Shorter Night Splinting by a Modified Ponseti Method With Similar Foot-Function and Health-Related Quality of Life.

Abstract

Background The Ponseti method is the most frequent method for clubfoot treatment. It includes a six-year night-splinting period, which is difficult to comply with. The objective of this study is to evaluate the clinical outcomes, recurrence rates, and patient-reported health-related quality of life following a modified Ponseti method with reduced night splinting duration. Methods We analyzed 107 children (77 boys, 30 girls, 152 clubfeet) who were treated for idiopathic clubfoot from January 1994 to January 2015. The initial treatment started at a mean age of 9.2 days. Long-leg Soft Casts TM3 were applied until the desired position of the foot was achieved. At a mean age of 3.2 months, the residual deformity was corrected surgically. We assessed the clinical outcome by chart review and the functional outcome by a questionnaire that included the disease specific instrument (DSI) and the health-related quality of life assessed by the pediatric quality of life inventory (PedsQL™).  Results In 101 patients (92.7%) and 142 feet (93.4%), we had a clinical follow-up at a mean age of 7.39±4.9 years. A Denise Brown splint or a unilateral orthosis was applied for a mean period of 7.8±4.8 months over the whole day and an additional 17.3 ±16.3) nights only. At a mean follow-up of 10.0±SD 6.2 years, 82.2% of patients returned the questionnaires. The mean DSI was 74.8±17.5. The mean overall PedsQL™ was 87.8±12.6. The PedsQL™ functional component score showed a mean of 89.4±5.6, and the PedsQL™ social component score a mean of 86.9±13.5. Ten (9.3%) patients had a bilateral, and 18 (16.8%) patients had a unilateral relapse. Conclusions Achilles tendon lengthening (ATL) and limited posterior release, followed by a reduced period of splinting of 2.1 years, provide similar results compared to the original Ponseti method.