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Plaster Casting Appears to be Superior in Treatment of Clubfoot Using the Ponsetti Method

Posted on: 03/20/2008
Treatment of clubfoot requires several casting or bracing changes throughout the process. Manipulation to correct the clubfoot has been done for centuries, reportedly as early as 400 BC. In the early 1800s, use of a plaster cast was introduced and this type of cast is still in use, albeit with modifications.

Plaster casts do have drawbacks, including weight and the care that must be taken to maintain their integrity. For that reason, semi-rigid fiberglass has become increasingly popular when bracing clubfeet with the Ponsetti method. The authors of this study sought to compare the effectiveness of plaster and fiberglass casts using the Ponsetti technique.

Thirty one children with 39 clubfeet total completed the study, which originally enrolled 34 children. The average age at start of treatment was two weeks of age. The children were randomized to be casted with either Plaster of Paris or a semirigid fiberglass cast. If a child had two clubfeet, the same cast material was used on both. Sixteen feet ended up with fiberglass and 23 with plaster.

Each foot was assessed before treatment began and follow-up was on a weekly basis. Parents completed questionnaires at each visit regarding any complications and their satisfaction with the cast material. The children had, on average, 6.1 fiberglass casts throughout the course of the treatment or 5.2 plaster casts. Of all patients, 37 feet were considered clinically corrected; three feet did not require further surgery. Of the 37 feet, 34 required surgery to lengthen the Achilles tendon, while one patient in the fiberglass group needed further surgeries. All of the children in the fiberglass group did require surgery.

Complications were minor and occurred in 10 patients total from both groups: cast slippage in six patients, and minor irritation in five.

The parents reported better satisfaction (cast convenience, weight, and durability, as well as willingness to recommend the cast material to a friend) with the fiberglass cast, but the differences were not statistically significant.

The authors report that their study confirmed the efficacy of the Ponsetti method. Eight percent of the feet were corrected just by casting, 87% only needed surgery for the Achilles tendon, and only 5 percent needed further intervention. Importantly, the researchers found that the plaster casts did perform better than did the fiberglass casts, despite the parent preference for the fiberglass.

This type of treatment relies greatly on parental compliance with treatment and as shown in a previous study, fiberglass casts are easier for parents and may increase compliance. However, as the authors of this study point out, the patients who were treated with the plaster casts had statistically better outcomes without having to have surgery. The authors do point out, however, that the long-term effectiveness of cast material was not evaluated in this study.

References:
Douglas E. Pittner, MD, Kevin E. Klingele, MD, and Allan C. Beebe, MD. Treatment of Clubfoot With the Ponsetti Method. A Comparison of Casting Materials. In Journal of Pediatric Orthopaedics. March 2008. Vol. 28, No. 2. pp. 250-253.

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