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The Use of the Ponseti Method to Treat Clubfeet Associated With Congenital Annular Band Syndrome

Zionts, Lewis E. MD; Habell, Barbara MSN, CPNP

Journal of Pediatric Orthopaedics: July/August 2013 - Volume 33 - Issue 5 - p 563–568
doi: 10.1097/BPO.0b013e31829178fd

Background: A clubfoot deformity may be associated with congenital annular band syndrome (CABS), and has, until recently, been thought to be resistant to nonoperative management. The purpose of this report was to describe the use of the Ponseti method in the treatment of 5 patients whose clubfeet were associated with this syndrome.

Methods: All patients with a diagnosis of clubfoot, who were treated at the Orthopaedic Hospital Clubfoot Clinic, over a period of 4 years, were reviewed. During that period, a total of 131 infants with 194 clubfeet were treated. We identified 5 infants (3.8%) with 6 clubfeet associated with CABS. The patients were managed using the Ponseti method. One of the patients, with a contralateral amputation of the limb opposite to the side with a clubfoot, required the use of a unilateral foot abduction orthosis rather than a conventional foot abduction orthosis. The outcomes evaluated included: the number of casts needed to obtain correction, the percentage of patients requiring a tendo-Achilles tenotomy, the number of relapses, and the need for additional secondary procedures.

Results: The mean age at presentation for the 5 patients was 6.2 weeks. Four of the clubfeet had an ipsilateral band and 2 did not. None of the patients had a neurological deficit distal to a band. The mean number of casts used to correct the deformity was 6, and a percutaneous tendo-Achilles tenotomy was done in all cases. All of the feet achieved initial correction. Four patients (5 feet) experienced a relapse attributed to failure to use the postcorrective brace as prescribed. Correction of the foot in 3 of these patients was regained and maintained by another series of manipulation and cast application followed by resumption of bracing. One patient underwent an anterior tibial tendon transfer. The patients were followed for an average of 32.6 months (21 to 49 mo). All feet were supple and plantigrade at latest follow-up evaluation.

Conclusions: The Ponseti method may be successfully applied to clubfeet associated with CABS.

Level of Evidence: Level IV.

UCLA / Orthopaedic Hospital, Department of Orthopaedics, David Geffen School of Medicine at the University of California, Los Angeles, CA

None of the authors have received financial support for this study.

The authors declare no conflict of interest.

Reprints: Lewis E. Zionts, MD, UCLA/Orthopaedic Hospital, Department of Orthopaedics, David Geffen School of Medicine at the University of California, 2400 South Flower Street, Los Angeles, CA 90007. E-mail:

© 2013 by Lippincott Williams & Wilkins