Researcher(s)
- Nicole Wang, Biochemistry, University of Delaware
Faculty Mentor(s)
- Chris Church, Gait Analysis Laboratory, Nemours Children's Hospital
Abstract
Background
The Ponseti method is an effective primary treatment for idiopathic clubfoot, but its outcomes associated with the rigid clubfoot in arthrogryposis are unclear. This study assesses the 10-year outcomes of the Ponseti method in children with idiopathic clubfoot and arthrogryposis.
Methods
Ten-year outcomes of the Ponseti method were retrospectively studied in children ages 8.0-12.9 in the gait lab between 2004 and 2024. Children were excluded due to presence of non-idiopathic or non-arthrogryposis-related clubfoot and history of posteromedial release. Clubfoot groups were compared with typically developing children by analyses of foot pressure data, passive range of motion, the Gross Motor Function Measure Dimension-D, and the Pediatric Outcomes Data Collection Instrument. Surgical history was also recorded. A subsection of children additionally visited the gait lab at 4.0-6.9 years (2003-2021) and their visits were abstracted for longitudinal study. For pairwise comparisons, the Shapiro-Wilk test was used to assess normality and Welch two sample t-tests (parametric) and Wilcoxon rank-sum tests (non-parametric) were used to analyze significant differences.
Results
A total of 177 children were reviewed in the study (48 with arthrogryposis, 129 with idiopathic clubfoot) with an average age of 9.4 ± 0.9 years. Surgical intervention was used in 33% of idiopathic and 44% of arthrogrypotic clubfeet. Residual equinovarus and limitations in range of motion were present in both clubfoot groups in comparison to norms (p < 0.05), more severe in children with arthrogryposis (p < 0.05). The arthrogryposis group additionally exhibited limited gross motor and global functionality (p < 0.001). In 5-to-10-year comparisons, both groups showed more limitations in ankle motion, but improvements in dynamic equinovarus deformity and function (p < 0.05).
Conclusions
Despite residual deformity, children with idiopathic clubfoot achieve typical functional outcomes via Ponseti treatment. Children with arthrogryposis exhibit functional limitations, but the Ponseti method is effective in improving foot position with largely conservative management.