title: Midterm results of the Ponseti method in the treatment of congenital clubfoot.
abstract: OBJECTIVE
  The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery.
  
  
  METHODS
  Patients from our prospective database of clubfeet treated with the Ponseti method with a minimum age of three years were identified. Exclusion criteria were syndrome or neurogenic association, address in a foreign country, presentation after six weeks of age, more than three casts applied elsewhere and correction with less than three casts. A total of 125 patients met the inclusion criteria. The Pediatric Outcomes Data Collection Instrument (PODCI), the disease-specific instrument (DSI) questionnaire and an invitation for a clinical examination were sent out. For patients not presenting for evaluation, data from the last follow-up were extracted.
  
  
  RESULTS
  Seventy questionnaires (56 %) of patients with a mean age of 5.7 years (3.3-8.9 years) were returned. The DSI score (n = 65) was 85.3 (± 13.01 SD) and the PODCI score (n = 59) was 95.5 (± 6.3 SD). A total of 113 of 125 patients (90.4 %) with 182 clubfeet were examined in the study or seen in follow-up. During a mean follow-up of 5.2 years (range 3-8.5 years) a repeat tenotomy was performed in 4 % of cases, a percutaneous Achilles tendon lengthening in 3 %, a tibialis anterior tendon transfer in 13 % and open joint surgery in 5 %. The mean dorsiflexion with knee extended was 15.9° (range 0-32°; SD ± 5.5) with 16 feet (9 %) presenting less than 10°.
  
  
  CONCLUSIONS
  The functional scores indicate that the Ponseti method results in mostly pain-free feet not limiting age-appropriate activity. In this consecutive case series open joint surgery could be avoided in 95 % of cases with a good functional and anatomic outcome.
authors.affiliation: Paediatric Orthopaedic Unit, Department of Paediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisinger, Vienna, Austria. cradler@chello.at
authors.forename: Christof
authors.initials: C
authors.lastname: Radler
authors.forename: Gabriel T
authors.initials: GT
authors.lastname: Mindler
authors.forename: Karin
authors.initials: K
authors.lastname: Riedl
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lipkowski
authors.forename: Andreas
authors.initials: A
authors.lastname: Kranzl
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008349:Manipulation, Orthopedic; D010027:Osteotomy; D020127:Recovery of Function; D058971:Tenotomy
references.citation: J Pediatr Orthop B. 2012 Jan;21(1):40-6
references.pmid: 22134651
references.citation: J Pediatr Orthop. 2005 Sep-Oct;25(5):623-6
references.pmid: 16199943
references.citation: J Bone Joint Surg Am. 2007 Mar;89(3):487-93
references.pmid: 17332096
references.citation: J Pediatr Orthop. 2001 Jan-Feb;21(1):42-9
references.pmid: 11176352
references.citation: J Bone Joint Surg Am. 2010 Apr;92(4):882-9
references.pmid: 20360511
references.citation: J Pediatr Orthop. 2001 Sep-Oct;21(5):619-21
references.pmid: 11521030
references.citation: J Bone Joint Surg Am. 1980 Jan;62(1):23-31
references.pmid: 7351412
references.citation: J Foot Ankle Surg. 2011 Sep-Oct;50(5):529-34
references.pmid: 21680202
references.citation: J Pediatr Orthop. 2002 Jul-Aug;22(4):517-21
references.pmid: 12131451
references.citation: Arch Orthop Trauma Surg. 2006 Jan;126(1):15-21
references.pmid: 16283342
references.citation: Clin Orthop Relat Res. 2009 May;467(5):1256-62
references.pmid: 19159116
references.citation: Z Orthop Ihre Grenzgeb. 2006 Jan-Feb;144(1):80-6
references.pmid: 16498565
references.citation: Z Orthop Unfall. 2012 Apr;150(2):190-7
references.pmid: 22354441
references.citation: Clin Orthop Relat Res. 2009 Oct;467(10):2668-76
references.pmid: 19350335
references.citation: J Bone Joint Surg Am. 1995 Oct;77(10):1477-89
references.pmid: 7593056
references.citation: Acta Orthop. 2012 Jun;83(3):288-93
references.pmid: 22616746
references.citation: Clin Orthop Relat Res. 2009 May;467(5):1263-70
references.pmid: 19130158
references.citation: J Pediatr Orthop B. 2007 Mar;16(2):98-105
references.pmid: 17273035
references.citation: J Foot Ankle Surg. 2003 Sep-Oct;42(5):259-67
references.pmid: 14566717