Clin Orthop Surg.  2020 Mar;12(1):100-106. 10.4055/cios.2020.12.1.100.

Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

• Islam MS
• Masood QM
• Bashir A
• Shah FY
• Halwai MA

• KMID: 2470057
• DOI: http://doi.org/10.4055/cios.2020.12.1.100

Abstract

BACKGROUND
The aim of this study was to compare the results of the standard once-weekly Ponseti casting technique to an accelerated twice-weekly regimen in our population cohort.
METHODS
A prospective randomized controlled study was conducted with a total of 100 consecutive patients (158 feet) being enrolled for the study. Fifty patients were randomized to each group and followed up for at least one year.
RESULTS
Initial mean Pirani score was 4.67 ± 0.73 in the standard group and 4.35 ± 0.76 in the accelerated group, and the score decreased to 0.34 ± 0.38 and 0.35 ± 0.31, respectively. Initial mean Dimeglio score was 11.75 ± 2.75 in the standard group and 10.51 ± 2.57 in the accelerated group, and the score decreased to 0.79 ± 0.77 and 0.79 ± 0.71, respectively, immediately after casting. The average number of casts required to correct all the deformities was 6.3 ± 1.2 in the standard group and 6.1 ± 1.4 in the accelerated group (p = 0.45). Average time spent in cast was 58.2 ± 8.3 days in the standard group and 39.5 ± 5.2 days in the accelerated group (p < 0.001). Percutaneous Achilles tendon tenotomy was done in 86.42% in the standard group and in 84.41% in the accelerated group (p = 0.72). Final results were assessed by using a modified functional rating scoring system: 55.55% clubfeet had excellent results and 44.45% had good results in the standard group, whereas 66.23% clubfeet had excellent results and 33.77% had good results in the accelerated group. None amongst the two groups had fair or poor results.
CONCLUSIONS
These results suggest that the accelerated Ponseti technique significantly reduces the correction time without affecting the final results and that it is as safe and effective as the traditional Ponseti technique.

Keyword

Foot deformities; Clubfoot; Plaster casts; Ponseti

MeSH Terms

Achilles Tendon
Casts, Surgical
Clubfoot*
Cohort Studies
Congenital Abnormalities
Foot Deformities
Humans
Prospective Studies*
Tenotomy

Figure

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  Fig. 1 The mean Pirani score at the pretreatment, immediate posttreatment, and final follow-up.

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  Fig. 2 The mean Dimeglio score at the pretreatment, immediate posttreatment, and final follow-up.

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  Fig. 3 Final results as per the modified functional system.

Reference

1. Ponseti IV. Congenital clubfoot: fundamentals of treatment. New York, NY: Oxford University Press;1996. p. 9.

2. Herring JA. Tachdjian's pediatric orthopaedics: from the Texas Scottish Rite Hospital for Children. 5th ed. Philadelphia, PA: Saunders;2014. p. 913.

3. Globalclubfoot.com [Internet]. Oxford: Global Clubfoot Initiative;c2019. cited 2019 Dec 22. Available from: http://globalclubfoot.com/countries/india.

4. Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. Clin Orthop Relat Res. 1963; 45:261–344.

5. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot: a thirty-year follow-up note. J Bone Joint Surg Am. 1995; 77(10):1477–1489.

6. Gray K, Pacey V, Gibbons P, Little D, Burns J. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev. 2014; (8):CD008602.

7. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol. 2015; 25(5):949–953.

8. Pirani S. Clubfoot scoring. In : Staheli L, editor. Clubfoot: Ponseti management. 3rd ed. Seattle, WA: Global-HELP;2009. p. 27.

9. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995; 4(2):129–136.

10. Simons GW. A standardized method for the radiographic evaluation of clubfeet. Clin Orthop Relat Res. 1978; (135):107–118.

11. Lohan I. Treatment of congenital clubfoot using the Ponseti method: workshop manual. 2nd Ed. Seattle, WA: Global-HELP;2009. p. 18–36.

12. Herring JA. Congenital talipes equinovarus (clubfoot) in Tachdjian's pediatric orthopedics. 5th ed. Philadelphia, PA: Saunders;2014. p. 921.

13. Evans D. Relapsed club foot. J Bone Joint Surg Br. 1961; 43(4):722–733.

14. Ponseti IV. Congenital clubfoot: fundamentals of treatment. New York, NY: Oxford University Press;1996. p. 61–81.

15. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital clubfoot. J Bone Joint Surg Am. 2002; 84(2):290–308.

16. Carroll NC. Clubfoot in the twentieth century: where we were and where we may be going in the twenty-first century. J Pediatr Orthop B. 2012; 21(1):1–6.

17. Scher DM. The Ponseti method for treatment of congenital club foot. Curr Opin Pediatr. 2006; 18(1):22–25.

18. Giesberts RB, van der Steen MC, Maathuis PG, Besselaar AT, Hekman EE, Verkerke GJ. Influence of cast change interval in the Ponseti method: a systematic review. PLoS One. 2018; 13(6):e0199540.

19. Terrazas-Lafargue G, Morcuende JA. Effect of cast removal timing in the correction of idiopathic clubfoot by the Ponseti method. Iowa Orthop J. 2007; 27:24–27.

20. Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res. 2009; 467(5):1146–1153.

21. Elshenawy EM, Hassanen EY, Ramadam AI, Ibrahim MM. The Mansoura experience in the treatment of idiopathic clubfoot deformity using the Ponseti technique. Acta Orthop Belg. 2008; 74(5):659–666.

22. Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles V. An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br. 2011; 93(3):404–408.

23. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005; 25(5):623–626.

24. Kampa R, Binks K, Dunkley M, Coates C. Multidisciplinary management of clubfeet using the Ponseti method in a district general hospital setting. J Child Orthop. 2008; 2(6):463–467.

25. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report. J Pediatr Orthop. 2011; 31(3):317–319.

26. Gerlach DJ, Gurnett CA, Limpaphayom N, et al. Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele. J Bone Joint Surg Am. 2009; 91(6):1350–1359.