Is Unilateral Lower Leg Orthosis with a Circular Foot Unit in the Treatment of Idiopathic Clubfeet a Reasonable Bracing Alternative in the Ponseti Method? Five-year Results of a Supraregional Paediatric-orthopaedic Centre

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2018 Jul 20

PMID 30021573

Citations 6

Authors

N Berger

D Lewens

M Salzmann

A Hapfelmeier

L Doderlein

P M Prodinger

Affiliations

Soon will be listed here.

Abstract

Background: In the Ponseti treatment of idiopathic clubfoot, children are generally provided with a standard foot abduction orthosis (FAO). A significant proportion of these patients experience irresolvable problems with the FAO leading to therapeutic non-compliance and eventual relapse. Accordingly, these patients were equipped with a unilateral lower leg orthosis (LLO) developed in our institution. The goal of this retrospective study was to determine compliance with and the efficacy of the LLO as an alternative treatment measure. The minimum follow-up was 5 years.

Results: A total of 45 patients (75 ft) were retrospectively registered and included in the study. Compliance with the bracing protocol was 91% with the LLO and 46% with the FAO. The most common problems with the FAO were sleep disturbance (50%) and cutaneous problems (45%). Nine percent of patients experienced sleep disturbance, and no cutaneous problems occurred with the LLO. Thirteen percent of patients being treated with an FAO until the age of four (23 patients; 40 ft) underwent surgery because of relapse, defined by rigid recurrence of any of the components of a clubfoot. Fourteen percent of patients being treated with an LLO (22 patients; 35 ft), mostly following initial treatment with an FAO, experienced recurrence.

Conclusion: Changing from FAO to LLO at any point during treatment did not result in an increased rate of surgery and caused few problems.

Citing Articles

Shorter Night Splinting by a Modified Ponseti Method With Similar Foot-Function and Health-Related Quality of Life.

Seidel A, Tinembart S, Kaiser N, Ziebarth K Cureus. 2025; 17(3):e80260.

PMID: 40061846 PMC: 11890394. DOI: 10.7759/cureus.80260.

Design and evaluation of a unilateral brace for preventing clubfoot relapse: A prospective study.

Zapparoli F, Volpon J J Rehabil Assist Technol Eng. 2025; 12:20556683251313768.

PMID: 39911205 PMC: 11795612. DOI: 10.1177/20556683251313768.

Midterm clinical and radiological outcomes of arthrogryposis-associated clubfoot treated with the Ponseti method: a retrospective observational study and comprehensive literature review.

Berger N, Forkl H, Heimkes B, Frimberger V, Wagner F, Hildebrand F J Orthop Surg Res. 2024; 19(1):595.

PMID: 39342344 PMC: 11437879. DOI: 10.1186/s13018-024-05101-3.

Duration and outcome of orthotic treatment in children with clubfoot - a four-year follow-up national register study of Swedish children born between 2015 and 2017.

Naili J, Lindeberg M, Esbjornsson A BMC Musculoskelet Disord. 2024; 25(1):425.

PMID: 38822269 PMC: 11143618. DOI: 10.1186/s12891-024-07544-5.

Two-year retrospective cohort results on use of a dynamic unilateral brace for treatment of clubfoot: Can compliance and prevention of recurrence both be achieved?.

Farrar E, Lo M, Groothoff L, Cunningham J, Theuri J J Rehabil Assist Technol Eng. 2022; 9:20556683221112084.

PMID: 35845117 PMC: 9280036. DOI: 10.1177/20556683221112084.

References

Morcuende J, Dolan L, Dietz F, Ponseti I . Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113(2):376-80. DOI: 10.1542/peds.113.2.376. View

Ramirez N, Flynn J, Fernandez S, Seda W, Macchiavelli R . Orthosis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: a relevant problem that needs reevaluation. J Pediatr Orthop. 2011; 31(6):710-5. DOI: 10.1097/BPO.0b013e318221eaa1. View

Zionts L, Dietz F . Bracing following correction of idiopathic clubfoot using the Ponseti method. J Am Acad Orthop Surg. 2010; 18(8):486-93. DOI: 10.5435/00124635-201008000-00005. View

Goksan S, Bilgili F, Eren I, Bursali A, Koc E . Factors affecting adherence with foot abduction orthosis following Ponseti method. Acta Orthop Traumatol Turc. 2015; 49(6):620-6. DOI: 10.3944/AOTT.2015.14.0348. View

Richards B, Faulks S, Rathjen K, Karol L, Johnston C, Jones S . A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008; 90(11):2313-21. DOI: 10.2106/JBJS.G.01621. View

Zhao D, Liu J, Zhao L, Wu Z . Relapse of clubfoot after treatment with the Ponseti method and the function of the foot abduction orthosis. Clin Orthop Surg. 2014; 6(3):245-52. PMC: 4143509. DOI: 10.4055/cios.2014.6.3.245. View

Zionts L, Zhao G, Hitchcock K, Maewal J, Ebramzadeh E . Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States?. J Bone Joint Surg Am. 2010; 92(4):882-9. DOI: 10.2106/JBJS.I.00819. View

Browne D . Modern Methods of Treatment of Club-foot. Br Med J. 2010; 2(4002):570-2. PMC: 2087301. DOI: 10.1136/bmj.2.4002.570. View

Shabtai L, Segev E, Yavor A, Wientroub S, Hemo Y . Prolonged use of foot abduction brace reduces the rate of surgery in Ponseti-treated idiopathic club feet. J Child Orthop. 2015; 9(3):177-82. PMC: 4486506. DOI: 10.1007/s11832-015-0663-y. View

10.

Dobbs M, Rudzki J, Purcell D, Walton T, Porter K, Gurnett C . Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004; 86(1):22-7. DOI: 10.2106/00004623-200401000-00005. View

11.

George H, Unnikrishnan P, Garg N, Sampath J, Bruce C . Unilateral foot abduction orthosis: is it a substitute for Denis Browne boots following Ponseti technique?. J Pediatr Orthop B. 2010; 20(1):22-5. DOI: 10.1097/BPB.0b013e32833fb8a5. View

12.

Abdelgawad A, Lehman W, van Bosse H, Scher D, Sala D . Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007; 16(2):98-105. DOI: 10.1097/BPB.0b013e32801048bb. View

13.

Desai L, Oprescu F, DiMeo A, Morcuende J . Bracing in the treatment of children with clubfoot: past, present, and future. Iowa Orthop J. 2010; 30:15-23. PMC: 2958265. View

14.

Kessler J . A new flexible brace used in the Ponseti treatment of talipes equinovarus. J Pediatr Orthop B. 2009; 17(5):247-50. DOI: 10.1097/BPB.0b013e32830cc3e5. View

15.

Seringe R, Wicart P . The talonavicular and subtalar joints: the "calcaneopedal unit" concept. Orthop Traumatol Surg Res. 2013; 99(6 Suppl):S345-55. DOI: 10.1016/j.otsr.2013.07.003. View

16.

Janicki J, Wright J, Weir S, Narayanan U . 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):700-4. DOI: 10.1302/0301-620X.93B5.24883. View

17.

Haft G, Walker C, Crawford H . Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am. 2007; 89(3):487-93. DOI: 10.2106/JBJS.F.00169. View

18.

Garg S, Porter K . Improved bracing compliance in children with clubfeet using a dynamic orthosis. J Child Orthop. 2009; 3(4):271-6. PMC: 2726866. DOI: 10.1007/s11832-009-0182-9. View

19.

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. 2012; 5(2):115-9. PMC: 3058207. DOI: 10.1007/s11832-010-0321-3. View

20.

Zionts L, Frost N, Kim R, Ebramzadeh E, Sangiorgio S . Treatment of idiopathic clubfoot: experience with the Mitchell-Ponseti brace. J Pediatr Orthop. 2012; 32(7):706-13. DOI: 10.1097/BPO.0b013e3182694f4d. View