Postcasting Orthotic Protocol Retooling Could Improve Ponseti Technique Success Rates

Success rates in treatment with the Ponseti technique can be improved through a reevaluation of the postcasting orthotic protocol, according to researchers in New York.

Norman Ramirez, MD, and colleagues treated 73 idiopathic talipes equinovarus feet with the Ponseti technique, following patients for 48 months after the completion of cast treatment. Twenty patients (38%) were reported as having bilateral involvement. Manipulation and casting treatments went on for a mean of 6 weeks, with 38 patients requiring Achilles tenotomy. A deterioration in Dimeglio severity score that required remanipulation and casting was considered the definition for recurrence in the study.

According to the study results, 24 of the 73 feet (33%) in the study displayed evidence of recurrence. The majority of demographic data did not demonstrate a significant correlation to risk of recurrence, but the authors noted that noncompliance with use of the orthotic was significantly correlated with recurrence rate. Demographics were not found to have any correlation with noncompliance rate.

“The use of the brace is extremely relevant with the Ponseti technique outcome (recurrence) in the treatment of idiopathic talipes equinovarus,” the authors wrote. “The Ponseti postcasting orthotic protocol needs to be reevaluated to a less demanding option to improve outcome and brace compliance.”

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