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Comparison of Surgeon and Physiotherapist-Directed Ponseti Treatment of Idiopathic Clubfoot

¹ Division of Pediatric Orthopaedic Surgery, Children's Memorial Hospital, 2300 Children's Plaza, Box 69, Chicago, IL 60614-3394
² Department of Orthopaedic Surgery, The Hospital for Sick Children, 555 University Avenue, S-107, Toronto, ON M5G 1X8, Canada. E-mail address: unni.narayanan{at}sickkids.ca
³ Orthopaedic Clubfoot Clinic, The Hospital for Sick Children, 555 University Avenue, M-550, Toronto, ON M5G 1X8, Canada
⁴ Department of Surgery, University of Toronto, 100 College Street, Room 302, Toronto, ON M5G 1L5, Canada
⁵ Child Health Evaluative Sciences Program, The Hospital for Sick Children, 123 Edward Street, Suite 401, Room 443, Toronto, ON M5G 1E2, Canada
⁶ Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Room 1254, Toronto, ON M5G 1X8, Canada

Investigation performed at The Hospital for Sick Children, Toronto, Ontario, Canada

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: We performed a retrospective cohort study of all patients with idiopathic clubfoot deformity treated from 2002 to 2006 and followed for a minimum of two years. Twenty-five children (thirty-four clubfeet) treated by surgeons were compared with ninety-five children (137 clubfeet) treated by a physiotherapist. The outcomes that were evaluated included the number of casts required, the rate of percutaneous Achilles tenotomy, the rate of recurrence, the failure rate, and the need for additional surgical procedures.

Results: At the time of presentation, the patients in the two groups were similar in terms of age, sex distribution, laterality of the clubfoot, and history of treatment. The mean duration of follow-up was thirty-four months in the physiotherapist-directed group and forty-eight months in the surgeon-directed group. No significant difference was found between the two groups with regard to the mean number of initial casts, the Achilles tenotomy rate, or the failure rate. Recurrence requiring additional treatment occurred in 14% of the feet in the physiotherapist-directed group and in 26% of the feet in the surgeon-directed group (p = 0.075). Additional procedures, including repeat Achilles tenotomy or a limited posterior or posteromedial release, were required in 6% of the feet in the physiotherapist-directed group and in 18% of those in the surgeon-directed group (p = 0.025).

Conclusions: In our institution, the Ponseti method of cast treatment of idiopathic clubfeet was as effective when it was directed by a physiotherapist as it was when it was directed by a surgeon, with fewer recurrences and a less frequent need for additional procedures in the physiotherapist-directed group. The introduction of the physiotherapist-supervised clubfoot clinic at our institution has been effective without compromising the quality of care of children with clubfoot deformity.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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