Outcomes of the Clubfoot Treatment with the Ponseti Method: Recurrence and Prognostic Factors

Abstract

Background: Clubfoot is a multifactorial disease with the prevalence of one in 1000 live births. The presentations of clubfoot are forefoot adductus, hindfoot varus, cavus, and equinus. Ponseti method is an efficient nonoperative clubfoot treatment containing manipulation, serial casting, and Achilles tendon tenotomy if necessary. Our prospective observational study assessed the outcome and probability of recurrence in the treated clubfoot with the Ponseti method. Methods: This prospective observational study was performed in Akhtar Hospital in Tehran, Iran. 27 patients with 38 feet of idiopathic clubfoot in our study were treated with the Ponseti method. The patients were assessed before and after treatment and demographic characteristics, Dimeglio scores, number of recurrenes, and need for tenotomy were recorded. Results: All patients (38 feet) successfully achieved complete deformity correction, but 13 feet had a relapse. The mean age of cases with relapse was more than cases without relapse. Cases with a higher initial Dimeglio score had a higher recurrence rate after Ponseti method treatment. Eight feet (five patients) out of 38 feet did not use Denis Browne (DB) splint as our protocol; all of them had a relapse. On the other hand, only 5 of 30 feet (16.7%) that used splint had recurrence. Conclusion: The treatment should be started as soon as possible because it is more effective at a younger age. Severe cases at the initial visit had more recurrence rate. Besides, the recurrence rate in cases that used DB orthosis improperly, irregularly, and incorrectly was higher than others.