Title: Treatment of the Complex Idiopathic Clubfoot
Authors: Ignacio V. Ponseti MD, Miroslav Zhivkov MD, Naomi Davis FRCSEd, Marc Sinclair MD, Mathew B. Dobbs MD, and Jose A. Morcuende MD PhD
Source: Clinical Orthopaedics and Related Research. 2006;451:171-176.
PODIATRIC RELEVANCE:
Although the majority of congenital idiopathic clubfeet can be corrected by Ponseti method of serial casting, a small population of them are resistant to the traditional method or surgical correction. Some of the authors have termed these feet as Complex Idiopathic Clubfeet. These feet are characterized with rigid equinus, severe plantar flexion of all metatarsals, a deep crease above the heel, a transverse crease in the sole of the foot and hyperextended first toe. Due to unsuccessful correction with traditional methods, Ponseti et al. developed a modification to the serial casting and manipulation that addresses this deformity. The purpose of this article is to determine the success rate of the modified Ponseti technique for the correction of the complex idiopathic clubfoot.
METHOD:
In this study, retrospective review was conducted of 50 patients with complex idiopathic clubfoot. Average age of patients at the time of presentation was 3 months old (range 1 – 9 months) and the last follow up age was 23 months (range 6 – 46 months). All of the patients received the modified Ponseti manipulation and serial casting. Modifications of the technique include abduction of the forefoot, lateral translocation of the anterior calcaneal process underneath the head of the talus, dorsiflexion of the metatarsals and the ankle. 11 of the patients received tendo Achilles lengthening or tenotomy. Additional information about the modifications are available in the article itself and is beyond the scope of this abstract. Results of this study were examined clinically.
RESULTS:
At the last follow up, all feet were well corrected with mean ankle dorsiflexion of 15° (range 10° - 25°). Correction required an average of five casts (range 1 – 10). 7 patients relapsed but were corrected with casting. 3 patients required additional Achilles tenotomy.
COMMENTS:
Complex idiopathic clubfeet are notoriously resistant to traditional manipulation/serial casting or surgical correction. This study intends to show successful outcome utilizing the modified Ponseti technique developed by Ponseti himself. Addressing the deformed talus and the abnormal STJ relationship is critical for this deformity including the plantarflexed metatarsals. The authors did not evaluate the patients radiographically, which maybe another way to assess outcome.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.