Early clubfoot recurrence after use of the Ponseti method in a New Zealand population.
BACKGROUND
Nonoperative treatment of idiopathic clubfoot has become increasingly accepted worldwide as the initial standard of care. The Ponseti method has become particularly popular as a result of published short and long-term success rates in North America. The purpose of the current study was to examine the early rate of clubfoot recurrence following the use of the Ponseti treatment method in a New Zealand population and to analyze patient characteristics to identify factors predictive of recurrence.


METHODS
Fifty-one consecutive babies with a total of seventy-three clubfeet treated by the Ponseti technique were followed prospectively for a minimum of two years from the start of treatment. Recurrence, defined as the need for any subsequent operative treatment, was analyzed with respect to the severity at presentation, the time of presentation, the number of casts needed to obtain the initial correction, any family history of clubfoot, ethnicity, and the compliance with postcorrection abduction bracing. Recurrence was classified as minor, defined as requiring a tendon transfer or an Achilles tendon lengthening, or major, defined as requiring a full posterior or posteromedial surgical release to achieve a corrected plantigrade foot.


RESULTS
Twenty-one (41%) of the fifty-one patients had a recurrence, which was major in twelve of them and minor in nine. The parents of twenty-six babies (51%) complied with the abduction bracing protocol, and only three of these children had a major recurrence. Compliance with abduction bracing was associated with the greatest risk reduction for recurrence (odds ratio, 0.2; p = 0.009). When the parents had not complied with the bracing protocol, the patient had a five times greater chance of having a recurrence. With the numbers studied, no significant relationships were found between recurrence and the severity at presentation, the time of presentation, the number of casts needed to obtain correction, ethnicity, or a family history of clubfoot.


CONCLUSIONS
Compliance with the postcorrection abduction bracing protocol is crucial to avoid recurrence of a clubfoot deformity treated with the Ponseti method. When the parents comply with the bracing protocol, the Ponseti method is very effective at maintaining a correction, although minor recurrences are still common. When the parents do not comply with the bracing protocol, many major and minor recurrences should be expected.
Haft
Geoffrey F
GF
Starship Children's Hospital, Auckland, New Zealand. haftg@mac.com
Walker
Cameron G
CG
Crawford
Haemish A
HA
D001915:Braces; D002370:Casts, Surgical; D003025:Clubfoot / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008349:Manipulation, Orthopedic / Q000379:methods*; D009520:New Zealand; D016017:Odds Ratio; D010349:Patient Compliance; D011446:Prospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index