Mid-term clinical outcomes for idiopathic clubfoot treated using the Ponseti method with alternative materials

Cheng-Hung Chiang ； Horng-Chaung Hsu ； Ken N. Kuo ； Chien-Chung Kuo

《Formosan Journal of Musculoskeletal Disorders》 13卷3期 (2022/08) Pp. 124-129

https://doi.org/10.6492/FJMD.202208_13(3).0003

摘要

Introduction: Traditionally, clubfoot deformity has been treated using the Ponseti method with the serial plaster of Paris (POP) cast. However, POP casts lead to several complications, including cast slippage, skin problems, low satisfaction, and home care difficulty for parents. Therefore, alternative materials should be used to lessen the complications for patients with clubfoot. Purpose: We aimed to evaluate the mid-term clinical outcomes of idiopathic clubfoot treated with the Ponseti method using serial soft cast (SC) as an alternative material. Methods: This retrospective study included 36 consecutive patients with 50 idiopathic clubfeet treated with the Ponseti method using SC or POP materials during a 5-year period. The follow-up period was a minimum of 3 years and 12 months following splint removal. Additionally, the Dimeglio score was used for pre-treatment and final evaluation. Patients with a sagittal plane Dimeglio score > 2 were treated with percutaneous Achilles tenotomy (PAT). Questionnaires for each clinic visit were collected from the caregivers. Results: Both groups showed significantly improved Dimeglio scores compared to the initial scores. Furthermore, the PAT rate was significantly lower in the SC group than in the POP group. Additionally, most questionnaire parameters showed significantly higher scores in the SC group than in the POP group, including cast tolerance, durability, and parent satisfaction (p < 0.05). The recurrence rate was approximately 12%, and all the recurrence cases underwent repeated PAT and anterior tibial tendon transfer for further treatment. Conclusion: This study provides evidence regarding the effectiveness of SC as an alternative material for clubfoot treatment with better correction outcomes and parents' satisfaction. The higher correction rate and superior midterm clinical outcomes were attributed to the success of the Ponseti method using SC as an alternative material and better family compliance.

關鍵字

clubfoot ； Ponseti ； soft cast