The
Ponseti method, a conservative alternative to surgery for
clubfoot deformity patients, has a success rate of 95.8% for
patients 12 months and older, according to a new study presented by Armando
Torres-Gomez, MD,ABC Medical Center, Mexico City, Mexico at the Annual Meeting
of the American Academy of Orthopaedic Surgeons (AAOS) held March 9-13 in New
Orleans.
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| Armando Torres-Gomez |
“The purpose of the study was to evaluate the outcome of patients
older than 12 months who were treated with the Ponseti method to determine
whether this method is still useful for this age group,” Torres-Gomez said
during his presentation.
The Ponseti method involves treatments in two phases. The first phase
corrects the deformity through gentle manipulation and casting. The second
phase focuses on maintenance. It is recommended that the patient wear orthotic
braces 23 hours a day for 3 months and then during the night for several years
in order to prevent recurrences, according to the Hospital for Special Surgery
website. Without these precautions, the risk of recurrence becomes more likely.
“Current evidence shows that the Ponseti method is effective for
the treatment of clubfoot in patients older than 12 months of age,”
Torres-Gomez told O&P Business News. “Moreover, in case
the method fails, a surgical procedure can still be used.”
Collaborating closely with Shriners Hospital in Mexico City, Mexico,
Torres-Gomez has diagnosed and treated clubfoot deformity on a regular basis.
Several years ago, he contemplated performing surgery for his clubfoot
patients, rather than practice a more conservative method, he said.
But since then, numerous studies have indicated that the Ponseti method
is a successful alternative to surgery for clubfoot patients younger than 12
months. However, there is less information on its success for clubfoot patients
after 12 months. The little information that has been available showed that the
Ponseti method can be successful in patients older than 12 months.
A retrospective evaluation of medical files of 62 patients with clubfoot
deformity ranging from 12 months to 48 months treated with the Ponseti method
was performed. In total 95 feet were evaluated.
The number of casts and the age of the patient during the first Ponseti
method were recorded along with the severity of the deformity. The severity was
determined by using the Dimeglio classification.
Of the 95 feet that underwent the Ponseti procedure, 67.4% or 64 feet,
were completely corrected. Recurrence or partial correction accounted for 32.6%
or 31 feet. After correcting the recurring feet with recasting or an Achilles
tenotomy, 28.4% or 27 feet achieved complete correction. This left four feet
that failed to correct after recasting or posteromedial release. Most reports
have shown the confidence interval to fall within 91.8% and 99.8%.
“The 95% confidence interval of our results fall within the success
rate reported in most of medical papers concerning success of the Ponseti
method in patients younger than 12 months of age — 91.8% to 99.8%,”
Torres-Gomez said.
Alternative techniques, including the French method, which consists of
physical therapy and stretching, has been shown to be less effective than the
Ponseti method, according to Torres-Gomez. Therefore, Torres-Gomez recommended
the Ponseti method as the initial treatment option for clubfoot patients older
than 12 months.
“The results were good,” Torres-Gomez said. “The Ponseti
method can be recommended for treatment of clubfoot deformity for this age
group. The recurrence rate is moderate, but responds to revision and the
failure rate is low.” — by Anthony Calabro
For more information:
- Hospital for Special Surgery. The Ponseti method for clubfoot
correction: An overview for parents. Available at:
http://www.hss.edu/conditions_the-ponseti-method-for-clubfoot-correction.asp.
Accessed: May 25, 2010.Torres-Gomez A. Outcome of patients older than 12 months with
clubfoot deformity treated with the Ponseti method. Paper #652. Presented at
the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March
9-13, 2010. New Orleans.
