SLR - July 2010 - Richard J Rand, III
Reference:
Halanski MA, Davison JE, Huang JC, Walker CG, Walsh JW, Crawford HA. J Bone Joint Surg Am. 2010;92:270-8
Scientific Literature Reviews
Reviewed by: Richard J Rand, III, DPM
Residency Program: Maricopa Medical Center PM&S 36, Phoenix AZ
Podiatric Relevance:
Clubfoot is frequently encountered by podiatric physicians who must decide between conservative versus surgical treatment of this complex deformity. The purpose of this article is to determine which method produces the best long term results.
Methods:
The design was a prospective study in New Zealand from 11/2001 to 1/2005. Parents of affected pediatric patients were given the option to choose a treatment plan or randomization. Following randomization, twenty-six patients (40 feet) were included in the Ponseti group, and twenty-nine patients (46 feet) were included in the below knee cast and surgery group. The Ponseti group had weekly above knee cast changes followed by percutaneus TAL, additional casting for 3 weeks, then splinting in Denis Browne bar until 2 years of age. The surgical group had below knee cast changed weekly-biweekly (until average 6 months age), followed by posterior or posterior-medial soft tissue release with no long term splinting or bracing.
Results:
The average follow-up was 3.5 years for the Ponseti group and 3.8 years for the surgical group. A recurrence rate of 38% was noted in the Ponseti group vs 30% in the surgical group. However, 73% of Ponseti recurrences were considered minor vs only 14% in surgical group. Minor recurrence was defined as only needing extra-articular soft tissue procedure. Major recurrence was defined as needing an intra-articular surgical procedure.
Conclusions:
Recurrence of deformity remains relatively high in both treatment protocols, however, Ponseti casting with percutaneus TAL results in significantly less operative intervention and major revisiona; surgery. Therefore, the authors of this study conclude that Ponseti casting should be attempted first for all reducible deformities.