Abstract
The Ponseti method has become accepted worldwide as the treatment of choice for nonoperative
management of clubfoot. However, there has been no research on whether casting should
begin in the newborn period (≤ 30 days old) or later (> 30 days but < 1 year old)
or on whether the length of the foot at the beginning of casting is predictive of
the outcome of therapy. Therefore, we conducted an investigation to compare outcomes
in patients started on casting therapy in the newborn period or later. Outcomes were
based on Pirani and Diméglio scores. The study population was comprised of 40 clubfeet
in 29 consecutive infants with no associated neuromuscular disease, who underwent
Ponseti treatment. The median follow-up was 34 months (range, 20-47 months). Casting
began in the newborn period on 26 feet of 18 patients (newborn group), and after 1
month of age on 14 feet of 11 patients (older infant group). Final Diméglio scores
were significantly worse for the patients whose casts were applied in the newborn
period, compared with those who had the first cast applied at a time >30 days postpartum
(P = .04). Infants with feet ≥8 cm in length at the start of cast treatment had better
final Diméglio scores than those with feet <8 cm. Our findings suggest that casting
according to the Ponseti method should begin in infants older than 1 month of age,
or with an involved foot ≥8 cm in length.
Level of Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
