SLR - April 2016 - Jason Havey

Title: The Effectiveness of the Ponseti Method for Treating Clubfoot Associated with Arthrogryposis: Up to 8 Years Follow-up

Reference: Matar HE, Beirne P, Garg N. The Effectiveness of the Ponseti Method for Treating Clubfoot Associated with Arthrogryposis: Up to 8 Years Follow-up. J Child Orthop. 2016 Feb;10(1):15-8.

Scientific Literature Review

Reviewed By: Jason Havey DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN

Podiatric Relevance: Podiatric surgeons will encounter idiopathic clubfoot on a regular basis. The Ponseti technique is an effective treatment to correct said deformity. Arthrogrypotic clubfoot is a rigid deformity that has traditionally been approached with an aggressive soft tissue release and/or talectomy. It is important for the podiatric surgeon to clinically recognize multiple etiologies for a certain condition in order to treat effectively. The authors were attempting to show that the Ponseti method is an appropriate first line treatment for this type of clubfoot, at the same time avoiding aggressive surgical intervention.

Methods: From 2005-2012 10 patients with 17 clubfeet presented to this specific facility and were treated by a single physician. Diagnosis of arthrogryposis was made by both a neurologist and geneticist and each patient was assessed initially using the Pirani score. Each patient was treated with the standard Ponseti method and Achilles tendon tenotomy was done if needed.  Follow up for each child was every four months for the first two years and then every six months after. The average follow up was 5.8 years with a 3 to 8 year range. The authors describe their primary outcome measure as functional correction of the deformity with a plantigrade, pain free foot.

Results: There were five males and five females. Seventy percent of the patients had bilateral deformities. The average age of presentation was five weeks and the average Pirani score was 5.5, with a range of 3-6. Initial correction required on average eight Ponseti casts, with a range of 4-10. Achilles tendon lengthening was required in 16/17 feet. Eleven patients were considered to have a satisfactory result, which the authors considered to be a pain free, plantigrade foot. Their study showed a satisfactory rate of 64.7 percent. Three successful patients required AFO’s during follow up while three patients failed altogether with persistent deformity.

Conclusions: The authors concluded that approaching an arthrogrypotic clubfoot with the Ponseti method is an appropriate first line treatment. They note, however, that this is an aggressive condition that often requires further procedures. The conclusions of the reader can be drawn from the literature review. Consider that the studies with shorter follow up have higher rates of satisfactory outcome. It is important to note that even with patient compliance, the aggressiveness of the deformity is difficult to correct and maintain. Though this study had a small sample size, it will nonetheless help me consider multiple etiologies to the next clubfoot patient I encounter in clinic and an option for treatment other than soft tissue release and/or talectomy.

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