title: The effect of a dedicated Ponseti service on the outcome of idiopathic clubfoot treatment.
abstract: We report the effect of introducing a dedicated Ponseti service on the five-year treatment outcomes of children with idiopathic clubfoot. Between 2002 and 2004, 100 feet (66 children; 50 boys and 16 girls) were treated in a general paediatric orthopaedic clinic. Of these, 96 feet (96%) responded to initial casting, 85 requiring a tenotomy of the tendo-Achillis. Recurrent deformity occurred in 38 feet and was successfully treated in 22 by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior, The remaining 16 required an extensive surgical release. Between 2005 and 2006, 72 feet (53 children; 33 boys and 20 girls) were treated in a dedicated multidisciplinary Ponseti clinic. All responded to initial casting: 60 feet (83.3%) required a tenotomy of the tendo-Achillis. Recurrent deformity developed in 14, 11 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The other three required an extensive surgical release. Statistical analysis showed that children treated in the dedicated Ponseti clinic had a lower rate of recurrence (p = 0.068) and a lower rate of surgical release (p = 0.01) than those treated in the general clinic. This study shows that a dedicated Ponseti clinic, run by a well-trained multidisciplinary team, can improve the outcome of idiopathic clubfoot deformity.
authors.affiliation: Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK.
authors.forename: A I W
authors.initials: AI
authors.lastname: Mayne
authors.affiliation: Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Bidwai
authors.affiliation: Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Beirne
authors.affiliation: Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK.
authors.forename: N K
authors.initials: NK
authors.lastname: Garg
authors.affiliation: Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Bruce
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D002370:Casts, Surgical; D002675:Child, Preschool; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Congenital talipes equinovarus; Idiopathic clubfoot; Ponseti; Re-operation; Recurrence; Treatment outcome