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Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet

PURPOSE: The Ponseti method for treating clubfoot was introduced in Norway in 2003, and a cohort of children has been followed for 8 to 11 years. In a previous study, we found good results after follow-up of two to five years, with 3% rate of extensive surgery (posterior release or posteromedial rel...

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Autores principales: Sætersdal, C., Fevang, J. M., Engesæter, L. B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone and Joint Surgery 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548038/
https://www.ncbi.nlm.nih.gov/pubmed/28828066
http://dx.doi.org/10.1302/1863-2548.11.160279
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author Sætersdal, C.
Fevang, J. M.
Engesæter, L. B.
author_facet Sætersdal, C.
Fevang, J. M.
Engesæter, L. B.
author_sort Sætersdal, C.
collection PubMed
description PURPOSE: The Ponseti method for treating clubfoot was introduced in Norway in 2003, and a cohort of children has been followed for 8 to 11 years. In a previous study, we found good results after follow-up of two to five years, with 3% rate of extensive surgery (posterior release or posteromedial release). During 8 to 11 years of follow-up, the rate of extensive surgery increased to 11%. The children had been treated with a bilateral brace or a unilateral brace. In this multicentre study we aimed to compare these two post-corrective treatment methods. METHODS: In all, 94 children (133 feet) were initially treated according to the Ponseti method, and had post-corrective treatment with either a bilateral foot abduction brace or a unilateral above-the-knee brace. The children were examined at a mean age of 9.3 years (8 to 11) regarding flexibility and deformity of the foot and ankle. Information including type of brace, brace compliance and surgical procedures was ­obtained from the patient records. The parents answered questionnaires and radiographs were taken of the feet. RESULTS: Feet treated with a bilateral brace had better dorsal flexion (p = 0.008), plantar flexion (p = 0.02), external rotation (p = 0.001) and less forefoot adduction (p = 0.04) than feet treated with a unilateral brace. Children using a bilateral brace had a better Functional Rating System score (p = 0.005) and Disease Specific Instrument score (p = 0.02). CONCLUSION: Children treated with a bilateral brace had better parent-reported outcomes and more flexible feet than children treated with a unilateral brace. Our results do not support the use of a unilateral foot abduction brace in clubfoot treatment.
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spelling pubmed-55480382017-08-21 Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet Sætersdal, C. Fevang, J. M. Engesæter, L. B. J Child Orthop Original Clinical Article PURPOSE: The Ponseti method for treating clubfoot was introduced in Norway in 2003, and a cohort of children has been followed for 8 to 11 years. In a previous study, we found good results after follow-up of two to five years, with 3% rate of extensive surgery (posterior release or posteromedial release). During 8 to 11 years of follow-up, the rate of extensive surgery increased to 11%. The children had been treated with a bilateral brace or a unilateral brace. In this multicentre study we aimed to compare these two post-corrective treatment methods. METHODS: In all, 94 children (133 feet) were initially treated according to the Ponseti method, and had post-corrective treatment with either a bilateral foot abduction brace or a unilateral above-the-knee brace. The children were examined at a mean age of 9.3 years (8 to 11) regarding flexibility and deformity of the foot and ankle. Information including type of brace, brace compliance and surgical procedures was ­obtained from the patient records. The parents answered questionnaires and radiographs were taken of the feet. RESULTS: Feet treated with a bilateral brace had better dorsal flexion (p = 0.008), plantar flexion (p = 0.02), external rotation (p = 0.001) and less forefoot adduction (p = 0.04) than feet treated with a unilateral brace. Children using a bilateral brace had a better Functional Rating System score (p = 0.005) and Disease Specific Instrument score (p = 0.02). CONCLUSION: Children treated with a bilateral brace had better parent-reported outcomes and more flexible feet than children treated with a unilateral brace. Our results do not support the use of a unilateral foot abduction brace in clubfoot treatment. The British Editorial Society of Bone and Joint Surgery 2017-06-01 /pmc/articles/PMC5548038/ /pubmed/28828066 http://dx.doi.org/10.1302/1863-2548.11.160279 Text en Copyright © 2017, The British Editorial Society of Bone and Joint Surgery: All rights reserved http://creativecommons.org/licenses/by-nc/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Original Clinical Article
Sætersdal, C.
Fevang, J. M.
Engesæter, L. B.
Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title_full Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title_fullStr Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title_full_unstemmed Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title_short Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet
title_sort inferior results with unilateral compared with bilateral brace in ponseti-treated clubfeet
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548038/
https://www.ncbi.nlm.nih.gov/pubmed/28828066
http://dx.doi.org/10.1302/1863-2548.11.160279
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