title: Ponseti method compared to previous treatment of clubfoot in Norway. A multicenter study of 205 children followed for 8-11 years.
abstract: OBJECTIVE
  Despite few studies comparing Ponseti treatment and traditional treatment of clubfoot (talipes equinovarus), the Ponseti method is now accepted as standard treatment for this deformity. The Ponseti method was introduced in Norway in 2003 and the purpose of this multicenter-study was to compare the results of Ponseti treatment with the results of the previous treatment for clubfoot in Norway.
  
  
  METHODS
  90 children (134 clubfeet) treated with previous treatment (pre-Ponseti group), were compared to 115 Ponseti treated children (160 clubfeet) (Ponseti group). The previous treatment consisted of casting and surgery if needed. At 8-11 years of age, all children were examined by the same orthopaedic surgeon, the parents answered a questionnaire, all feet were X-rayed and information about surgical procedures was obtained from the patient records.
  
  
  RESULTS
  The number of surgeries was higher in the pre-Ponseti group, and the number of extensive surgeries was 119 in the pre-Ponseti group compared to 19 in the Ponseti group. The range of motion in the ankle joint was better in the Ponseti group. Children in this group had better function, higher satisfaction and less pain according to patient and parent reported outcome measures. The incidence of moderate or severe talar flattening was higher in the pre-Ponseti group.
  
  
  CONCLUSIONS
  Ponseti treatment seems to be superior to the previous treatment in Norway, with regards to number and severity of operations, flexibility of the foot and ankle, parent/patient reported outcome and the presence of talar flattening on X-ray.
authors.affiliation: Department of Orthopedic Surgery, Haukeland University Hospital, 5021, Bergen, Norway. christian.saetersdal@helse-bergen.no.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-4716-1990
authors.initials: C
authors.lastname: Sætersdal
authors.affiliation: Department of Orthopedic Surgery, Haukeland University Hospital, 5021, Bergen, Norway.
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Fevang
authors.affiliation: Department of Pediatric Radiology, Haukeland University Hospital, 5021, Bergen, Norway.
authors.forename: John Asle
authors.initials: JA
authors.lastname: Bjørlykke
authors.affiliation: Department of Orthopedic Surgery, Haukeland University Hospital, 5021, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Lars B
authors.initials: LB
authors.lastname: Engesæter
keywords: Clubfoot; Number of surgeries; Outcome; Ponseti; Surgical treatment; Talar flattening