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Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review

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Abstract

Purpose

In 2006, Ponseti modified the standard technique to treat cases of “atypical” and “complex” clubfoot. To determine the outcomes of Ponseti’s modified method to treat complex idiopathic clubfoot patients, we asked the following: (1) What is the deformity correction success rate? (2) What is the relapse rate after the correction? (3) What is the incidence of complications?

Materials and methods

We performed a systematic review by searching the EMBASE, MEDLINE, Cochrane Library, and Web of Science databases from inception to March 1, 2021. All studies on idiopathic, complex, and atypical clubfoot that assessed Ponseti’s modified technique were included. Of 699 identified articles, ten met the inclusion criteria. The mean index for non-randomized studies score for the included studies was 11.8 ± 1.7.

Results

Early detection of the deformity and modifying the standard protocol, as described by Ponseti, resulted in a high rate of success. Initial correction occurred in all children, with a mean ankle dorsiflexion of 15°. Relapse occurred often ranging between 10.5 and 55%. The incidence of complications associated with the modified Ponseti method ranged from 6 to 30%.

Conclusions

Studies using the modified Ponseti technique have shown high initial correction rates and a smaller number of relapses. However, studies with prospective designs and long-term follow-up are required to conclude whether these observations are due to properly performing the modified method or if higher rates of relapse increase with further follow-up.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on request.

Code availability

Not aplicable.

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Acknowledgements

We would like to thank prof. Nassser Al-Sanea general director at King Abdullah Bin Abdulaziz University, Riyadh, Saudi Arabia, for allowing us to perform the investigations at his center. We sincerely acknowledge Prof. Al-Sanea for his support and the constructive feedback that he always provides. His willingness to give his time so generously has been very much appreciated.

Author information

Authors and Affiliations

  1. Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Omar A. Al-Mohrej

  2. Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia

    Omar A. Al-Mohrej

  3. Department of Orthopedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Fawaz N. Alshaalan & Thamer S. Alhussainan

Authors
  1. Omar A. Al-Mohrej
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  2. Fawaz N. Alshaalan
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  3. Thamer S. Alhussainan
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Contributions

OAM: Study design, data analysis, and processing, writing, and approval of final draft.

FNA: Data collection and processing and writing—original draft.

TSA: Data curation, methodology, validation, visualization, project administration, and approval of final manuscript.

Corresponding author

Correspondence to Omar A. Al-Mohrej.

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Ethics approval

Each author certifies that his institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research. Investigation was performed at Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Al-Mohrej, O.A., Alshaalan, F.N. & Alhussainan, T.S. Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review. International Orthopaedics (SICOT) 45, 2589–2597 (2021). https://doi.org/10.1007/s00264-021-05092-4

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  • DOI: https://doi.org/10.1007/s00264-021-05092-4

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