title: Ponseti casting for club foot - above- or below-knee?: A prospective randomised clinical trial.
abstract: We undertook a randomised clinical trial to compare treatment times and failure rates between above- and below-knee Ponseti casting groups. Eligible children with idiopathic clubfoot, treated using the Ponseti method, were randomised to either below- or above-knee plaster of Paris casting. Outcome measures were total treatment time and the occurrence of failure, defined as two slippages or a treatment time above eight weeks. A total of 26 children (33 feet) were entered into the trial. The above-knee group comprised 17 feet in 13 children (ten boys and three girls, median age 13 days (1 to 40)) and the below-knee group comprised 16 feet in 13 children (ten boys and three girls, median age 13 days (5 to 20)). Because of six failures (37.5%) in the below-knee group, the trial was stopped early for ethical reasons. The rate of failure was significantly higher in the below-knee group (p = 0.039). The median treatment times of six weeks in the below-knee and four weeks in the above-knee group differed significantly (p = 0.01). This study demonstrates that the use of a below-knee plaster of Paris cast in conjunction with the Ponseti technique leads to unacceptably high failure rates and significantly longer treatment times. Therefore, this technique is not recommended.
authors.affiliation: The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, UK.
authors.forename: S N
authors.initials: SN
authors.lastname: Maripuri
authors.forename: P D
authors.initials: PD
authors.lastname: Gallacher
authors.forename: J
authors.initials: J
authors.lastname: Bridgens
authors.forename: J H
authors.initials: JH
authors.lastname: Kuiper
authors.forename: N T
authors.initials: NT
authors.lastname: Kiely
mesh_terms: D002133:Calcium Sulfate / Q000009:adverse effects / Q000627:therapeutic use*; D002370:Casts, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D003025:Clubfoot / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002133:Calcium Sulfate
keywords: Clubfoot; Ponseti; Randomised clinical trial; Talipes; above-knee cast; below-knee cast; cast slippage