Clubfoot is a congenital deformity
that occurs in 1/10.000 birth. It is more common in boys. The deformity includes
four components: metatarsus adductus, cavus, hindfoot varus and equinus.
Treatment of clubfoot has evolved
from minimal surgery to casting technique then to extensive surgery.
The old serial casting technique,
known as Kite technique, has been the standard one for almost half century.
However, the excellent results of Dr Kite could not be reproduced by most of the
Orthopedic Surgeon. This failure has lead to the misconception of 2 clubfoot
types: positional clubfoot that would respond to the casting; and the true
clubfoot that would need surgical release.
In the last 2 decades, and with
the increase of surgical expertise of the Pediatric Orthopedic Surgeons,
posteromedial release at the age of 1 year became the standard treatment;
casting was used to distract the soft tissue and skin to decrease the rate of
wound dehiscence.
Ignatio Ponseti, one of the
Pionner of pediatric Orthopaedics in North America has developed a new casting
technique, based on 2 concepts:
1-
the basic deformity in the clubfoot is fibrosis of the
soft tissue
2-
Abduction of the forefoot with a countertraction applied
on the head of talus is capable to allow the calcaneus to freely derotate to its
normal position.
Since the fifties, Ponseti has managed to treat hundreds of
clubfoot deformity in his arena ‘Iowa University Hospital’. He had little time
to spend on advertising his technique; thus the world had to wait till the
nineties when one of his fellows and his successor published the results of
Ponseti technique with 20 years follow up. Since then, it became evident that
Ponseti casting technique will result in more than 90% of excellent correction
without the need of extensive surgical release. The real advantage is the
preservation of the foot and ankle mobility so the functional score is much
better than in kids treated with surgery.
Ponseti technique has gained popularity worldwide and it is
the treatment of choice for clubfoot in North America.
