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Open Access 01-06-2015 | Original Clinical Article

Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

Authors: Mia Dunkley, Yael Gelfer, Debbie Jackson, Evette Parnell, Jennifer Armstong, Cristina Rafter, Deborah M. Eastwood

Published in: Journal of Children's Orthopaedics | Issue 3/2015

Abstract

Background

The Ponseti method is the preferred treatment for idiopathic clubfoot. Although popularised by orthopaedic surgeons it has expanded to physiotherapists and other health practitioners. This study reviews the results of a physiotherapist-led Ponseti service for idiopathic and non-idiopathic clubfeet and compares these results with those reported by other groups.

Method

A prospective cohort of clubfeet (2005–2012) with a minimum 2-year follow-up after correction was reviewed. Physiotherapists treated 91 children—41 patients (69 feet) had non-idiopathic deformities and 50 children (77 feet) were idiopathic. Objective outcomes were evaluated and compared to results from other groups managing similar patient cohorts.

Results

The mean follow-up was 4.6 years (range 2–8.3 years) for both groups. The non-idiopathic group required a median of 7 casts to correct the clubfoot deformity with an 83 % tenotomy rate compared to a median of 5 casts for the idiopathic group with a 63 % tenotomy rate. Initial correction was achieved in 96 % of non-idiopathic feet and in 100 % of idiopathic feet. Recurrence requiring additional treatment was higher in the non-idiopathic group with 40 % of patients (36 % of feet) sustaining a relapse as opposed to 8 % (6 % feet) in the idiopathic group. Surgery was required in 26 % of relapsed non-idiopathic feet and 6 % of idiopathic.

Conclusions

Although Ponseti treatment was not as successful in non-idiopathic feet as in idiopathic feet, deformity correction was achieved and maintained in the mid-term for the majority of feet. These results compare favourably to other specialist orthopaedic-based services for Ponseti management of non-idiopathic clubfeet.

Level of evidence

Prognostic Level III.

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Title: Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot
Authors: Mia Dunkley
Yael Gelfer
Debbie Jackson
Evette Parnell
Jennifer Armstong
Cristina Rafter
Deborah M. Eastwood
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 3/2015
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-015-0658-8

At a glance: The STEP trials

Springer Medicine

Mid-term results of a physiotherapist-led Ponseti service for the management of non-idiopathic and idiopathic clubfoot

Abstract

Background

Method

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Level of evidence

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