Researchers assessed the compliance and efficacy of an alternative treatment for children with idiopathic clubfoot who experienced irresolvable problems that led to therapeutic non-compliance with the standard foot abduction orthosis of the Ponseti method. The results indicated that changing from a foot abduction orthosis to a lower-leg orthosis at any point during treatment did not lead to an increased rate of surgery and caused few problems, according to the authors. The minimum follow-up was five years.
The research team equipped 45 patients with a unilateral lower-leg orthosis developed at a facility in Germany. The orthoses were custom-made with resin and carbon and were built in three parts following Baise and Pohlig’s design with a circular foot unit, a lower-leg unit, and an inner liner made of Tepefoam. The foot unit followed the principles of the calcaneus-rotation-ring-type orthosis, described by Baise and Pohlig for the treatment of spastic clubfeet. It fixed the subtalar joint in a valgus position.
The 45 patients (75 feet) were retrospectively registered and included in the study. Compliance with the bracing protocol was 91 percent with the lower-leg orthosis and 46 percent with the foot abduction orthosis. The most common problems with the foot abduction orthosis were sleep disturbance (50 percent) and cutaneous problems (45 percent). With the lower-leg orthosis, nine percent of patients experienced sleep disturbance, and no cutaneous problems occurred.
Thirteen percent of patients being treated with a foot abduction orthosis until the age of four (23 patients; 40 feet) underwent surgery because of relapse, defined by rigid recurrence of any of the components of a clubfoot. Fourteen percent of patients being treated with a lower-leg orthosis (22 patients; 35 feet), who mostly following initial treatment with a foot abduction orthosis, experienced recurrence.
The open-access study, “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,” was published July 18 in BMC Musculoskeletal Disorders.