Skip to main content
SpringerLink
Log in

Improved bracing compliance in children with clubfeet using a dynamic orthosis

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Non-compliance with foot abduction bracing in children with clubfeet treated with the Ponseti method is the leading risk factor for deformity recurrence. A dynamic foot abduction orthosis is believed to result in improved compliance, fewer skin complications, and fewer recurrences. A case–control trial was conducted to test this hypothesis.

Methods

A prospective cohort of children with idiopathic clubfoot using a dynamic brace was compared to a historical control group treated with a standard orthosis. Compliance, skin complications, recurrence, and the need for surgical soft tissue release were compared between groups at equivalent follow-up.

Results

The dynamic and standard brace groups are equivalent in age at the start of treatment (1.9 vs. 2.9 months), number of affected feet (97 vs. 92), and severity (average of four casts required for correction in each group). Fifty-seven children were followed in each group for an average of 2 years. All were corrected initially with the Ponseti method. Compliance is higher using the dynamic brace (47/57, 81%) compared to the standard brace (21/57, 47%) (P < 0.001). The recurrence rate is lower using the dynamic brace (11/57, 19%) compared to the standard brace (22/57, 39%) (P < 0.02). Skin complications are fewer in the dynamic brace (2/57, 3%) compared to the standard brace (11/57, 19%) (P < 0.008). Most importantly, five children using the standard brace underwent posteromedial release within 2 years of treatment, compared to none in the dynamic brace group.

Conclusion

The dynamic foot abduction brace results in improved compliance, fewer recurrences, fewer skin complications, and reduced rates of surgery in idiopathic clubfoot than the traditional brace after non-operative correction with the Ponseti method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Heilig MR, Matern RV, Rosenzweig SD et al (2003) Current management of idiopathic clubfoot questionnaire: a multicentric study. J Pediatr Orthop 23:780–787. doi:10.1097/00004694-200311000-00017

    Article  Google Scholar 

  2. Bor N, Herzenberg JE, Frick SL (2006) Ponseti management of clubfoot in older infants. Clin Orthop Relat Res 444:224–228. doi:10.1097/01.blo.0000201147.12292.6b

    Article  Google Scholar 

  3. Colburn M, Williams M (2003) Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg 42:259–267. doi:10.1016/S1067-2516(03)00312-0

    Article  Google Scholar 

  4. Dobbs MB, Rudzki JR, Purcell DB et al (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 86-A:22–27

    Google Scholar 

  5. Herzenberg JE, Radler C, Bor N (2002) Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 22:517–521. doi:10.1097/00004694-200207000-00019

    Google Scholar 

  6. Morcuende JA, Abbasi D, Dolan LA et al (2005) Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 25:623–626. doi:10.1097/01.bpo.0000162015.44865.5e

    Article  Google Scholar 

  7. Morcuende JA, Dolan LA, Dietz FR et al (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113:376–380. doi:10.1542/peds.113.2.376

    Article  Google Scholar 

  8. Ponseti IV, Smoley EN (1963) Congenital club foot: the results of treatment. J Bone Joint Surg Am 45-A:261–266

    Google Scholar 

  9. Thacker MM, Scher DM, Sala DA et al (2005) Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 25:225–228. doi:10.1097/01.bpo.0000150814.56790.f9

    Article  Google Scholar 

  10. Tindall AJ, Steinlechner CW, Lavy CB et al (2005) Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world? J Pediatr Orthop 25:627–629. doi:10.1097/01.bpo.0000164876.97949.6b

    Article  Google Scholar 

  11. Cooper DM, Dietz FR (1995) Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am 77:1477–1489

    CAS  Google Scholar 

  12. Laaveg SJ, Ponseti IV (1980) Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 62:23–31

    CAS  Google Scholar 

  13. Ponseti IV (1996) Congenital clubfoot: fundamentals of treatment. Oxford University Press, New York

    Google Scholar 

  14. Haft GF, Walker CG, Crawford HA (2007) Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am 89:487–493. doi:10.2106/JBJS.F.00169

    Article  Google Scholar 

  15. Lehman WB, Mohaideen A, Madan S et al (2003) A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop B 12:133–140. doi:10.1097/00009957-200303000-00011

    Google Scholar 

  16. Aronson J, Puskarich CL (1990) Deformity and disability from treated clubfoot. J Pediatr Orthop 10:109–119

    Article  CAS  Google Scholar 

  17. Atar D, Lehman WB, Grant AD (1991) Complications in clubfoot surgery. Orthop Rev 20:233–239

    CAS  Google Scholar 

  18. Crawford AH, Gupta AK (1996) Clubfoot controversies: complications and causes for failure. Instr Course Lect 45:339–346

    CAS  Google Scholar 

  19. Dobbs MB, Nunley R, Schoenecker PL (2006) Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am 88:986–996. doi:10.2106/JBJS.E.00114

    Article  Google Scholar 

  20. Hutchins PM, Foster BK, Paterson DC et al (1985) Long-term results of early surgical release in club feet. J Bone Joint Surg Br 67:791–799

    CAS  Google Scholar 

  21. Ippolito E, Farsetti P, Caterini R et al (2003) Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am 85-A:1286–1294

    CAS  Google Scholar 

  22. Ponseti IV, Campos J (1972) Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res 84:50–60. doi:10.1097/00003086-197205000-00011

    Article  CAS  Google Scholar 

  23. Chotigavanichaya C, Scaduto AA, Snelson D et al (2003) A novel orthosis for the treatment of clubfoot. J Pediatr Orthop B 12:272–276. doi:10.1097/00009957-200307000-00007

    Google Scholar 

  24. Yamamoto H, Muneta T, Morita S (1998) Nonsurgical treatment of congenital clubfoot with manipulation, cast, and modified Denis Browne splint. J Pediatr Orthop 18:538–542. doi:10.1097/00004694-199807000-00027

    CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge Matthew B. Dobbs, MD, for the use of his patients as the research material for this study, Melissa Kirchofer for assistance in gathering the clinical records, and Jie Zheng for the statistical analysis.

Author information

Authors and Affiliations

  1. Washington University Orthopaedics, 660 S. Euclid Ave, Mail Stop 8233, St. Louis, MO, 63110, USA

    Sumeet Garg

  2. Shriners Hospital for Children, 2001 S. Lindbergh Blvd., St. Louis, MO, 63131-3597, USA

    Kristina Porter

Authors
  1. Sumeet Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sumeet Garg.

About this article

Cite this article

Garg, S., Porter, K. Improved bracing compliance in children with clubfeet using a dynamic orthosis. J Child Orthop 3, 271–276 (2009). https://doi.org/10.1007/s11832-009-0182-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-009-0182-9

Keywords

Search

Navigation