The Ponseti protocol for treating idiopathic talipes equinovarus requires four years of orthotic management to guarantee good results, and a recent study has shown that it is difficult for patients to comply with the orthotic post-treatment protocol. A new study in the September 2011 issue of the Journal of Pediatric Orthopaedics evaluated whether poor compliance is due to the complexity of the orthotic use or if it is related to family education, cultural, or income factors.
The study cohort included 53 patients with 73 idiopathic talipes equinovarus feet, who were treated with the Ponseti technique. The five-member research team followed the patients for 48 months after completing the cast treatment. There was a male predominance (72 percent). The mean age at presentation was one month (range: one week to seven months). Twenty patients (38 percent) had bilateral involvement, 17 patients (32 percent) had right-side involvement, and 16 patients (30 percent) had left-side involvement. The mean time of manipulation and casting treatment was six weeks (range: four to ten weeks). Thirty-eight patients (72 percent) required Achilles tenotomy as stipulated by the protocol. Recurrence was considered if there was a deterioration of the Dimeglio severity score requiring re-manipulation and casting.
The results show a recurrence rate of 33 percent. Sex, age at presentation, cast-treatment duration, unilateral or bilateral, severity score, the necessity of Achilles tenotomy, family educational, or income level did not reveal any significant correlation with the recurrence risk; however, noncompliance with the orthotic use showed a significant correlation with the recurrence rate. The noncompliance rate did not show any correlation with the patient demographic data or parent’ education level, insurance, or cultural factors.
The researchers concluded that the use of the brace is extremely relevant to the Ponseti technique outcomes in the treatment of idiopathic talipes equinovarus. Further, they recommend that the Ponseti post-casting orthotic protocol be reevaluated and that a less demanding option be developed to improve outcome and brace compliance.
Researchers on the study include Norman Ramírez-Lluch, MD, and John M. Flynn, MD, of the Pediatric Orthopaedic Department, Hospital de La Concepción, San Germán, Puerto Rico; Samuel Fernández, MD, Pediatric Orthopaedic Department, Hospital San Pablo, Bayamón, Puerto Rico; Wallace Seda, BS, University of Puerto Rico, Mayagüez; and Raúl E. Macchiavelli, PhD, College of Agricultural Sciences, University of Puerto Rico, Mayagüez.
