title: Comparative study: Ponseti method versus French physiotherapy for initial treatment of idiopathic clubfoot deformity.
abstract: BACKGROUND
  Nonoperative treatment avoids the complications after extensive surgery for idiopathic clubfeet. The purpose of this study was to compare retrospectively French physiotherapy and Ponseti method used to treat idiopathic clubfoot in 2 institutions.
  
  
  METHODS
  Two hundred nineteen idiopathic clubfeet (146 patients) managed during a 3-year period (2000 to 2003) were included in this study: 116 clubfeet in group FM were treated according to modified French physiotherapy (with percutaneous heel-cord tenotomy in 17%) and 103 clubfeet in group PM were treated according to the Ponseti method. The use of further surgery was considered as failure of the nonoperative management: complete posteromedial release were noted poor, limited posterior release were noted fair, and nonrelease surgery or nonoperated feet were scored with the modified Ghanem score.
  
  
  RESULTS
  After a mean follow-up of 5.5 years (range, 2.5 to 7.4 y), similar rate of surgery was performed in both groups (21% in group FM and 16% in group PM) but complete posteromedial release was mainly done in group FM (19% of feet), and limited surgery was done in group PM. Results were noted excellent, good, fair, and poor in respectively 55%, 20%, 6%, and 19% of patients in group FM and 79%, 15%, 4%, and 2% of patients in group PM. Results for Dimeglio grade II clubfeet were not different, but results for grade III and grade IV clubfeet were better in PM group.
  
  
  CONCLUSIONS
  Ponseti method enables reduction of extensive surgery compared with French physiotherapy mainly for severe deformities.
authors.affiliation: Service de Chirurgie Orthopédique Pédiatrique, Hôpital Universitaire Mère Enfant de Lyon, Hospices Civils de Lyon, Université Claude Bernard Lyon I, 59 Boulevard Pinel Bron 69677, France. franck.chotel@yahoo.co.uk
authors.forename: Franck
authors.initials: F
authors.lastname: Chotel
authors.forename: Roger
authors.initials: R
authors.lastname: Parot
authors.forename: Raphaël
authors.initials: R
authors.lastname: Seringe
authors.forename: Jérôme
authors.initials: J
authors.lastname: Berard
authors.forename: Philippe
authors.initials: P
authors.lastname: Wicart
mesh_terms: D002370:Casts, Surgical; D003025:Clubfoot / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D026741:Physical Therapy Modalities; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome