According to a new study published in The Journal of Bone and Joint Surgery, two non-surgical treatments most commonly used to correct the condition known as clubfoot, have similarly high levels of success.
The two non-surgical treatments are the Ponseti method and the French Functional method.
“These treatments have been around for decades, but they hadn’t received wide acceptance,” B. Stephens Richards, MD, assistant chief of staff and medical director of inpatient services at Texas Scottish Rite Hospital for Children and the current president of the Pediatric Orthopaedic Society of North America and primary author of the study, said.
“Until about 15 years ago, the common treatment for clubfoot was still surgery. However, things began to change with the emergence of the Internet,” Richards said. “Parents began researching treatment options for their children and found information about the Ponseti and French methods. Interest in these treatments began to spread and we saw how successful they can be.”
In the Ponseti method, the foot is stretched and then placed in a cast extending above the knee. Each week, the practitioner removes the cast, stretches the foot further toward the correct position, and recasts it. After three to five casts, the foot is straightened but the Achilles tendon often remains too tight. The Achilles tendon is then surgically lengthened so the foot can be placed in the normal position. A final cast is worn for 3 weeks as the heel cord mends. After the cast is removed, the child must then wear a full-time brace for 3 months and then at night for about 2 years.
The French Functional method consists of daily stretching, exercise, massage and immobilization of the foot with non-elastic tape to slowly move the foot to the correct position. These therapy sessions are performed primarily by a physical therapist for the first three months, when most of the improvement occurs, but parents receive training during this time in order to perform some of the treatments at home. The taping and splinting continues until the child is two years old. It is important to note that this method is currently not available in many parts of the United States.
In the study, parents were given the choice of the two treatment methods. More than twice as many parents chose the Ponseti method, in part because of the difficulty for some parents to make the daily visits to the hospital required by the French Functional method. The average severity of the condition within both groups was about the same. The patients were then followed through the next 2 years of treatment.
The results were similar. In the Ponseti group, 94.4% achieved satisfactory initial correction and 37% had some recurrence of the condition requiring repeated casting treatments.
In the French group, 95% achieved satisfactory initial correction and 29% had some recurrence of the condition requiring further intervention later.
In both groups, 16% of the patients eventually required surgery.
“One of the main reasons for recurrence is noncompliance,” Richards said in a news release. “For example, the parents might not brace the child’s feet for the required number of hours or may not perform the stretching every day. We know now that non-surgical treatment can have a very good chance of a positive outcome, but parents need to know that complying with the treatment plan is extremely important.