Pedobarographic analysis following Ponseti treatment for congenital clubfoot.

UNLABELLED: Current methods of treating congenital clubfeet provide high rates of functional outcomes. Despite the clinical outcomes, radiographic assessment suggests residual equinus deformity of the hindfoot. It is unclear whether these deformities result in abnormal foot-floor pressures and whether they correlate with clinical outcome. We evaluated 28 feet in 20 patients following Ponseti treatment for clubfoot by clinical and pedobarographic examination a mean of 33 months after removal of the last cast. The data were compared to age- and weight-matched normal subjects and to the unaffected foot in the unilaterally affected patients. Despite ankle range of motion of 30 degrees and a physiologic hindfoot valgus alignment in 19 cases, pedobarography suggested differences in maximum force, impulse, contact area, and peak pressure compared to normal subjects. Compared to the unaffected foot the only difference was reduced peak pressure over the medial hindfoot and forefoot with increased pressure over the lateral midfoot. Similar to radiographic abnormalities in studies on treated clubfeet with good functional outcome, pedobarographic analyses show differences compared to a control group. The value of pedobarographic analysis for predicting successful treatment of congenital clubfoot is questionable since it does not correlate with the clinical outcome in patients treated with the Ponseti method. LEVEL OF EVIDENCE: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Early results of the Ponseti method for the treatment of clubfoot in distal arthrogryposis.

BACKGROUND: Clubfoot occurs in approximately one in 1000 live births and is one of the most common congenital birth defects. Although there have been several reports of successful treatment of idiopathic clubfoot with the Ponseti method, the use of this method for the treatment of other forms of clubfoot has not been reported. The purpose of the present study was to evaluate the early results of the Ponseti method when used for the treatment of clubfoot associated with distal arthrogryposis. METHODS: Twelve consecutive infants (twenty-four feet) with clubfoot deformity associated with distal arthrogryposis were managed with the Ponseti method and were retrospectively reviewed at a minimum of two years. The severity of the foot deformity was classified according to the grading system of Diméglio et al. The number of casts required to achieve correction was compared with published data for the treatment of idiopathic clubfoot. Recurrent clubfoot deformities or complications during treatment were recorded. RESULTS: Twenty-two clubfeet in eleven patients were classified as Diméglio grade IV, and two clubfeet in one patient were classified as Diméglio grade II. Initial correction was achieved in all clubfeet with a mean of 6.9 +/- 2.1 casts (95% confidence interval, 5.6 to 8.3 casts), which was significantly greater than the mean of 4.5 +/- 1.2 casts (95% confidence interval, 4.3 to 4.7 casts) needed in a cohort of 219 idiopathic clubfeet that were treated during the same time period by the senior author with use of the Ponseti method (p = 0.002). Six feet in three patients had a relapse after initial successful treatment. All relapses were related to noncompliance with prescribed brace wear. Four relapsed clubfeet in two patients were successfully treated with repeat casting and/or tenotomy; the remaining two relapsed clubfeet in one patient were treated with extensive soft-tissue-release operations. CONCLUSIONS: Our early-term results support the use of the Ponseti method for the initial treatment of distal arthrogrypotic clubfoot deformity. Longer follow-up will be necessary to assess the risk of recurrence and the potential need for corrective clubfoot surgery in this patient population, which historically has been difficult to treat nonoperatively.