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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