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Ponseti Method Compared with Surgical Treatment of Clubfoot: A Prospective Comparison

Halanski, Matthew A. MD; Davison, Jan E. NZRGON; Huang, Jen-Chen MBChB; Walker, Cameron G. PhD; Walsh, Stewart J. FRACS; Crawford, Haemish A. FRACS

Journal of Bone & Joint Surgery - American Volume: February 2010 - Volume 92 - Issue 2 - p 270–278
doi: 10.2106/JBJS.H.01560
Scientific Articles

Background: Current trends in the treatment of idiopathic clubfoot have shifted from extensive surgical release to more conservative techniques. The purpose of the present study was to prospectively compare the results of the Ponseti method with those of surgical releases for the correction of clubfoot deformity.

Methods: We prospectively compared patients who had idiopathic clubfoot deformities that were treated at a single institution either with the Ponseti method or with below-the-knee casting followed by surgical release. The clinical records of the patients with a minimum duration of follow-up of two years were reviewed. All scheduled and completed operative interventions and associated complications were recorded.

Results: Fifty-five patients with eighty-six clubfeet were treated; forty feet were included in the group that was treated with the Ponseti method, and forty-six feet were included in the group that was treated with below-the-knee casts followed by surgery (with three of these feet requiring casting only). There was no difference between the groups in terms of sex, ethnicity, age at the time of first casting, pretreatment Pirani score (average, 5.2 in both groups), or family history. The average number of casts was six in the Ponseti group and thirteen in the surgical group. Of the feet that were treated with below-the-knee casts, forty-three underwent surgery, with forty-two undergoing major surgery (posterior release [eleven] or posteromedial release [thirty-one]). In the Ponseti group, fourteen feet required fifteen operative interventions for recurrences, with only one foot requiring revision surgery. Four of these fifteen were major (necessitating posterior [one] or posteromedial release [three]) while eleven were minor. Thirteen feet in the surgical group required fourteen surgical revisions. Two postoperative complications were seen in each group.

Conclusions: While both cohorts had a relatively high recurrence rate, the Ponseti cohort was managed with significantly less operative intervention and required less revision surgery. The Ponseti method has now been adopted as the primary treatment for clubfoot at our institution.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

1Pediatric Orthopaedics, Helen DeVos Children's Hospital, MC 142, 1425 Michigan Street N.E., Suite D, Grand Rapids, MI 49503. E-mail address: matthew.halanski@devoschildrens.org

2Department of Paediatric Orthopaedics, Starship Children's Hospital, Private Bag 92024, Park Road, Auckland 5, New Zealand

3Department of Engineering Science, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand

Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated
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