Abstract: Background: Congenital idiopathic clubfoot is a complex congenital deformity. The goal of treatment is to achieve pain-free plantigrade feet with good mobility and without deformity. Prior treatment for congenital idiopathic clubfoot included manipulation, serial casting, and major soft tissue release surgically by any of the following techniques: modified posteromedial release, complete subtalar release and posterior release. The objective of this study was to compare the functional outcome between Ponseti method and major surgical treatment.
Materials and Methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or major surgical soft tissue release between 2000 to 2012. Outcome measurements included the Functional Rating System of Laaveg and Ponseti, the talocalcaneal angle (TCA) in antero-posterior (AP) and lateral view radiographs.
Results: Nineteen children (28 feet) were treated with Ponseti method and 19 children (30 feet) were treated with major surgery. The minimum follow up was 5.07 years (mean 5.94±1.01 years in the Ponseti group and 8.73±2.78 years in the surgical treatment group). In the last follow up, there was statically significant difference of the mean Functional Rating score between the Ponseti group and major surgery group. (95.35±2.31 and 89.76±4.97, p<0.001). There was statically significant difference of the satisfaction score between the Ponseti group and major surgery group (20 and 18.27±2.01, p<0.001). The passive motion score was statically significant better in Ponseti group (5.79±1.37 and 4.57±1.45, p=0.003). The mean TCA in AP and lateral views were within normal range in both groups with statically significant better in Ponseti group (24.89±4.83 and 21.63±4.62, p=0.009 and 23.46±4.88 and 21.13±7.96, p=0.013).
Conclusion: Ponseti method is effective and satisfactory treatment for congenital idiopathic clubfoot and should be considered as initial treatment for congenital idiopathic clubfoot. Major surgery should be reserved for deformity that cannot be completely corrected.
