Brace Yourselves: Outcomes of Ponseti Casting and Foot Abduction Orthosis Bracing in Idiopathic Congenital Talipes Equinovarus

Alexander L. Kuzma, Vishwas R. Talwalkar, Ryan D. Muchow, Henry J. Iwinski, Todd A. Milbrandt, Cale A. Jacobs, Janet L. Walker

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background:Foot abduction orthoses (FAO) are believed to decrease recurrence following treatment of congenital talipes equinovarus (CTEV) as described by Ponseti. The purpose of this project is to examine the outcomes of FAO bracing following treatment by the Ponseti method in a cohort of idiopathic CTEV patients.Methods:After IRB approval, a cohort of patients aged 3 to 46 days with idiopathic CTEV was identified in a previous prospective study of brace compliance by family report and sensor. Dimeglio score and family demographic information were collected. Initial treatment was by the Ponseti method, with or without Achilles tenotomy. Following correction, patients had three months of full-time FAO bracing during which parents kept a log of compliance. Patients were followed until recurrence (need for further treatment) or age 5.Results:In total, 42 patients with 64 affected feet met the above criteria and were included in the final analysis. Twenty-six feet (40%) went on to develop recurrence requiring further treatment, including casting, bracing, or surgery. Because of poor tolerance of the original FAO, 20 feet were transitioned to an alternative FAO, and 14 of these (70%) went on to recur (P<0.01). The casting duration (P=0.02) had a statistically significant relationship to recurrence. Patients who were casted for 9 weeks or more had a higher rate of recurrence (57.1% vs. 27.8%; P=0.02). Age at treatment start, Dimeglio score, demographic factors, and compliance during full-time bracing, whether by report or sensor, did not show a significant relationship with recurrence.Conclusions:The study showed a statistically significant relationship between the difficulty of CTEV correction and the risk of recurrent deformity requiring treatment. This relationship could be used to provide prognostic information for patients' families. Caregiver-reported compliance was not significantly related to recurrence.

Original languageEnglish
Pages (from-to)E25-E29
JournalJournal of Pediatric Orthopaedics
Volume40
Issue number1
DOIs
StatePublished - 2020

Bibliographical note

Funding Information:
From the *Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY; and †Department of Orthopaedics, Mayo Clinic, Rochester, MN. Funding for this project was provided by the Kosair Charities, In-corporated. The authors declare no conflicts of interest. Reprints: Alexander L. Kuzma, MD, Department of Orthopaedics and Sports Medicine, University of Kentucky, 740 S. Limestone, K403 Lexington, KY 40536. E-mail: alex.kuzma@uky.edu. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000001380

Publisher Copyright:
Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • clubfoot
  • compliance
  • recurrence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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