Davi de Podesta Haje1,2, Daniel Augusto Maranho2, Gabriel Ferraz Ferreira3, Adolfo Cuauhtemoc Rocha Geded4, Alaric Aroojis5, Ana Claudia Queiroz6, Anisuddin Bhatti7, Antonio Luiz Gonçalves Brandão8, Edwin Giovanny Valencia Lucero9, Erika Iliana Arana Hernández10, Guillermo Oscar Hernández Tierno11, Juan Carlos Ocampo12, Jung Ho Kim13, Leopoldina Milanez da Silva Leite14, Nariman Abol Oyoun15, Ranjeet Kumar7, Sandra Jannel Santana Canto4, Monica Paschoal Nogueira3. 1. Hospital de Base do Distrito Federal and Clinical Center Orthopectus - Brasília, DF, Brazil. 2. Hospital Sírio Libanês - Brasília, DF, Brazil. 3. Department of Pediatric Orthopaedics and Limb Reconstruction, Hospital do Servidor Público Estadual - São Paulo, SP, Brazil. 4. Hospital de Ortopedia - Mérida, Yucatán, México. 5. Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children - Parel, Mumbai, Maharashtra, India. 6. Associação dos Deficientes Físicos de Alagoas (ADEFAL) - Maceió, AL, Brazil. 7. Jinnah Postgraduate Medical Centre - J. S. Medical University - Karachi, Pakistan. 8. Hospital das Obras Sociais de Irmã Dulce (OSID) - Salvador, BA, Brazil. 9. Hospital General Torre Medica San Andres - Santo Domingo, Equador. 10. Department of Pediatric Orthopaedic Surgery, Benemérito Hospital Civil de Guadalajara Fray Antonio Alcalde - Guadalajara, Jalisco, México. 11. Hospital Martagão Gesteira - Salvador, BA, Brazil. 12. Hospital Santa Clara - Bogotá, Colombia. 13. Universidade Federal da Fronteira Sul - Passo Fundo, RS, Brazil. 14. Universidade Federal do Maranhão - São Luis, MA, Brazil. 15. Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Assiut University - Assiut, Egypt.
Abstract
Objective: Ponseti method is suitable to treat neglected clubfoot after the walking age. However, limited evidence exists on its effectiveness, outcomes and rate of relapse. Methods: 429 clubfeet in 303 patients with no previous treatment and older than one-year were treated with the Ponseti method in 15 centers from seven countries. The median age at treatment onset was three years, and the median follow-up of 1.3 years. Standard Ponseti Method was applied. Bilateral abduction brace was recommended after casting. Patients were classified according to group ages (<2 years, 2-4 years, >4-8years, >8 years). Feet were evaluated by Pirani score and a clinical outcome classification. Relapses were described in a subset of 103 clubfeet with minimal follow-up of two years. Results: Ponseti method was able to correct the deformity in 87% (373 of 429) of neglected clubfeet, after a mean of 6.8 casts. Residual equinus was treated with percutaneous sectioning of the Achilles tendon in 356 (83%) of 429 clubfeet. A bilateral foot abduction brace was prescribed and used in 70% of children. Relapses occurred in 31% (32 of 103) of clubfeet and were associated with age less than 4 years at treatment onset, and bracing noncompliance. Conclusion: The Ponseti method is effective to correct neglected clubfeet. Relapses occurred in one-third of clubfeet, mainly in children younger than four years and in noncompliance with the brace. Our study reinforces the recommendation for the Ponseti method with no major modification to treat neglected clubfoot in patients after walking age.Level of Evidence: IV.
Objective: Ponseti method is suitable to treat neglected clubfoot after the walking age. However, limited evidence exists on its effectiveness, outcomes and rate of relapse. Methods: 429 clubfeet in 303 patients with no previous treatment and older than one-year were treated with the Ponseti method in 15 centers from seven countries. The median age at treatment onset was three years, and the median follow-up of 1.3 years. Standard Ponseti Method was applied. Bilateral abduction brace was recommended after casting. Patients were classified according to group ages (<2 years, 2-4 years, >4-8years, >8 years). Feet were evaluated by Pirani score and a clinical outcome classification. Relapses were described in a subset of 103 clubfeet with minimal follow-up of two years. Results: Ponseti method was able to correct the deformity in 87% (373 of 429) of neglected clubfeet, after a mean of 6.8 casts. Residual equinus was treated with percutaneous sectioning of the Achilles tendon in 356 (83%) of 429 clubfeet. A bilateral foot abduction brace was prescribed and used in 70% of children. Relapses occurred in 31% (32 of 103) of clubfeet and were associated with age less than 4 years at treatment onset, and bracing noncompliance. Conclusion: The Ponseti method is effective to correct neglected clubfeet. Relapses occurred in one-third of clubfeet, mainly in children younger than four years and in noncompliance with the brace. Our study reinforces the recommendation for the Ponseti method with no major modification to treat neglected clubfoot in patients after walking age.Level of Evidence: IV.
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