Can We Improve on Casts and Braces to Correct Clubfoot?

FEATURED SEARCH TERM:   congenital talipes equinovarus



Has any better way to correct clubfoot come along since the nonsurgical Ponseti method was introduced in the 1940s involving extended casting and bracing? Clinicians at a University of Iowa center that specializes in treating the condition recently addressed the question with a systematic review. The Ponseti approach is still the best solution, they report. The only evidence-based improvement they found was to extend the bracing period to 4 years. Noncompliance with wearing the brace is the most common reason for treatment failure. (According to other studies, clubfoot affects about 1.3 of every 1000 children born in the United States.)


RESULT: Management of congenital talipes equinovarus using the Ponseti method: a systematic review
The Journal of Bone and Joint Surgery (PubMed) | Sep 1, 2011 (Free abstract. Full text $25)



It’s easy to assume (and many have) that the reasons behind noncompliance with the brace have to do with poor education, low economic status, cultural issues, or other “demographic” matters that relate to the parents and the patients. These authors from a hospital in Puerto Rico took a careful look at the question and find this assumption to be incorrect. But they agree that compliance is essential to the success of the method. So what’s the solution?


RESULT: Orthosis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: a relevant problem that needs reevaluation
Journal of Pediatric Orthopaedics | Sep 1, 2011 (Free abstract. Full text $49)