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Klumpfußbehandlung im Wandel der Zeit

Die Ponseti-Methode im Vergleich zu anderen konservativen Therapieansätzen sowie operativen Verfahren

Clubfoot treatment through the ages

The Ponseti method in comparison to other conservative approaches and operative procedures

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Zusammenfassung

Der Klumpfuß gehört zu den häufigsten kongenitalen Deformitäten des muskuloskelettalen Systems mit Inzidenzen von 0,6–6,8/1000 Lebendgeburten. Die Klumpfußbehandlung gehört geschichtlich zu einer der ältesten orthopädischen Therapien. Bis zum Ende des 19. Jahrhunderts galt die Therapie durch Redression mit unterschiedlichsten Hilfsmitteln wie Zwingen, Orthesen und Gipsverbänden als Standard der Klumpfußbehandlung. Durch die Weiterentwicklung der operativen Möglichkeiten und die Erkenntnis, dass die Band- und Kapselstrukturen auf Druck und Dehnung viel resistenter reagieren als umgebender Knorpel und Knochen, wurde die operative Therapie im späten 20. Jahrhundert favorisiert. Die operative Korrektur beinhaltet das Release der kontrakten Kapsel- und Bandstrukturen unterschiedlichen Ausmaßes sowie die Verlängerung von Sehnen.

Im Jahr 1963 publizierte Ponseti seine Methode. Er erkannte die Innenrotation und Plantarflexion des Kalkaneus als Schlüsseldeformität. Allerdings setzte sich seine Methode erst um die Jahrtausendwende zunehmend weltweit durch, als man in Langzeitstudien erkannte, dass die Releaseoperationen zu narbiger steifer Verheilung führen und die Gefahr der Überkorrektur in sich bergen.

Viele vergleichende Studien zeigen die Überlegenheit der Ponseti-Methode hinsichtlich Invasivität, Primärkorrekturrate, funktionellem Ergebnis als auch Rezidivrate sowohl beim idiopathischen als auch nichtidiopathischen Klumpfuß. In der vorliegenden Arbeit wird die diesbezüglich vorliegende aktuelle Literatur vorgestellt. Des Weiteren zeigt sie herausragende Meilensteine in der Entwicklung der Klumpfußbehandlung auf.

Abstract

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.

In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.

Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.

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  1. Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    H. Delbrück, M. Schaltenbrand, S. Schröder & C. Schwenninger

  2. Orthopädische Universitätsklinik Friedrichsheim, Frankfurt a.M., Deutschland

    M. Rauschmann

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  2. M. Schaltenbrand
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Correspondence to H. Delbrück.

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Delbrück, H., Schaltenbrand, M., Schröder, S. et al. Klumpfußbehandlung im Wandel der Zeit. Orthopäde 42, 427–433 (2013). https://doi.org/10.1007/s00132-012-1989-5

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