Management of Clubfoot
Introduction[edit | edit source]
Clubfoot has been managed over the years both conservatively and surgically.
Conservative Methods[edit | edit source]
Of the all the nonsurgical treatment options that are currently available, one technique that has been shown to be safer and more efficient than surgery for the treatment of clubfoot is Ponseti's Method.[1] This method was came about around 1990[2] and has since gained popularity to the point where it is now considered to be the approved gold standard for the treatment of idiopathic clubfoot in numerous countries. Other conservative methods, such as Kite’s Method and the French Method, also exist and are still applied in many clinical settings.[1]
A recent meta-analysis of nine eligible studies concluded that Ponseti’s Method decreases the number of surgical interventions required as compared to other “non-Ponseti” methods. Analysis of the pooled odds ratios demonstrated a significantly higher rate of poor-to-fair results, relapses, and requirement for major surgery when using Kite’s method as opposed to Ponseti’s, but no significant difference was detected comparing Ponseti’s to the French method.[1]
This present meta-analysis showed that Ponseti’s method avoided major surgery among various institutions in an average of 84.9% patients, succeeded in an average of 75.6% patients, and achieved a good-to-excellent functional prognosis in an average of 91.1% patients.[1]
Surgical Intervention[edit | edit source]
Guidelines[edit | edit source]
Recently, the Dutch Clubfoot Guideline on Primary Treatment of Clubfoot was developed aimed at providing evidence-based advice to both clinicians and parents in order to minimize variation in treatment and improve therapeutic compliance. This guideline covers the primary diagnosis and treatment of idiopathic clubfoot in children presenting with the deformity in the first 6 months after birth, but does not cover the treatment of clubfeet after delay or in children with residual deformities.[2]
The Dutch Clubfoot Guidelines address the following four clinical questions:
- What is the optimal treatment for clubfoot?
- What is the importance of brace compliance and other patient-related factors in the successful treatment of clubfoot?
- What is the optimal method to be used for the diagnosis and classification of a clubfoot?
- With respect to organization of care, what are the preconditions for optimal treatment of patients with clubfoot?
Resources[edit | edit source]
- The Dutch Clubfoot Guidelines: http://www.tandfonline.com/doi/full/10.1080/17453674.2017.1294416
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 He JP, Shao JF, Hao Y. Comparison of different conservative treatments for idiopathic clubfoot: Ponseti's versus non-Ponseti's methods. J Int Med Res, 2017; 45(3): 1190-1199.
- ↑ 2.0 2.1 Besselaar AT, Sakkers RJB, Schuppers HA, Witbreuk MMEH, Zeegers EVCM, Visser JD, Boekestijn RA, Margés SD, Van der Steen MCM, Burger KNJ. Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta Orthop, 2017; 88(3): 305-309.
