Clin Orthop Surg.  2014 Sep;6(3):245-252. 10.4055/cios.2014.6.3.245.

Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis

Affiliations
  • 1Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. orthzl@126.com

Abstract

Ponseti clubfoot treatment has become more popular during the last decade because of its high initial correction rate. But the most common problem affecting the long-term successful outcome is relapse of the deformity. Non-compliance with Ponseti brace protocol is a major problem associated with relapse. Although more comfortable braces have been reported to improve the compliance, they all have the same design and no significant changes have been made to the protocols. After refinement in the Ponseti method and emphasizing the importance of brace to parents, the relapse rate has been markedly decreased. Nevertheless, there are patients who do not have any recurrence although they are not completely compliant with the brace treatment, whereas other patients have a recurrence even though they are strictly compliant with the brace treatment. The aim of this article is to review the relapse of clubfoot and the function of the brace and to develop an individualized brace protocol for each patient by analyzing the mechanism of the brace and the biomechanical properties of muscles, tendons, and ligaments.

Keyword

Clubfoot; Ponseti method; Relapse; Foot abduction orthosis

MeSH Terms

Clubfoot/physiopathology/*therapy
Humans
Orthotic Devices
Patient Compliance
Range of Motion, Articular
Recurrence
Treatment Outcome

Figure

  • Fig. 1 Different kinds of foot abduction orthoses. (A) Markell brace. (B, C) Mitchell-Ponseti brace. (D) Brace in our institute.


Cited by  1 articles

Long-Term Results of Surgical Treatment for the Idiopathic Clubfoot
Hui Taek Kim, In Hee Kim, Yoon Je Cho, Tae Young Ahn
J Korean Orthop Assoc. 2019;54(6):547-556.    doi: 10.4055/jkoa.2019.54.6.547.


Reference

1. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980; 62(1):23–31.
2. Ponseti IV. Congenital clubfoot: fundamentals of treatment. Oxford: Oxford University Press;1996.
3. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004; 86(1):22–27.
4. Ponseti IV, Smoley EN. The classic: congenital club foot: the results of treatment. 1963. Clin Orthop Relat Res. 2009; 467(5):1133–1145.
5. Thacker MM, Scher DM, Sala DA, van Bosse HJ, Feldman DS, Lehman WB. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop. 2005; 25(2):225–228.
6. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007; 16(2):98–105.
7. Chen RC, Gordon JE, Luhmann SJ, Schoenecker PL, Dobbs MB. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop. 2007; 27(5):522–528.
8. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot: a thirty-year follow-up note. J Bone Joint Surg Am. 1995; 77(10):1477–1489.
9. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002; 22(4):517–521.
10. Lehman WB, Mohaideen A, Madan S, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B. 2003; 12(2):133–140.
11. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg. 2003; 42(5):259–267.
12. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113(2):376–380.
13. Changulani M, Garg NK, Rajagopal TS, et al. Treatment of idiopathic club foot using the Ponseti method: initial experience. J Bone Joint Surg Br. 2006; 88(10):1385–1387.
14. Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America. J Bone Joint Surg Am. 2009; 91(3):530–540.
15. Panjavi B, Sharafatvaziri A, Zargarbashi RH, Mehrpour S. Use of the Ponseti method in the Iranian population. J Pediatr Orthop. 2012; 32(3):e11–e14.
16. Verma A, Mehtani A, Sural S, et al. Management of idiopathic clubfoot in toddlers by Ponseti's method. J Pediatr Orthop B. 2012; 21(1):79–84.
17. Morcuende JA, Dobbs MB, Frick SL. Results of the Ponseti method in patients with clubfoot associated with arthrogryposis. Iowa Orthop J. 2008; 28:22–26.
18. Boehm S, Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB. Early results of the Ponseti method for the treatment of clubfoot in distal arthrogryposis. J Bone Joint Surg Am. 2008; 90(7):1501–1507.
19. Gerlach DJ, Gurnett CA, Limpaphayom N, et al. Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele. J Bone Joint Surg Am. 2009; 91(6):1350–1359.
20. Nogueira MP, Ey Batlle AM, Alves CG. Is it possible to treat recurrent clubfoot with the Ponseti technique after posteromedial release?: a preliminary study. Clin Orthop Relat Res. 2009; 467(5):1298–1305.
21. Ramirez N, Flynn JM, Fernandez S, Seda W, Macchiavelli RE. Orthosis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: a relevant problem that needs reevaluation. J Pediatr Orthop. 2011; 31(6):710–715.
22. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot: (a study of 67 clubfeet with mean five year follow-up). J Orthop Surg Res. 2011; 6:3.
23. Bouchoucha S, Smida M, Saied W, et al. Early results of the Ponseti method using the Steenbek foot abduction brace: a prospective study of 95 feet. J Pediatr Orthop B. 2008; 17(3):134–138.
24. Staheli L. Clubfoot: Ponseti management [Internet]. 3rd ed. Seattle, WA: Global HELP;2009. cited 2013 Nov 20. Available from: http://www.global-help.org/publications/books/book_cfponseti.html.
25. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am. 2007; 89(3):487–493.
26. Janicki JA, Wright JG, Weir S, Narayanan UG. A comparison of ankle foot orthoses with foot abduction orthoses to prevent recurrence following correction of idiopathic clubfoot by the Ponseti method. J Bone Joint Surg Br. 2011; 93(5):700–704.
27. Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year followup. Clin Orthop Relat Res. 2009; 467(5):1263–1270.
28. Segev E, Keret D, Lokiec F, et al. Early experience with the Ponseti method for the treatment of congenital idiopathic clubfoot. Isr Med Assoc J. 2005; 7(5):307–310.
29. Boehm S, Sinclair M. Foot abduction brace in the Ponseti method for idiopathic clubfoot deformity: torsional deformities and compliance. J Pediatr Orthop. 2007; 27(6):712–716.
30. Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010; 92(6):1343–1352.
31. Hemo Y, Segev E, Yavor A, Ovadia D, Wientroub S, Hayek S. The influence of brace type on the success rate of the Ponseti treatment protocol for idiopathic clubfoot. J Child Orthop. 2011; 5(2):115–119.
32. Ponseti IV. Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J. 2002; 22:55–56.
33. Fukuhara K, Schollmeier G, Uhthoff HK. The pathogenesis of club foot: a histomorphometric and immunohistochemical study of fetuses. J Bone Joint Surg Br. 1994; 76(3):450–457.
34. Buckwalter JA, Einhorn TA, Simon SR. Orthopaedic basic science: biology and biomechanics of the musculoskeletal system. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons;2000. p. 581–616.
35. Nakamura M, Ikezoe T, Takeno Y, Ichihashi N. Effects of a 4-week static stretch training program on passive stiffness of human gastrocnemius muscle-tendon unit in vivo. Eur J Appl Physiol. 2012; 112(7):2749–2755.
36. Zhao D, Li H, Zhao L, Liu J, Wu Z, Jin F. Results of clubfoot management using the Ponseti method: do the details matter? A systematic review. Clin Orthop Relat Res. 2014; 472(4):1329–1336.
37. Sano H, Uhthoff HK, Jarvis JG, Mansingh A, Wenckebach GF. Pathogenesis of soft-tissue contracture in club foot. J Bone Joint Surg Br. 1998; 80(4):641–644.
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