The ‘Hybrid method’ for the treatment of congenital clubfoot

BACKGROUND: The hybrid method combines the advantages of the Ponseti technique and of the French Physical Therapy method. The main goal of this study is to present our results on 139 consecutive newborns with clubfoot (n=212 feet) treated at our Institution with the hybrid method. METHODS: From May 2010 until August 2020, 139 consecutive newborns with congenital clubfoot (66 unilateral; 73 bilateral) were treated by the hybrid method protocol and were retrospectively reviewed. All patients were admitted via the maternity ward with their family and personal history records, i.e., parental age, parity, gender, birth weight, involved side and presence/absence of associated medical conditions. At birth, all clubfeet were graded in ascending order of severity according to Dimeglio et al.’s classification system. AP and lateral radiographs of each foot are taken every 5 to 6 months from age 6 months to 2 years, then once a year until age 4 years, to assess divergence between talus and calcaneus on both projections RESULTS: The cohort counted a total of 100 boys (71.9%) and 39 girls (28.1%). Clubfoot was unilateral in 66 patients (47.5%) and bilateral in 73 (52.5%). All but 10 patients had idiopathic clubfoot deformity (92.8%). Mean number of casts per patient was 8 (range: 4–11). One hundred and thirty patients out of 139 underwent percutaneous Achilles tenotomy under general anesthesia (93.5%). Overall, tibialis anterior transfer was performed in 6/212 feet (2.8%), posterior release in 9/212 (4.2%) and medial release in 1/212 foot (0.05%). CONCLUSIONS: Our experience with the hybrid method has allowed us to constantly reduce the number of patients requiring surgery over the years, as well as the extent of surgical release. These results are encouraging, but larger cohorts of patients from different institutions and with longer follow up are needed to confirm our findings.