Comparison of Ponseti versus surgical treatment in congenital talipes equinovarus.

In the present study we compared the rate of relapse after conservative Ponseti treatment method with that of a historical cohort who underwent conventional operative treatment. From June 2002 to December 2004, 70 patients presented with 107 clubfeet and started Ponseti treatment. Of these 70 patients, 9 (15 feet) were excluded because of a teratologic deformity. Thus, 50 patients with 75 clubfeet were studied (41 [82%] boys and 9 [18%] girls). Data were compiled from the clinic assessment forms and patient notes. All cases resulting in recasting or additional operative procedures were regarded as failure of conservative treatment. The minimum follow-up period was 2 years or failure of the Ponseti method within this period. These data were then compared with the published data from the same center, regarding relapse after the 2-stage operative method. From 1988 to 1995, 86 patients had presented with 120 clubfeet and undergone operative treatment. Of the 86 patients, 68 (91 clubfeet; 48 boys and 20 girls) underwent the 2-stage operative procedure and were followed up to a mean age of 5.7 (range 2.2 to 9.6) years. The mean age at operative treatment was 8.9 months. The relapse rate of both treatment methods was compared for all feet in all Dimeglio grades. The relapse rate for Ponseti versus surgery was 18.2% versus 0% for grade 2, 36.2% versus 20.4% for grade 3, and 35.3% versus 65.4% for grade 4, respectively. No statistically significant difference was found. The Ponseti method is as valid as the 2-stage operative method for the treatment of clubfoot. The functional outcomes of the 2 treatment methods need to be compared.