title: Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age.
abstract: Although the Ponseti method has been effective in patients up to 2 years old, limited information is available on the use of this method in older patients. We retrospectively reviewed the records of 171 patients (260 feet) to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 1 and 6 years. A mean of seven casts was required, and there were no differences in the number of casts between the different age groups. Two hundred fifty (95%) of the 260 feet were treated surgically for residual equinus after a plateau in casting, and procedures included percutaneous tendo-Achilles release (n = 205 [79%]), open tendo-Achilles lengthening (n = 8 [3%]), posterior release (n = 21 [8%]), and extensive soft tissue release (posteromedial release, n = 16 [6%]). The mean dorsiflexion after removal of the last cast was 12.5 degrees for the entire group and was greater in 1 year olds compared with 3 year olds. Although all patients achieved a plantigrade foot, the importance of the mild loss of passive dorsiflexion remains to be determined. An extensive soft tissue release was avoided in 94% of patients using the Ponseti method. We intend a followup study to ascertain whether the correction is maintained.
  
  
  METHODS
  Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. spiegeld@email.chop.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
authors.forename: Om P
authors.initials: OP
authors.lastname: Shrestha
authors.forename: Prakash
authors.initials: P
authors.lastname: Sitoula
authors.forename: Tarun
authors.initials: T
authors.lastname: Rajbhandary
authors.forename: Binod
authors.initials: B
authors.lastname: Bijukachhe
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Banskota
mesh_terms: D000367:Age Factors; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D026201:Musculoskeletal Manipulations; D009390:Nepal; D019637:Orthopedic Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome