Clinical Bottom Line
“How should I apply this information?”
This retrospective study proposes that a modified Copenhagen method for the treatment of clubfoot deformity reduces the rate of surgical intervention. Conservative, nonoperative treatments for clubfoot are documented in the literature and have shown promise in improving outcomes in this population. Previous studies on the French and Ponseti methods have outlined their use and compared their methods. This modified Copenhagen method is similar to the French method differing primarily with the application of the dressings and splints.
The authors clearly describe the modified Copenhagen method with details outlined for manipulation, sensory stimulation, casting, splinting, and footwear. The photographs depict the hand placement and desired foot positions in the treatment method. This treatment is straight forward, noninvasive and is easily monitored on a daily basis. The information in this article supports the conservative treatment of clubfoot deformity in the reduction of surgical intervention. In addition, because of the daily monitoring in this method the treatment could be tailored or modified immediately if necessary.
“What should I be mindful about in applying this information?”
This treatment requires training, daily follow-up, parent education, and compliance. Therefore, the success may be dependent on the skills of the physical therapist providing the treatment and the parents' ability to understand and comply with the home program. To enhance the success of expected outcomes, this treatment should not be undertaken without assuring competency and consistency for all components.
The physical therapist should maintain an awareness of the longitudinal outcomes of this condition regardless of the primary method used in treatment. This deformity is not an acute condition but one that requires monitoring over the years of growth. Some patients with this condition, regardless of the treatment utilized will require a surgical procedure. As a treating therapist, your responsibility lies in educating the family, communicating with the orthopedic surgeon, and knowing when to refer for surgical consideration. Therapy will play an integral role after surgery as well.
Lastly, this treatment could be quite costly for the family due to the intensive follow-up that is required. Therefore, it is imperative to discuss the issue of health care reimbursement with the family and insurance provider to determine coverage.
Claudia Ann Senesac, PT, PhD, PCS
University of Florida, Gainesville, Florida
Barbara J Bour, PT
Shands Hospital, Gainesville, Florida