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The Current Management of Idiopathic Clubfoot Revisited: Results of a Survey of the POSNA Membership

Zionts, Lewis E. MD*,†; Sangiorgio, Sophia N. PhD*,†; Ebramzadeh, Edward PhD*,†; Morcuende, Jose A. MD

Journal of Pediatric Orthopaedics: July/August 2012 - Volume 32 - Issue 5 - p 515–520
doi: 10.1097/BPO.0b013e318259ff79

Background: In 2001, the members of the Pediatric Orthopaedic Society of North America (POSNA) were surveyed regarding their approach to treating idiopathic clubfoot deformity. Since that time, several studies have advocated a change in the approach to treating this deformity, moving away from surgical release and toward less invasive methods. The purpose of this study was to assess the recent approach to treating clubfoot among the POSNA membership.

Methods: A survey was emailed to all POSNA members to define their current treatment of idiopathic clubfoot deformity.

Results: We received 323 responses. Ninety-three percent of participants were fellowship trained and were in practice for an average of 17.2 years. On an average, physicians reported each treating 23.5 new clubfoot patients during the year of survey. Nearly all (96.7%) of those surveyed stated that they use the Ponseti treatment method. The average time to initial correction was estimated at 7.1 weeks. Eighty-one percent of patients were estimated to require a tenotomy; 52.7% were performed under general anesthesia or conscious sedation, whereas 39.4% were done under local. Those surveyed estimated that 22% of clubfeet relapsed and 7% required a comprehensive release. Seventy-five percent of the respondents stated that their current treatment approach differed from how they were trained, and 82.7% were trained in the Ponseti method in the last few years.

Conclusions: Our study provides convincing evidence that a large majority of pediatric orthopaedic surgeons now prefer the Ponseti method to treat idiopathic clubfoot and indicates that the move away from extensive release surgery occurred during the past decade.

Level of Evidence: Not applicable.

*UCLA/Orthopaedic Hospital, Department of Orthopaedics, David Geffen School of Medicine, University of California

The J. Vernon Luck Sr, MD Orthopaedic Research Center, Orthopaedic Hospital, Los Angeles, CA

The Ponseti Clubfoot Treatment Center, University of Iowa, Iowa City, IA

Presented at the POSNA Annual Meeting, Montreal, QC, Canada, May 13, 2011.

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Lewis E. Zionts, MD, Orthopaedic Hospital, 2400 S. Flower Street, Los Angeles, CA 90007. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.