A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report.

BACKGROUND

The regular Ponseti method for the treatment of idiopathic clubfoot requires a series of manipulations and castings at weekly intervals. It is not known whether the correction could be achieved in a shorter period of time with multiple manipulations and castings per week. This study was designed to evaluate the outcome of a modified treatment program with manipulation and casting offered twice a week.

METHODS

The study included the modified group (26 patients with 40 idiopathic clubfeet treated with the Ponseti method twice a week) and the regular group (20 patients with 32 idiopathic clubfeet treated once a week). The average age of the patients at the time of treatment was 63.05 days in the regular group and 92.7 days in the modified group.

RESULTS

All aspects of the deformity with the exception of the equinus were corrected in 20.61 days in the modified group and in 35.35 days in the regular group (P=0.0001). There were no differences between the 2 groups in the average number of casts (P=0.61). Percutaneous Achilles tenotomy was performed in 87.5% (35 of 40) of those in the modified group and 87.5% (28 of 32) of those in the regular group (P=0.47). A corrective surgery for a complete correction of the deformity was performed in 4 feet in the modified group (10%; 2 posteromedial releases; 2 posterior releases) and 3 feet in the regular group (10%; 2 posteromedial releases; 1 posterior release).

CONCLUSIONS

The modified Ponseti method with the treatment program twice a week is safe and effective. It significantly shortens the timeframe for the treatment.

LEVEL OF EVIDENCE

The study of therapeutic studies investigating the results of the treatment is level II.