Two non-surgical treatments, the Ponseti method and the French functional method, are effective in treating
clubfoot and provide sustained improvements.
Clubfoot is a birth defect in which the foot is angled improperly. The Ponseti method of correcting the defect involves serial casting of the leg on a weekly basis, as the foot is stretched closer and closer to the correct position. The French functional method, a type of physiotherapy, involves daily stretching, exercising, massaging, and immobilising the foot with tape, to slowly correct the abnormal position.
Researchers from America compared the outcomes of 176
children (i.e. 267 feet) treated with the Ponseti method and 80 children (i.e. 119 feet) treated with the French functional method. All the participants were under 3 months of age at the time of the treatment and the average follow-up period was 4 years. The patient's parents selected the type of treatment.
It was found that the Ponseti method was better than the French functional method, although the differences were not statistically significant. The initial correction rates for the Ponseti and French functional methods were 94 percent and 95 percent respectively. Relapses were seen in 37 percent of the feet treated with the Ponseti method and 29 percent of the feet treated with the French functional method. Roughly one-third of the former were able to avoid
surgery with further non-surgical treatment, whereas all of the latter required surgical intervention.
At a follow up of after 4 years, the Ponseti treatment was found to be associated with good outcomes in 72 percent children, fair outcomes in 12 percent and poor in 16 percent. The corresponding proportions with the French functional method were 67 percent, 17 percent and 16 percent respectively.
The researchers concluded that the non-operative primary treatment for clubfeet in recent years has been warranted, regardless of whether the Ponseti method or the French functional method is used.
The Journal of Bone and Joint Surgery
November 2008
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