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Long-Term Comparative Results in Patients with Congenital Clubfoot Treated with Two Different Protocols

Investigation performed at the Department of Orthopaedic Surgery, University of Rome, Rome, Italy

E. Ippolito, MD
P. Farsetti, MD
R. Caterini, MD
C. Tudisco, MD
Department of Orthopaedic Surgery, University of Rome "Tor Vergata," Via Montpellier, 1-00133 Rome, Italy. E-mail address for E. Ippolito: e.ippolito{at}mclink.it

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Santa Lucia Foundation for Assistance and Research, which allowed them to perform all of the radiographic and computed tomography studies in its hospital. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Long-term follow-up studies of adults who had been treated for congenital clubfoot as infants are rare. The purpose of this study was to review and compare the long-term results in two groups of patients with congenital clubfoot treated with two different techniques. In both groups, treatment was started within the first three weeks of life by manipulation and application of toe-to-groin plaster casts, with a different technique in each group. At the end of the manipulative treatment, a posteromedial release was performed when the patient was between eight and twelve months of age in the first group and a limited posterior release was performed when the patient was between two and four months of age in the second group.

Methods: At the follow-up evaluations, all patients were interviewed and examined, and standing anteroposterior and lateral radiographs and computed tomography scans of the foot were made. The results of treatment were graded according to the system of Laaveg and Ponseti. Numerous angular measurements were made on the radiographs, and the measurements in the two groups were compared.

Results: The first group, which included thirty-two patients (forty-seven clubfeet), was followed until an average age of twenty-five years. The second group, with thirty-two patients (forty-nine clubfeet), was followed until an average age of nineteen years. In the first group, there were two excellent, eighteen good, eleven fair, and sixteen poor results. In the second group, there were eighteen excellent, twenty good, six fair, and five poor results. According to the system of Laaveg and Ponseti, the mean rating in the first group was 74.7 points and that in the second group was 85.4 points.

Conclusions: In the second group, use of Ponseti's manipulation technique and cast immobilization followed by an open heel-cord lengthening and a limited posterior ankle release gave much better long-term results than those obtained in the first group, treated with our manipulation technique and cast immobilization followed by an extensive posteromedial release of the foot. In our hands, this operation did not prevent relapse, and neither cavovarus nor forefoot adduction was completely corrected.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

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Long-Term Comparative Results in Patients with Congenital Clubfoot Treated with Two Different Protocols • E. Ippolito, P. Farsetti, R. Caterini, and C. Tudisco reply

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