Review of the effectiveness of the treatment of idiopathic congenital clubfoot with the ponseti techinique

Abstract

Purpose: the idiopathic congenital clubfoot is a complex deformity that afects 100.000 children per year worldwide. The treatment must be initiated as soon as possible, in the first 15 days of life. Among the therapeutic options, the clinical technique of choice is the Ponseti technique. Poor treatment adherence is the cause of most of the recurrence cases. This study aims to evaluate the effectiveness of the correction of idiopathic clubfoot by the Ponseti method, the importance of the correct use of abduction orthosis and its relationship to recurrence in our service. Methods: the analysis was performed in 92 patients with dyagnosis of idiopathic clubfoot in our service between 2005 and 2014. The results were classified as satisfactory or unsatisfactory. Residual deformities, flexibility and need for additional surgery were analysed. Regarding the use of orthesis, patients were divided into three categories:correct use of the orthosis, not used and irregular use. Results: the patients used on average 9 plasters. Of the total 92 participants, 87 underwent tenotomy. Seventy-one obtained satisfactory results (77.17%) and 21 (22.82%) unsatisfactory. Among the 56 who used the orthesis correctly, 94.6% were satisfactory and 5.4% unsatisfactory. But those who did not use it, one showed satisfactory results (11.1%) and 8 (88.9%) unsatisfactory. As for the irregular use of the orthosis 63% were satisfactory and 37% unsatisfactory. In patients who properly used the orthosis, the recurrence rate was 14.3%; those who did not use it, 77.8%; and of improperly used the orthosis, 55.5%. Conclusion: the proper use of the abduction orthesis is essential for the satisfactory result of idiopathic clubfoot correction by Ponseti’s technique, just as for the minimization of recurrence of this pathology.