title: The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age.
abstract: Our goal was to evaluate the use of Ponseti's method, with minor adaptations, in the treatment of idiopathic clubfeet presenting in children between five and ten years of age. A retrospective review was performed in 36 children (55 feet) with a mean age of 7.4 years (5 to 10), supplemented by digital images and video recordings of gait. There were 19 males and 17 females. The mean follow-up was 31.5 months (24 to 40). The mean number of casts was 9.5 (6 to 11), and all children required surgery, including a percutaneous tenotomy or open tendo Achillis lengthening (49%), posterior release (34.5%), posterior medial soft-tissue release (14.5%), or soft-tissue release combined with an osteotomy (2%). The mean dorsiflexion of the ankle was 9° (0° to 15°). Forefoot alignment was neutral in 28 feet (51%) or adducted (< 10°) in 20 feet (36%), > 10° in seven feet (13%). Hindfoot alignment was neutral or mild valgus in 26 feet (47%), mild varus (< 10°) in 19 feet (35%), and varus (> 10°) in ten feet (18%). Heel-toe gait was present in 38 feet (86%), and 12 (28%) exhibited weight-bearing on the lateral border (out of a total of 44 feet with gait videos available for analysis). Overt relapse was identified in nine feet (16%, six children). The parents of 27 children (75%) were completely satisfied. A plantigrade foot was achieved in 46 feet (84%) without an extensive soft-tissue release or bony procedure, although under-correction was common, and longer-term follow-up will be required to assess the outcome.
authors.affiliation: Hospital and Rehabilitation Centre for Disabled Children, Banepa, P.O. Box 6757, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Banskota
authors.forename: A K
authors.initials: AK
authors.lastname: Banskota
authors.forename: R
authors.initials: R
authors.lastname: Regmi
authors.forename: T
authors.initials: T
authors.lastname: Rajbhandary
authors.forename: O P
authors.initials: OP
authors.lastname: Shrestha
authors.forename: D A
authors.initials: DA
authors.lastname: Spiegel
mesh_terms: D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D058971:Tenotomy / Q000379:methods; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Clubfoot; Outcome; Ponseti; Relapse; Undercorrection; Walking age