2016, Number 1
PDF size: 333.58 Kb.
ABSTRACTIntroduction: The Ponseti method is the gold standard in the treatment of clubfoot. It is well known that in expert hands the results have been uniformly satisfactory, however little is known about the reproducibility of the technique depending on the medical degree of training. The main objective of this study was to determine the reproducibility of this technique when performed by personnel with varying degrees of training. Material and methods: A retrospective review of 36 patients (50 feet) treated with the Ponseti method with at least one year of follow-up was performed. The degree of deformity and the result according to the scale of Dimeglio were determined and the number of casts that were used were documented, as well as the degree of training in years of the physician who carried out the treatment. Three physicians were involved in the treatment of the patients; one with four years of experience working as a pediatric orthopedist, one of them with one year of experience and finally a fellow resident of pediatric orthopedics without previous training in the Ponseti technique. Results: Of the 36 patients, 19 were treated by the physician with more experience in the Ponseti method, 9 were treated by the physician with one year of experience, while the remaining 8 were treated by the fellow resident. The average number of Ponseti cast per patient were 7.9. The rating of Dimeglio at baseline average was classified as grade III or severe, while at the end of the treatment the deformity was entirely corrected in 94.4% of patients, while recurrence of the adduct was observed in two patients, representing 5.6%. There was stastistically significance in the results of reproducibility by the three physician using the Ponseti method (p ≤ 0.05). Conclusions: The Ponseti method proved to be a reproducible technique with excellent results in correcting clubfoot deformities regardless of the degree of training of the physician who performed the treatment.
Ponseti IV, Campos J. Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res. 1972; 84: 50-60.
Lochmiller C, Johnston D et al. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998; 79(2): 90-96.
Torres GA, Pérez-Salazar D et al. Pie equino varo aducto congénito, prevalencia en una población mexicana. Rev Mex Ortop Ped. 2010; 12(1): 15-18.
Gray K, Barnes E et al. Unilateral versus bilateral clubfoot: an analysis of severity and correlation. J Pediatr Orthop B. 2014; 23(5): 397-399.
Bocahut N, Simon AL et al. Medial to posterior release procedure after failure of functional treatment in clubfoot: a prospective study. J Child Orthop. 2016; 10(2): 109-117.
Derzsi Z, Nagy Ö et al. Kite versus Ponseti method in the treatment of 235 feet with idiopathic clubfoot. Medicine (Baltimore). 2015; 94(33): e1379.
Likissas M, Crawford A. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World J Orthop. 2013; 4(3): 144-153.
Church C, Coplan J. A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms. J Child Orthop. 2012; 6: 51-59.
Jayawardena A, Zionts L, Morcuende J. Management of idiopathic clubfoot after formal training in the Ponseti method: a multi-year, international survey. Iowa Orthop. 2013; 33: 136-141.
Morcuende JA, Dolan LA et al. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113(2): 376-380.
Shabtai L, Specht SC et al. Worldwide spread of the Ponseti method for clubfoot. World J Orthop. 2014; 5(5): 585-590.