Baghdadi Taghi, Bagheri Nima, Najafi Arvin, Mansouri Pejman, Farzan Mahmoud
Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2017 May;5(3):168-173.
The aim of this study was to evaluate the idiopathic congenital clubfoot deformity treated by Ponseti method to determine the different factors such as radiological investigations that may have relations with the risk of failure and recurrence in mid-term follow-up of the patients.
Since 2006 to 2011, 226 feet from 149 patients with idiopathic congenital clubfoot were treated with weekly castings by Ponseti method. Anteroposterior and lateral foot radiographies were performed at the final follow-up visit and the data from clinical and radiological outcomes were analysed.
In our patients, 191(84.9%) feet required percutaneous tenotomy. The successful correction rate was 92% indication no need for further surgical correction. No significant correlation was found between the remained deformity rate and the severity of the deformity and compliance of using the brace (=0.108 and 0.207 respectively). The remained deformity rate had an inverse association with the beginning age of treatment (=0.049). No significant correlation was found between the percutaneous tetonomy and passive dorsiflexion range (=0.356).
According to our results treatment with the Ponseti method resulted in poor or no correlation. The diagnosis of clubfoot is a clinical judgment; therefore, the outcome of the treatment must only be clinically evaluated. Although the Ponseti method can retrieve the normal shape of the foot, it fails to treat the bone deformities and eventually leads to remained radiologic deformity. Further studiesare suggested to define a different modification that can address the abnormal angles between the foot and ankle bones to minimize the risk of recurrence.
本研究旨在评估采用庞塞蒂方法治疗特发性先天性马蹄内翻足畸形，以确定在患者中期随访中可能与失败和复发风险相关的不同因素，如影像学检查。
自2006年至2011年，对149例特发性先天性马蹄内翻足患者的226只脚采用庞塞蒂方法每周进行石膏固定治疗。在末次随访时进行足部正侧位X线摄影，并对临床和影像学结果数据进行分析。
在我们的患者中，191只（84.9%）脚需要经皮跟腱切断术。成功矫正率为92%，表明无需进一步手术矫正。残留畸形率与畸形严重程度及支具使用依从性之间未发现显著相关性（分别为0.108和0.207）。残留畸形率与治疗开始年龄呈负相关（0.049）。经皮跟腱切断术与被动背屈范围之间未发现显著相关性（0.356）。
根据我们的结果，采用庞塞蒂方法治疗的相关性较差或无相关性。马蹄内翻足的诊断是一种临床判断；因此，治疗结果必须仅通过临床评估。尽管庞塞蒂方法可以恢复足部的正常形状，但它无法治疗骨骼畸形，最终导致残留的放射学畸形。建议进一步研究确定一种不同的改良方法，以解决足踝骨之间的异常角度，将复发风险降至最低。
