The initial treatment of the congenital clubfoot is still a debated subject among different schools. We report our current experience with Ponseti method.
Materials and Methods: From April 1999 to May 2001 we have consecutively treated with this method 80 idiopathic clubfeet of 57 children put under treatment at neo-natal period. Progressive correction of the deformity has been obtained with 7 toe-to-groin plaster casts changed weekly. When complete derotation of the hindfoot and forefoot has been reached, subcutaneus tenotomy of the tendon Achilles has been performed. At the end of thisfirst period, the feet have been adapted in Denis Browne splint, worn full time for four months and thereafter just at night. The feet have been evaluated clinically (score of Dimeglio and Bensahel),radiologically and some with MRI.
Results: Whole correction of the deformity at the end of treatment with plaster casts, has been achieved for 71 times. When the plaster casts areremoved, the talocalcaneal divergence, on antero-posterior and lateral views and the tibial-calcaneal angle (x-ray in maximum dorsal flexion), were respectively, as an average of 20; 30,7; 21,9 degrees. At an average of 20 months follow up, 54 feet of 80 had a score of 0 or 1 of 20, and 14 had a score of 2; on radiological aspect the talo-calcaneal divergence in antero-posterior and lateral views and the tibial-calcaneal angle were respectively as an average of 29; 24,5; 14 degrees. At this evaluation the percentage of relapses of the deformity was 20% (17 cases). All the relapses have been treated again in plaster casts with 40% of success. So far, only four medial release operations have been necessary. Six feet benefited by the transfer of the tibialis anterior tendon to the third cuneiform and slight medial release.
Discussion and Conclusion: The Ponseti's method presents several advantages: high quality reduction of the clubfoot with the restoration of a "sub-normal" anatomy, low cost and small displeasing worry for the parents, with this method the functional re-education does not seem to improve the quality of results. The prevention of the relapse goes by good compliance to the splint.
Chotel, F., Durand J.M., Mancini F., Garnier E., Berard J.
Hopital Debrousse, Lyon Cedex 05, France
Copyright British Editorial Society of Bone & Joint Surgery 2003
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