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Effect of Ponseti Bracing for Clubfoot on Leg Rotation

Posted on: 09/20/2007
Clubfoot is a condition that some children are born with. The foot is turned under and towards the other foot. The toes are pointed down and the ankle is bent forward. Three bones of the heel and midfoot are involved: the calcaneus, talus, and navicular.

Treatment today for clubfoot follows the Ponseti method developed by Dr. Ignacio Ponseti in the 1980s. This method has been studied and tested. It is effective in more than 90 per cent of all cases.

The Ponseti method uses serial casting to hold the foot in a normal position. Once the foot is corrected, a foot abduction brace is applied for 23 hours each day. The brace is worn full-time for three months. Then the time can be reduced to 14 hours/day (nap and night time).

There has been some question about whether holding the foot in a neutral position causes a change in the rotation of the leg. Rotation of the tibia (lower leg) is called tibial torsion. Rotation of the femur (thigh bone) is called femoral anteversion.

In this study, the effect of using the Ponseti method on leg rotation was measured. Twenty children used the Ponseti method for clubfoot. They were tested for tibial torsion and femoral anteversion and followed for an average of 33 months.

Results showed no effect of foot abduction bracing on leg rotation. Rotations remained within the normal range even after 33 months. For the 19 patients who followed the method, the results were excellent. One family did not use the brace as instructed. Their child had a recurrence of severe clubfoot.

The authors conclude that the Ponseti brace method works well for clubfoot without changing leg rotations.

References:
Stephanie Boehm, MD, and Marc Sinclair, MD. Foot Abduction Brace in the Ponseti Method for Idiopathic Clubfoot Deformity. In Journal of Pediatric Orthopaedics. September 2007. Vol. 27. No. 6. Pp. 712-716.

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