title: Ponseti treatment for idiopathic clubfoot: minimum 5-year followup.
abstract: Ponseti clubfoot treatment has become more popular during the last decade. We reviewed the medical records of 74 consecutive infants (117 club feet) who underwent Ponseti treatment. Minimum followup was 5 years (mean, 6.3 years; range, 5-9 years). We studied age at presentation, previous treatment, the initial severity score of the Pirani scoring system, number of casts, need for Achilles tenotomy or other surgical procedures, and brace use. We measured final ankle motion and parents' perception of outcome. Late presentation and previous non-Ponseti treatment were associated with lower initial severity score, fewer casts, and less need for tenotomy. Forty-four percent of patients had poor brace use. We observed better brace use (75%) in babies who presented late for treatment. Good brace use predicted less need for extensive surgical procedures. Twenty-four (32%) babies underwent additional surgical procedures other than tenotomy, including 21% who underwent tibialis anterior tendon transfer. At followup, 89% of feet had adequate dorsiflexion (5 degrees or greater). Parents indicated high satisfaction with the treatment results. Ankle motion was not associated with parents' satisfaction. The Ponseti method is effective, even if treatment starts late or begins after failure at other centers. Brace use influenced the success of treatment.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Pediatric Orthopedic Unit, Emek Medical Center, Afula, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Bor
authors.forename: Julie A
authors.initials: JA
authors.lastname: Coplan
authors.forename: John E
authors.initials: JE
authors.lastname: Herzenberg
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology; D015142:Baltimore; D001915:Braces; D002370:Casts, Surgical; D003025:Clubfoot / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D026201:Musculoskeletal Manipulations; D010290:Parents; D010349:Patient Compliance; D017060:Patient Satisfaction; D011788:Quality of Life; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013709:Tendon Transfer; D013997:Time Factors; D016896:Treatment Outcome