The 5-Year Outcome of the Ponseti Method in Children With Idiopathic Clubfoot and Arthrogryposis

J Pediatr Orthop. 2020 Aug;40(7):e641-e646. doi: 10.1097/BPO.0000000000001524.

Abstract

Background: The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis.

Methods: The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded.

Results: A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility.

Conclusions: Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention.

Level of evidence: Level III, Therapeutic Studies-Investigating the Results of Treatment.

MeSH terms

  • Ankle Joint / physiopathology
  • Arthrogryposis* / complications
  • Arthrogryposis* / physiopathology
  • Arthrogryposis* / therapy
  • Casts, Surgical*
  • Child, Preschool
  • Clubfoot* / complications
  • Clubfoot* / physiopathology
  • Clubfoot* / therapy
  • Equinus Deformity / diagnosis
  • Equinus Deformity / etiology
  • Female
  • Gait Analysis
  • Humans
  • Male
  • Orthopedic Procedures* / adverse effects
  • Orthopedic Procedures* / instrumentation
  • Orthopedic Procedures* / methods
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Range of Motion, Articular
  • Recovery of Function
  • Retrospective Studies
  • Tenotomy* / adverse effects
  • Tenotomy* / methods