Ponseti method has been found to be more effective in treating clubfoot than surgical treatment, say researchers.
Clubfoot is a complex deformity in which the feet are twisted inward with the top of the foot where the bottom should be. This condition can sometimes be detected in a prenatal ultrasound, but always is readily apparent at birth.
AdvertisementPonseti method involves weekly manipulation with above-knee casting often followed by cutting of the Achilles tendon to correct the condition; bracing is then used to maintain the correction.
Surgical correction involves lengthening of the Achilles tendon and release of the ankle joint, multiple joints in the foot, often with re-alignment and pinning of the bones in the foot.
The research team compared two common treatment options for clubfoot - Ponseti method and surgical treatment and Ponseti method was found to be more effective.
"This is the first controlled prospective study to compare the short-term outcomes for clubfeet treated either surgically or with the Ponseti method," said Dr Matthew Halanski, co-author of the study at the Starship Children's Hospital in Auckland, New Zealand.
For the study, the research team recruited fifty-five patients with 86 clubfeet.
Forty patients' feet were treated with the Ponseti method. Forty-six were treated with surgery and casting.
The study found that fifteen feet in the Ponseti group had a recurrence requiring some surgery. Four of these feet had a major recurrence and 11 had a minor recurrence.
Fourteen feet in the surgical group required revision (follow-up) surgery however only one foot in the Ponseti group required revision surgery.
Patients treated in both groups had a 30 percent to 40 percent rate of relapse. While this is a relatively high recurrence rate for both groups, feet in the Ponseti group needed significantly less invasive operative intervention and required less revision surgery.
And for patients in the surgical group who required revision surgery, it was actually a repeat procedure, which has been shown in other studies to lead to poorer function.
"The case for Ponseti treatment is much stronger than for surgery considering Ponseti treatment involves less severe recurrence; and feet treated with too many surgeries have less favorable outcomes," said Dr. Halanski.
"Any infant born with clubfoot should be taken to an orthopaedic surgeon specializing in pediatrics, preferably within the first few months of life.
"While primary surgical treatment may still be required in select cases, we strongly advise any parent who receives a recommendation for surgery as primary treatment to seek a second opinion," he added.
The study appears in Journal of Bone and Joint Surgery (JBJS).
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