[Initial management of congenital varus equinus clubfoot by Ponseti's method].
The choice of first-line treatment for congenital varus equine clubfoot remains a controversial issue largely dependent on experience. In France, functional treatment predominates. In 1948, Ponseti proposed reducing the deformity with successive casts. Although cast treatment is a very old method, Ponseti's method is original because it is based on strict rules established from anatomic evidence. The goal is not to correct the apparent deformation, but on the contrary to impose a simultaneous supination and abduction of the foot. Once the calcaneopedal block has been derotated, percutaneous tenotomy of the Achilles tendon is performed. We relate our experience with this method and recall the precise technique used to make the casts. After the cast, derotation braces are worn at night but rehabilitation exercises are not required. We emphasize the quality of the clinical reduction achieved as well as the smaller number of patients who require surgery at walking age.
Chotel
F
F
Service Chirurgie Pédiatrique, Hôpital Debrousse, 29, rue Soeur-Bouvier, 69322 Lyon Cedex 05, France. franck.chotel@chu-lyon.fr
Parot
R
R
Durand
J M
JM
Garnier
E
E
Hodgkinson
I
I
Bérard
J
J
D000125:Achilles Tendon / Q000601:surgery*; D001915:Braces; D002370:Casts, Surgical; D003025:Clubfoot / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D007231:Infant, Newborn; D008349:Manipulation, Orthopedic / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D012720:Severity of Illness Index; D013484:Supination; D016896:Treatment Outcome