Skip to main content
SpringerLink
Log in

Evidence-Based Treatment for Clubfoot

  • Chapter
  • First Online:
Paediatric Orthopaedics

  • 1990 Accesses

Abstract

The management of clubfoot has been the subject of active research interest for some time and there is a large body of evidence supporting its treatment strategy. The spectrum of evidence includes randomised controlled trials (RCT), long term prospective follow up as well as systematic reviews including a recent Cochrane review. The actual quality of evidence does vary and there are no real level I studies. Besides, evidence was not always available for the most pertinent clinical questions. However, most published evidence consistently supported the superiority of the Ponseti technique for treating idiopathic clubfoot. Evidence was less clear for management of the complex idiopathic type or the non-idiopathic type clubfoot. Since the publication of results from Ponseti’s team this technique has been adopted widely and results published from numerous centres from as far afield as Brazil to Bangladesh. On the basis of available publications it is estimated that the Ponseti technique is in use in at least 113 countries around the world Shabtai et al. (World J Orthop 5:585–590, 2014). The basic principle of the Ponseti technique is well established although minor variations have been attempted by different researchers. In the ensuing paragraphs we have reviewed the evidence base for management of clubfoot recommendations.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Shabtai L, Specht SC, Herzenberg JE. Worldwide spread of the Ponseti method for clubfoot. World J Orthop. 2014;5(5):585–90.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ponseti I, Morcuende J, Mosca V, Pirani S, Dietz F, Herzenberg J. Clubfoot: Ponseti management. 2nd ed. Global-HELP Organization; 2005.

    Google Scholar 

  3. Gray K et al. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev. 2014;8:CD008602.

    Google Scholar 

  4. Sanghvi AV, Mittal VK. Conservative management of idiopathic clubfoot: Kite versus Ponseti method. J Orthop Surg (Hong Kong). 2009;17(1):67–71.

    Article  CAS  Google Scholar 

  5. Sud A et al. Ponseti’s vs. Kite’s method in the treatment of clubfoot–a prospective randomised study. Int Orthop. 2008;32(3):409–13.

    Article  PubMed  Google Scholar 

  6. Rijal R et al. Comparison of Ponseti and Kite’s method of treatment for idiopathic clubfoot. Indian J Orthop. 2010;44(2):202–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77(10):1477–89.

    Article  CAS  PubMed  Google Scholar 

  8. Ippolito E et al. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85-A(7):1286–94.

    Article  CAS  PubMed  Google Scholar 

  9. Smith PA et al. Long-term results of comprehensive clubfoot release versus the Ponseti method: which is better? Clin Orthop Relat Res. 2013;472(4):1281–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Alshryda S, Wright J. Congenital club foot: the result of treatment, in classic papers in Orthopaedics. London: Springer; 2014. p. 571–3.

    Google Scholar 

  11. Richards BS et al. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008;90(11):2313–21.

    Article  PubMed  Google Scholar 

  12. Steinman S et al. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2):299–312.

    Article  PubMed  Google Scholar 

  13. Faulks S, Richards BS. Clubfoot treatment: Ponseti and French functional methods are equally effective. Clin Orthop Relat Res. 2009;467(5):1278–82.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gottschalk HP, Karol LA, Jeans KA. Gait analysis of children treated for moderate clubfoot with physical therapy versus the Ponseti cast technique. J Pediatr Orthop. 2010;30(3):235–9.

    Article  PubMed  Google Scholar 

  15. Jeans KA, Karol LA. Plantar pressures following Ponseti and French physiotherapy methods for clubfoot. J Pediatr Orthop. 30(1):82–9.

    Google Scholar 

  16. Jeans KA, Erdman AL, Karol LA. Plantar pressures after nonoperative treatment for clubfoot: intermediate follow-up at age 5 years. J Pediatr Orthop. 2015. (published ahead of print). doi: 10.1097/BPO.0000000000000589.

  17. Zwick EB et al. Comparison of Ponseti versus surgical treatment for idiopathic clubfoot: a short-term preliminary report. Clin Orthop Relat Res. 2009;467(10):2668–76.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23–31.

    Article  CAS  PubMed  Google Scholar 

  19. Graf A et al. Long-term outcome evaluation in young adults following clubfoot surgical release. J Pediatr Orthop. 2010;30(4):379–85.

    Article  PubMed  Google Scholar 

  20. Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006;88(5):986–96.

    PubMed  Google Scholar 

  21. Lourenco AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg Br. 2007;89(3):378–81.

    Article  CAS  PubMed  Google Scholar 

  22. Khan SA, Kumar A. Ponseti’s manipulation in neglected clubfoot in children more than 7 years of age: a prospective evaluation of 25 feet with long-term follow-up. J Pediatr Orthop B. 2010;19(5):385–9.

    Article  PubMed  Google Scholar 

  23. Yagmurlu MF et al. Ponseti management of clubfoot after walking age. Pediatr Int. 2011;53(1):85–9.

    Article  PubMed  Google Scholar 

  24. Banskota B et al. The Ponseti method in the treatment of children with idiopathic clubfoot presenting between five and ten years of age. Bone Joint J. 2013;95-B(12):1721–5.

    Article  CAS  PubMed  Google Scholar 

  25. Ayana B, Klungsoyr PJ. Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia. A prospective study of 22 children (32 feet) from 2 to 10 years of age. Acta Orthop. 2014;85(6):641–5.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Singh A. Evaluation of neglected idiopathic ctev managed by ligamentotaxis using jess: a long-term followup. Adv Orthop. 2011;2011:218489.

    Article  PubMed  Google Scholar 

  27. Singh A et al. Ligamentotaxis for complex calcaneal fractures using Joshi’s external stabilization system. Indian J Orthop. 2008;42(3):330–5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ponseti I. Congenital clubfoot: fundamentals of treatment. 2nd ed. Oxford: Oxford University Press; 1996.

    Google Scholar 

  29. Iltar S et al. Treatment of clubfoot with the Ponseti method: should we begin casting in the newborn period or later? J Foot Ankle Surg. 2010;49(5):426–31.

    Article  PubMed  Google Scholar 

  30. Bohm S, Sinclair M. Report of the 1st European consensus meeting on Ponseti clubfoot treatment. J Child Orthop. 2013. doi:10.1007/s11832-013-0497-4.

  31. Pittner DE, Klingele KE, Beebe AC. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. J Pediatr Orthop. 2008;28(2):250–3.

    Article  PubMed  Google Scholar 

  32. Hui C et al. Comparison of cast materials for the treatment of congenital idiopathic clubfoot using the Ponseti method: a prospective randomized controlled trial. Can J Surg. 2014;57(4):247–53.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Brewster MB et al. Ponseti casting: a new soft option. J Bone Joint Surg Br. 2008;90(11):1512–5.

    Article  CAS  PubMed  Google Scholar 

  34. Maripuri SN et al. Ponseti casting for club foot – above- or below-knee? A prospective randomised clinical trial. Bone Joint J. 2013;95-B(11):1570–4.

    Article  CAS  PubMed  Google Scholar 

  35. Morcuende JA et al. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005;25(5):623–6.

    Article  PubMed  Google Scholar 

  36. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report. J Pediatr Orthop. 2011;31(3):317–9.

    Article  CAS  PubMed  Google Scholar 

  37. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol. 2015;25(5):949–53.

    Article  PubMed  Google Scholar 

  38. Harnett P et al. An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br. 2011;93(3):404–8.

    Article  CAS  PubMed  Google Scholar 

  39. Terrazas-Lafargue G, Morcuende JA. Effect of cast removal timing in the correction of idiopathic clubfoot by the Ponseti method. Iowa Orthop J. 2007;27:24–7.

    Google Scholar 

  40. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082–4.

    Article  CAS  PubMed  Google Scholar 

  41. Radler C et al. Midterm results of the Ponseti method in the treatment of congenital clubfoot. Int Orthop. 2013;37(9):1827–31.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160–4.

    Article  CAS  PubMed  Google Scholar 

  43. Ponseti IV, Morcuende JA. Current management of idiopathic clubfoot questionnaire: a multicenter study. J Pediatr Orthop. 2004;24(4):448.

    Article  PubMed  Google Scholar 

  44. Zionts LE et al. The current management of idiopathic clubfoot revisited: results of a survey of the POSNA membership. J Pediatr Orthop. 2012;32(5):515–20.

    Article  PubMed  Google Scholar 

  45. Radler C. The Ponseti method for the treatment of congenital club foot: review of the current literature and treatment recommendations. Int Orthop. 2013;37(9):1747–53.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Alvarez CM et al. The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up. J Pediatr Orthop. 2009;29(6):570–5.

    Article  PubMed  Google Scholar 

  47. Cummings RJ. The effectiveness of botulinum A toxin as an adjunct to the treatment of clubfeet by the Ponseti method: a randomized, double blind, placebo controlled study. J Pediatr Orthop. 2009;29(6):564–9.

    Article  PubMed  Google Scholar 

  48. Zhao D et al. Results of clubfoot management using the Ponseti method: do the details matter? A systematic review. Clin Orthop Relat Res. 2014;472(4):1329–36.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Zhao D et al. Relapse of clubfoot after treatment with the Ponseti method and the function of the foot abduction orthosis. Clin Orthop Surg. 2014;6(3):245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop. 2013;47(4):370–6.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Dobbs MB et al. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004;86-A(1):22–7.

    Article  PubMed  Google Scholar 

  52. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am. 2007;89(3):487–93.

    PubMed  Google Scholar 

  53. Ponseti IV. Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J. 2002;22:55–6.

    PubMed  PubMed Central  Google Scholar 

  54. Lovell ME, Morcuende JA. Neuromuscular disease as the cause of late clubfoot relapses: report of 4 cases. Iowa Orthop J. 2007;27:82–4.

    PubMed  PubMed Central  Google Scholar 

  55. Morin ML, Hoopes DM, Szalay EA. Positive communication paradigm decreases early recurrence in clubfoot treatment. J Pediatr Orthop. 2013;34(2):219–22.

    Article  Google Scholar 

  56. Ponseti IV et al. Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res. 2006;451:171–6.

    Article  PubMed  Google Scholar 

  57. Turco V. Recognition and management of the atypical idiopathic clubfoot. Foot Ankle. 1991;11(5):328.

    Google Scholar 

  58. Morcuende JA, Dobbs MB, Frick SL. Results of the Ponseti method in patients with clubfoot associated with arthrogryposis. Iowa Orthop J. 2008;28:22–6.

    PubMed  PubMed Central  Google Scholar 

  59. Boehm S et al. Early results of the Ponseti method for the treatment of clubfoot in distal arthrogryposis. J Bone Joint Surg Am. 2008;90(7):1501–7.

    Article  PubMed  Google Scholar 

  60. Gerlach DJ et al. Early results of the Ponseti method for the treatment of clubfoot associated with myelomeningocele. J Bone Joint Surg Am. 2009;91(6):1350–9.

    Article  PubMed  Google Scholar 

  61. Janicki JA et al. Treatment of neuromuscular and syndrome-associated (nonidiopathic) clubfeet using the Ponseti method. J Pediatr Orthop. 2009;29(4):393–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Royal Manchester Children’s Hospital, Manchester, UK

    Munier Hossain

  2. Department of Paediatric Orthopaedic Surgery, Royal Manchester Children’s Hospital, Manchester, UK

    Naomi Davis

Authors
  1. Munier Hossain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naomi Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Munier Hossain .

Editor information

Editors and Affiliations

  1. Royal Manchester Children’s Hospital, Manchester, United Kingdom

    Sattar Alshryda

  2. Sidra Medical and Research Center, Doha, Qatar

    James S. Huntley

  3. Queen Elizabeth Hospital, Gateshead, United Kingdom

    Paul A. Banaszkiewicz

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Hossain, M., Davis, N. (2017). Evidence-Based Treatment for Clubfoot. In: Alshryda, S., Huntley, J., Banaszkiewicz, P. (eds) Paediatric Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-41142-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-41142-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-41140-8

  • Online ISBN: 978-3-319-41142-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation