Abstract

The optimal management of idiopathic clubfoot has changed over three decades. Recently there has been an enthusiastic embracing of the Ponseti technique with a move away from the traditional stretch and strap technique. The purpose of this 14-year comparative prospective longitudinal study was to directly assess the differences in results between these two treatment methods. Over the period of this study there were 52,514 births in the local population and all newborns with clubfoot were referred directly to the paediatric orthopaedic surgeon. Patient demographics, the Harrold & Walker Classification, and associated risk factors for clubfoot were collected prospectively and analyzed. If conservative treatment failed to correct the deformity adequately, a radical subtalar release (RSR) was undertaken (the primary outcome measure of the study). There were 114 feet (80 patients) : 64 feet treated ‘traditionally' and 50 feet with the Ponseti technique. Idiopathic clubfoot was present in 76.25% of patients. Mean time to RSR was 33.3 and 44.1 weeks for the traditional and Ponseti groups respectively. In the traditional group 65.6% (CI : 53.4 to 76.1%) of feet underwent RSR surgery compared to 25.5% (CI : 15.8 to 38.3%) in the Ponseti group. When idiopathic clubfoot alone was analysed, these rates reduce to 56.5% (CI : 42.3 to 69.8%) and 15.8% (CI : 7.4 to 30.4%) respectively. The Relative Risk of requiring RSR in traditional compared to Ponseti groups was 2.58 (CI : 1.59 to 4.19) for all patients and 3.58 (CI : 1.65 to 7.78) for idiopathic clubfoot. Introduction of the Ponseti technique into our institution significantly reduced the need for RSR in fixed clubfoot.