Study finds Ponseti method of clubfoot correction

Feb 01, 2010

Clubfoot affects one in a thousand babies born in the United States, but with proper corrective treatment and follow-up, infants born with clubfoot can have feet compatible with an active, normal lifestyle. A new study in the February 2010 issue of the Journal of Bone and Joint Surgery (JBJS) compared two common treatment options for clubfoot - Ponseti method and surgical treatment.

"While more conservative treatment methods have become popular in the United States over the last several years, surgical treatment has been the primary option in New Zealand until quite recently," explained Matthew Halanski, MD, who authored the study with mentors at the Starship Children's Hospital in Auckland, New Zealand.

"This is the first controlled prospective study to compare the short-term outcomes for clubfeet treated either surgically or with the Ponseti method," continued Dr. Halanski.

Fifty-five patients with 86 clubfeet were treated as part of the study. Forty patients' were treated with the Ponseti method. Forty-six were treated with surgery and casting. The average number of casts per patient was six in the Ponseti Group and 13 in the surgical group.

The study found that among the patients treated:

  • 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.
  • 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, who is now a practicing pediatric orthopaedic surgeon at the Helen DeVos Children's Hospital in Grand Rapids, Michigan and also clinical assistant professor in Department of Surgery and Pediatrics & Human Development, Michigan State University College of Human Medicine.

The Ponseti method has been adopted as the primary treatment for clubfoot at the children's hospital in New Zealand where the study took place.

"Any infant born with clubfoot should be taken to an orthopaedic surgeon specializing in pediatrics, preferably within the first few months of life," concluded Dr. Halanski. "While primary surgical treatment may still be required in select cases, we strongly advise any parent who receives a recommendation for as primary treatment to seek a second opinion."

About Clubfoot 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. Despite successful initial treatment, clubfeet have a natural tendency to recur. Regardless of medical treatment option, bracing is necessary for several years post treatment to prevent relapses, almost constantly for a few months, then typically during sleep.

The study took place in New Zealand where clubfoot is more common, due to the heavy Polynesian population and the propensity for clubfoot among Polynesians. This study reviewed the two most common treatments of clubfoot:

  • Ponseti 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.

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

First gene for clubfoot identified

Oct 23, 2008

Clubfoot, one of the most common birth defects, has long been thought to have a genetic component. Now, researchers at Washington University School of Medicine in St. Louis report they have found the first gene linked to ...

Timing of surgery for knee injuries may not affect outcomes

Dec 01, 2009

Multiple-ligament knee injuries resulting from traumatic knee dislocations - such as high impact car accidents or certain sports are uncommon, and the optimal timing of surgical repair or reconstruction has not been definitively ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Filipino tests negative for Middle East virus

A Filipino nurse who tested positive for the Middle East virus has been found free of infection in a subsequent examination after he returned home, Philippine health officials said Saturday.

Study says we're over the hill at 24

(Medical Xpress)—It's a hard pill to swallow, but if you're over 24 years of age you've already reached your peak in terms of your cognitive motor performance, according to a new Simon Fraser University study.

NASA's space station Robonaut finally getting legs

Robonaut, the first out-of-this-world humanoid, is finally getting its space legs. For three years, Robonaut has had to manage from the waist up. This new pair of legs means the experimental robot—now stuck ...

Ex-Apple chief plans mobile phone for India

Former Apple chief executive John Sculley, whose marketing skills helped bring the personal computer to desktops worldwide, says he plans to launch a mobile phone in India to exploit its still largely untapped ...

Egypt archaeologists find ancient writer's tomb

Egypt's minister of antiquities says a team of Spanish archaeologists has discovered two tombs in the southern part of the country, one of them belonging to a writer and containing a trove of artifacts including reed pens ...

Airbnb rental site raises $450 mn

Online lodging listings website Airbnb inked a $450 million funding deal with investors led by TPG, a source close to the matter said Friday.