Treatment outcomes for standard Ponseti method in amyoplastic clubfoot

Background
Arthrogrypotic clubfoot tends to be more rigid and severe than their idiopathic counterparts. Ponseti method has shown satisfactory results in treating clubfoot with distal arthrogryposis; however, no published work yet has investigated the role of Ponseti technique in dealing with the more rigid amyoplastic clubfoot. In the present study, we aimed to assess the outcomes of standard rather than modified Ponseti technique in the management of infants with amyoplastic clubfoot deformity.
Patients and methods
Standard Ponseti technique was used to treat 14 clubfeet (seven patients) with classic arthrogryposis (amyoplasia congenita) between July 2011 and March 2015. Our primary outcome measure was the quantitative degree of deformity correction assessed by Dimeglio and Pirani scoring systems. Secondary outcome measures included relapses with/without the need for surgical interference and the assessment of functional results.
Results
All patients were followed up for an average of 40.4 months (range, 21–69). The mean precorrection score of Dimeglio was 17.57 (range, 16–20), which significantly improved to a mean of 3.1 (range, 2–4) after correction. The average Pirani score was 5.6 (range, 5–6) and 1.2 (range, 0.5–2.5) initially and before tenotomy, respectively. Satisfactory results were reported in 71.5% of the treated feet, whereas 43% of them had a relapse.
Conclusion
The Ponseti method can be an effective first-line management for amyoplastic clubfeet, decreasing the unnecessary need for multiple surgical procedures and improving the final functional outcome.