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Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review

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Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 19 February 2014

Abstract

Background

Although the Ponseti method is accepted as the best choice for treatment of clubfoot, the treatment protocol is labor intensive and requires strict attention to details. Deviations in strict use of this method are likely responsible for the variations among centers in reported success rates.

Questions/purposes

We wished to determine (1) to what degree the Ponseti method was followed in terms of manipulation, casting, and percutaneous Achilles tenotomy, (2) whether there was variation in the bracing type and protocol used for relapse prevention, and (3) if the same criteria were used to diagnose and manage clubfoot relapse.

Methods

We conducted a systematic review of MEDLINE, EMBASETM, and the Cochrane Library. Studies were summarized according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Five hundred ninety-one records were identified with 409 remaining after deduplication, in which 278 irrelevant studies and 22 review articles were excluded. Of the remaining 109 papers, 19 met our inclusion criteria. All 19 articles were therapeutic studies of the Ponseti method.

Results

The details of manipulation, casting, or percutaneous Achilles tenotomy of the Ponseti method were poorly described in 11 studies, whereas the main principles were not followed in three studies. In three studies, the brace type deviated significantly from that recommended, whereas in another three studies the bracing protocol in terms of hours of recommended use was not followed. Furthermore no unified criteria were used for judgment of compliance with brace use. The indication for recognition and management of relapse varied among studies and was different from the original description of the Ponseti method.

Conclusions

We found that the observed clinically important variation may have been the result of deviations from the details regarding manipulation, casting, percutaneous Achilles tenotomy, use of the bar-connected brace, and indication for relapse recognition and management recommended for the classic Ponseti approach to clubfoot management. We strongly recommend that clinicians follow the Ponseti method as it initially was described without deviation to optimize treatment outcomes.

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Acknowledgments

We thank David A. Spiegel MD and Monica P. Nogueira MD for their input in the discussion and communications which encouraged us to do this investigation.

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Authors and Affiliations

  1. Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China

    Dahang Zhao MD, Hai Li MD, PhD, Li Zhao MD, PhD, Jianlin Liu MD, Zhenkai Wu MD & Fangchun Jin MD, PhD

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  1. Dahang Zhao MD
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  2. Hai Li MD, PhD
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Corresponding author

Correspondence to Li Zhao MD, PhD.

Additional information

The institution of all the six authors has received, during the study period, funding from the Science Foundation of Shanghai Science and Technology Commission (11ZR1423900).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Zhao, D., Li, H., Zhao, L. et al. Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review. Clin Orthop Relat Res 472, 1329–1336 (2014). https://doi.org/10.1007/s11999-014-3463-7

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  • DOI: https://doi.org/10.1007/s11999-014-3463-7

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