SLR - April 2016 - Jackie Pham

Title: Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast

Reference: Aydin BK, Sofu H, Senaran H, Erkocak OF, Acar MA, Kirac Y. Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast. Medicine (Baltimore). 2015 Nov;94(47): e2072.

Scientific Literature Review
Reviewed By: Jackie Pham, DPM
Residency Program: Hennepin County Medical Center
Podiatric Relevance: Clubfoot is the most common congenital foot deformity in newborns. The primary treatment is serial casting with plaster of Paris using the Ponseti technique. Although use of plaster cast is cheap and easily molded, it can be heavy and difficult to remove. Semi-rigid synthetic softcast is another material that may be used for serial manipulative cast applications. It is similar to the classic fiberglass material, however is more moldable, flexible, comfortable, and easily removed with unwrapping. The aim of this study was to compare the effectiveness, advantages, and complications of using semi-rigid synthetic softcast with respect to plaster cast for treatment of clubfoot.

Methods: There was a total of 196 patients (249 feet) who underwent serial casting using Ponseti technique between 2009 and 2010. The exclusion criteria included patients with clubfoot related to neuromuscular disorders, history of failed clubfoot treatment, and patients with any accompanying lower extremity congenital deformity. The patients were randomized into two groups with 133 feet at one orthopedic facility using semi-rigid synthetic softcast and 116 feet at another orthopedic facility using plaster cast. Serial weekly cast applications were performed using Ponseti technique. Evaluation included Pirani scoring system at initial exam and last exam prior to Achilles tenotomy. Also documented were the number of cast applications, skin problems, and parent satisfaction based on a 5-point scale (excellent, very good, good, fair, and poor) on cast convenience, cast weight, infant tolerance, durability, material satisfaction, and likelihood of recommending cast material.

Results: There was no significant difference between the two groups’ improved Pirani scores at final casting. There was also no significant difference in the number of casting. The number of cast applications until patients reached Achilles tenotomy ranged from two to five in both groups. Twelve minor complications and three cast slippages were noted in the softcast group. Twenty-three complications and nine cast slippages were noted in the plaster cast group. The mean parent satisfaction scores were higher in all categories in the softcast group compared to the plaster cast group.

Conclusions: The results of this study confirms the effectiveness of the Ponseti technique. It also demonstrates that use of semi-rigid synthetic softcast provides higher parent satisfaction, lower complications, and easier removal compared to plaster cast. The Ponseti technique traditionally calls for use of plaster cast as it can easily be molded, however, it is heavy and difficult to remove. This is important to take into consideration as parental compliance is one of the key factors in treatment outcome. The advantages of using semi-rigid synthetic softcast include its lightweight, moldability, durability, and ease of removal. A disadvantage is it is more expensive than plaster cast. Although long term results were not evaluated, this study shows promising results with an alternative casting material that can be valuable in practice. 

Educational Opportunities