Congenital Clubfoot Treated with the Ponseti Method

Jong Sup Shim; Sung Wook Seo; Chang Young Kim; Chulhee Jung

doi:10.4055/jkoa.2009.44.6.634

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Shim, Seo, Kim, and Jung: Congenital Clubfoot Treated with the Ponseti Method

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(6): 634-641.

Published online: 21 December 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.6.634

Congenital Clubfoot Treated with the Ponseti Method

Jong Sup Shim, M.D., Sung Wook Seo, M.D., Chang Young Kim, M.D., Chulhee Jung, M.D.

Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to Jong Sup Shim, M.D. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82.2-3410-3509, Fax: +82.2-3410-0061, jss3505@skku.edu

Received 16 June 2009 Accepted 1 October 2009

Abstract

Purpose

This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot.

Materials and Methods

A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace.

Results

Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace.

Conclusion

The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.

Keywords: Congenital clubfoot, Ponseti method

Figures and Tables

Fig. 1

(A) A 21days old baby showed severe (14/21) and very severe (15/21) bilateral clubfeet. (B) Severe deformity was revealed in the X-ray films of both feet prior to casting.

Fig. 2

(A) Supination of the forefoot improved cavus deformity of the forefoot. Also, supination has an effect of forefoot lengthening. (B) Long leg cast was applied with supination position of the foot. Knee was bended about 90 degrees. (C) External rotation (60-70 degrees) position of the foot in cast corrected forefoot adduction, varus and internal rotation.

Fig. 3

(A) After 36 months follow-up, the clubfeet were corrected successfully with the Ponseti method. The Dimeglio score was 3 in both feet. (B, C) Last follow-up (36 months) radiograph showed markedly improved deformity in the both feet.

Table 1

A Classification Scheme for Clubfoot (Group I vs. Group II) by Diméglio et al6)

Table 2

Factors Associated with Result of Clubfoot Treated with the Ponseti Method

^*Mann-Whitney test; ^†Chi square test; ^‡talocalcaneal angle on AP view; ^§talo-1st metatarsal angle on AP view, ^∥talocalcaneal angle on lateral view.

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