Church Chris, Wang Nicole, Butler Stephanie, Salazar-Torres Jose J, Henley John, Miller Freeman, Carlin Nancy, Donohoe Maureen, Nichols L Reid
Department of Orthopaedics, Nemours Children's Health, Wilmington, DE.
J Pediatr Orthop. 2025 Oct 1;45(9):552-558. doi: 10.1097/BPO.0000000000003007. Epub 2025 May 21.
The Ponseti method is accepted as an effective primary conservative treatment for idiopathic clubfoot (IC) using serial casting, percutaneous Achilles tenotomy, and prolonged bracing. The outcomes of its use in treating rigid clubfoot in arthrogryposis are unclear. This study assesses the outcomes of the Ponseti method in children with IC and arthrogrypotic clubfoot at an average age of 10 years.
Outcomes of the Ponseti method were retrospectively studied in ambulatory children ages 8.0 to 12.9 years in the gait lab between 2004 and 2024. Children were excluded due to the presence of nonidiopathic or nonarthrogryposis-related clubfoot and history of posteromedial release. The Ponseti treatment included serial casting and Achilles tenotomy in infancy, followed by night bracing until age 5 in both cohorts. Clubfoot groups were compared with typically developing children by analyses of foot pressure data, passive range of motion, Gross Motor Function Measure Dimension-D, and Pediatric Outcomes Data Collection Instrument. Surgical history was also recorded. A subsection of these children visited the gait lab at age 4.0 to 6.9 years (2003 to 2021) and data from their visits were abstracted for a longitudinal study.
One hundred seventy-seven children were reviewed (48 with clubfoot associated with arthrogryposis, 129 with IC) with an average age of 9.4±0.9 years. Repeat surgical intervention was used in 33% of IC feet and 44% of arthrogrypotic clubfeet. Residual equinovarus and limitations in range of motion were present in both clubfoot groups compared with typically developing feet ( P <0.05). The foot deformity and passive range of motion restrictions were more severe in children with arthrogrypotic clubfeet ( P <0.05). The arthrogrypotic clubfoot group additionally exhibited limited gross motor and global function ( P <0.001). In 5-year to 10-year comparisons, both subgroups showed more limitations in ankle motion but improvements in dynamic equinovarus deformity and function at age 10 years ( P <0.05).
Despite residual deformity, children with idiopathic clubfoot achieve typical functional outcomes through Ponseti treatment. Children with arthrogrypotic clubfeet exhibit functional limitations, but the Ponseti method is effective in improving foot position while minimizing the need for surgical intervention.
Level III-therapeutic studies-investigating the results of treatment.
庞塞蒂方法被公认为是一种有效的原发性保守治疗方法，用于特发性马蹄内翻足（IC），包括连续石膏固定、经皮跟腱切断术和长期支具治疗。其用于治疗关节挛缩症中僵硬性马蹄内翻足的效果尚不清楚。本研究评估了庞塞蒂方法在平均年龄为10岁的IC患儿和关节挛缩性马蹄内翻足患儿中的治疗效果。
对2004年至2024年间步态实验室中年龄在8.0至12.9岁的门诊患儿采用庞塞蒂方法的治疗效果进行回顾性研究。因存在非特发性或非关节挛缩症相关的马蹄内翻足以及后内侧松解病史而排除患儿。庞塞蒂治疗包括婴儿期连续石膏固定和跟腱切断术，随后两组患儿均进行夜间支具治疗直至5岁。通过分析足部压力数据、被动活动范围、粗大运动功能测量维度-D和儿科结局数据收集工具，将马蹄内翻足组与正常发育儿童进行比较。还记录了手术史。这些患儿中的一部分在4.0至6.9岁（2003年至2021年）时到步态实验室就诊，提取他们就诊时的数据用于纵向研究。
共纳入177例患儿进行评估（48例为合并关节挛缩症的马蹄内翻足，129例为IC），平均年龄为9.4±0.9岁。33%的IC足和44%的关节挛缩性马蹄内翻足需要再次手术干预。与正常发育的足部相比，两个马蹄内翻足组均存在残留马蹄内翻畸形和活动范围受限（P<0.05）。关节挛缩性马蹄内翻足患儿的足部畸形和被动活动范围受限更为严重（P<0.05）。关节挛缩性马蹄内翻足组还表现出粗大运动和整体功能受限（P<0.001）。在5年至10年的比较中，两个亚组均显示踝关节活动度受限更多，但在10岁时动态马蹄内翻畸形和功能有所改善（P<0.05）。
尽管存在残留畸形，但特发性马蹄内翻足患儿通过庞塞蒂治疗可获得典型的功能结局。关节挛缩性马蹄内翻足患儿存在功能受限，但庞塞蒂方法在改善足部位置的同时能有效减少手术干预的需求。
III级治疗性研究 - 调查治疗结果。
