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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

A. Clubfoot, right side, before treatment. B. Clubfoot, right side, after casting and Achilles tenotomy. C. Clubfoot, right side, at 3 years old.
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Figure 3: A. Clubfoot, right side, before treatment. B. Clubfoot, right side, after casting and Achilles tenotomy. C. Clubfoot, right side, at 3 years old.

Mentions: The mean Pirani score before treatment was 4.8 (2.5–6) (116/162 feet). For all 162 feet, the mean number of casts during initial treatment, including the last cast after tenotomy, was 7.2 (3–13). 79% of the feet were treated with a percutaneous Achilles tenotomy. Figure 3 shows a unilateral clubfoot throughout the treatment period.


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. Clubfoot, right side, before treatment. B. Clubfoot, right side, after casting and Achilles tenotomy. C. Clubfoot, right side, at 3 years old.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A. Clubfoot, right side, before treatment. B. Clubfoot, right side, after casting and Achilles tenotomy. C. Clubfoot, right side, at 3 years old.
Mentions: The mean Pirani score before treatment was 4.8 (2.5–6) (116/162 feet). For all 162 feet, the mean number of casts during initial treatment, including the last cast after tenotomy, was 7.2 (3–13). 79% of the feet were treated with a percutaneous Achilles tenotomy. Figure 3 shows a unilateral clubfoot throughout the treatment period.

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