Though treatment of idiopathic clubfoot has shifted from extensive surgical release to conservative Ponseti method, randomized prospective trials to compare both methods are lacking. Researchers, therefore, conducted a study to compare the long-term results of Ponseti method with those of surgery in terms of morphology, function, X-rays, overall health and gait. The results of the study, published in the September issue of Gait & Posture, suggest the Ponseti method provides superior long-term outcomes for idiopathic clubfoot deformity.
A single center, prospective, randomized, and controlled trial with a parallel design began in 2001. Twenty-four feet of 15 patients were randomly assigned to two groups: 12 feet each to a Ponseti and surgical group. Mean follow-up was 10 years. International Clubfoot Study Group score (ICFSG), the Pediatric Outcomes Data Collection Instrument (PODCI), and the Functional Rating System (FRS) were used to compare morphology, functional, radiological and subjective outcomes, and the Oxford Foot Model (OFM) was used to evaluate foot kinematics.
No significant difference was seen between groups in the initial Pirani scores. The Ponseti group had more favorable long-term outcomes according to the FRS, higher ICFSG scores for morphology, function, and X-rays, as well as better parent-reported functional status according to the PODCI. Surgically treated clubfeet were stiffer—ankle dynamic range of motion and the maximal hindfoot dorsiflexion during gait were limited as measured by the OFM. This was compensated by an increase in motion between the hindfoot and forefoot. Children whose clubfeet were surgically treated also had more difficulty playing sports and experienced more pain, which might have led to inferior results in the happiness domain of the PODCI, according to the study.
