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Comparative Study: Ponseti Method Versus French Physiotherapy for Initial Treatment of Idiopathic Clubfoot Deformity

Chotel, Franck MD, PhD; Parot, Roger MD; Seringe, Raphaël MD; Berard, Jérôme MD; Wicart, Philippe MD, PhD

Journal of Pediatric Orthopaedics: April/May 2011 - Volume 31 - Issue 3 - p 320–325
doi: 10.1097/BPO.0b013e31820f77ba

Background Nonoperative treatment avoids the complications after extensive surgery for idiopathic clubfeet. The purpose of this study was to compare retrospectively French physiotherapy and Ponseti method used to treat idiopathic clubfoot in 2 institutions.

Methods Two hundred nineteen idiopathic clubfeet (146 patients) managed during a 3-year period (2000 to 2003) were included in this study: 116 clubfeet in group FM were treated according to modified French physiotherapy (with percutaneous heel-cord tenotomy in 17%) and 103 clubfeet in group PM were treated according to the Ponseti method. The use of further surgery was considered as failure of the nonoperative management: complete posteromedial release were noted poor, limited posterior release were noted fair, and nonrelease surgery or nonoperated feet were scored with the modified Ghanem score.

Results After a mean follow-up of 5.5 years (range, 2.5 to 7.4 y), similar rate of surgery was performed in both groups (21% in group FM and 16% in group PM) but complete posteromedial release was mainly done in group FM (19% of feet), and limited surgery was done in group PM. Results were noted excellent, good, fair, and poor in respectively 55%, 20%, 6%, and 19% of patients in group FM and 79%, 15%, 4%, and 2% of patients in group PM. Results for Dimeglio grade II clubfeet were not different, but results for grade III and grade IV clubfeet were better in PM group.

Conclusions Ponseti method enables reduction of extensive surgery compared with French physiotherapy mainly for severe deformities.

*Service de Chirurgie Orthopédique Pédiatrique, Hôpital Universitaire Mère Enfant de Lyon, Hospices Civils de Lyon, Université Claude Bernard Lyon I

Service de chirurgie orthopédique Pédiatrique, Hôpital Saint Vincent de Paul, Assistance Publique Hôpitaux de Paris, 82 avenue Denfert-Rochereau

Université Paris Descartes, Faculté de Médecine, Rue de l'Ecole de Médecine, Paris, France

Supported by none.

Source of Funding: None.

Reprints: Franck Chotel, MD, PhD, Hôpital Universitaire Mère Enfant de Lyon, Université Claude Bernard Lyon I, 59 Boulevard Pinel Bron 69677 France. e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.