal view.
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Figure 2: A. Bilateral foot abduction brace. B. Unilateral foot abduction brace, side and frontal view.

Mentions: 62% of the children used a standard, bilateral foot abduction brace (FAB) as recommended by Ponseti, immediately after the casting period (Figure 2A). In 55% of the children using the FAB, no changes in brace use were made, while 30% changed to another bilateral FAB from a different producer (for example, from Markell to Mitchell). 12% of the children with bilateral FAB changed to a different type of brace—the flexible custom-made unilateral above-the-knee brace, which has traditionally been used at some hospitals in Norway (Figure 2b). 3% of the children with bilateral FAB changed to a softcast/scotchcast removable brace/cast.


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)

A. Bilateral foot abduction brace. B. Unilateral foot abduction brace, side and frontal view.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A. Bilateral foot abduction brace. B. Unilateral foot abduction brace, side and frontal view.
Mentions: 62% of the children used a standard, bilateral foot abduction brace (FAB) as recommended by Ponseti, immediately after the casting period (Figure 2A). In 55% of the children using the FAB, no changes in brace use were made, while 30% changed to another bilateral FAB from a different producer (for example, from Markell to Mitchell). 12% of the children with bilateral FAB changed to a different type of brace—the flexible custom-made unilateral above-the-knee brace, which has traditionally been used at some hospitals in Norway (Figure 2b). 3% of the children with bilateral FAB changed to a softcast/scotchcast removable brace/cast.

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