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New Treatment for Clubfoot in Infants with Arthrogryposis

Posted on: 11/30/1999
This study presents the first published information using the Ponseti method for treating clubfoot in infants with arthrogryposis.

Clubfoot is a condition affecting the feet and ankles that is present at birth. It's fairly common and occurs in about one in a 1000 infants. The clubfoot is unmistakable. The foot is turned under and towards the other foot. Arthrogryposis is a condition of joint loss of motion called contracture. The contractures are present in two or more different body parts.

The Ponseti method to treat clubfoot is defined as a series of casts on the foot and ankle. As the deformity is gradually corrected, the old cast is removed and a new cast is put on with the joint in the new, more corrected position. Surgery to release the Achilles' tendon is done to help align the joint first. Bracing is done for several years after casting to keep the foot in good alignment.

Twelve children with bilateral (both sides) clubfoot associated with arthrogryposis were included in this study. A complex (Diméglio) scoring system was used to classify or grade the severity of each foot. In simple terms, Grade I is a mild deformity that can be almost fully corrected. Grade II describes feet with a moderate deformity. Grade III refers to a severe deformity. Grade IV is a very severe deformity.

Points are given in the scoring system that help distinguish between the grades. Areas that are scored with points include 1) the ability to reduce (correct) the problem manually (by moving the joint into a better position), 2) condition of the muscles, 3) presence of other foot deformities, and 4) ability to flex the ankle upwards toward the knee. The total number of points determines the grade given the deformity.

Most of the children in this study were graded as very severe (Grade IV). Treatment was started in the first six months of life (the earlier the better). Five to eight sets of casts were used within the group. This is more than usual for clubfoot correction but consistent with the severity of the problem.

There was a relapse in three children (total of six feet). Recurrence of the clubfoot position occurred within the first six months after correction. The cause was failure to wear the braces. This is referred to as noncompliance. But in all cases, there were problems with slippage of the foot and blisters with the braces. Repeat casting and switching to a different bracing system corrected this problem.

In the past, multiple surgeries to release the soft tissues around the contracted foot have been the main treatment for clubfoot associated with Arthrogryposis. Scar tissue often prevents a good outcome and results in repeated surgeries.

The final results showed that the Ponseti method was successful for 11 of the 12 patients. Deformities from Arthrogryposis can be well corrected with this treatment. The authors suggest the Ponseti method may work just as well (if not better) and without as much surgery as with the more traditional treatment.

References:
Stephanie Boehm, MD, et al. Early Results of the Ponseti Method for the Treatment of Clubfoot in Distal Arthrogryposis. In The Journal of Bone and Joint Surgery. July 2008. Vol. 90-A. No. 7. Pp. 1501-1507.

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